obamacare question from my car mech.

[tapermaker]

I took my Subaru in to the dealer for a blown radiator hose.The service techand I began talking about healthcare.He told me his employer had lousy insurance that wasn't worth enrolling in .It has high copays and ludicrous out of pocket yearly limits. I told him my experience of getting a gold kiaser permanente plan on the health exchange for 500.00 mo with the gov.kickback of 291.00 .He told me he would love that plan ,but told me he is not allowed to access obamacare because his co. offers the shitty plan. Is this correct or is he misunderstanding the law.

[sharp_stick]

1. If I understand it right

he's not eligible for the subsidies but he can access the plans. Not 100% certain though.

[lumberjack_jeff]

3. You're right.

If insurance is offered by your employer - no subsidy.

You can turn down your employers insurance and shop on the exchange, but still no subsidy. Further, his wife can't get a subsidy either, if she's able to purchase insurance on his group plan.

[Bandit]

13. However the insurance the employer offers now has to meet higher standards.

So he will still be better off than he was in 2013.

[lostincalifornia]

4. He can get subsidies if his income doesn't exceed the ACA limits

[lumberjack_jeff]

7. No, he can't.

http://www.kaiserhealthnews.org/stories/2013/july/24/interview-with-cathy-livingston-on-how-to-apply-for-tax-credit-subsidies-for-premiums.aspx

https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/

If coverage is available at his workplace, he's ineligible for a subsidy, whether he rejects the employer coverage or not.

[lostincalifornia]

9. Thanks for the links. It looks like it also depends if it is considered "affordable", which it

Probably is in his case.

Now I am a little concerned. I will be laid off at the end of this year, and my employer told me they would cover 100% COBRA for 3 months, after which I would be responsible for 100% of the COBRA costs.

I was told by the coveredca that in March I could apply for the ACA, drop COBRA, and if I qualify with income receive a subsidy. Based on what I am reading now, that may not be the case since COBRA might be considered existing coverage.

So I need to get some assurances that is so or it may put me in a very expensive situation

Any thoughts, assuming I don't find anything in 3 months?

[Yo_Mama]

10. If the insurance is at least 60/40 and covers the basics

He is correct - having access to employer insurance makes him ineligible for the exchange subsidies & cost-sharing (although not many mechanics would get that).

[lostincalifornia]

2. False. He can opt out of his employer's plan, and can go through the ACA, however, if his income is

Too much he won't get a subsidy, so he better evaluate before jumping

[Yo_Mama]

12. Not if it is minimum value and the premium cost is no higher than 9.5% of his wage

And minimum value just means that it has the required coverages and that the insurance plan has a 60/40 actuarial split, which does imply higher deductibles and copays than ACA Silver plans, which have a 70/30 actuarial split. (Unless you also qualify for cost-sharing, in which case the government pays some of the 30%.)

[SheilaT]

5. If the employer's plan doesn't meet the requirements of the ACA

he can go looking elsewhere. Actually, I don't think a company can continue to offer such a plan. In any case, the mechanic needs to go on-line and find out exactly what he's eligible for.

[Yo_Mama]

11. It only has to be a 60/40 actuarial split, so yes, it probably is ACA compliant n/t

[sharp_stick]

6. This looks like the relevant part

Qualifying for Marketplace savings

If you decide to check out Marketplace plans, be aware that you may not qualify for lower costs on your monthly premiums and out-of-pocket costs, even if your income would qualify you otherwise.

Whether you qualify for lower costs based on your income will depend on the coverage the employer offers. You won't be able to get lower costs if your job-based coverage is considered affordable and meets minimum value.

The employer can tell you whether the insurance plan it offers meets minimum value. It can provide you with information to determine if the plan is considered affordable to you.

One way to gather this information is by asking your employer to fill out an Employer Coverage Tool.

From the following:

https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/

[MindPilot]

8. Your mechanic needs to find a dealer who appreciates his talents.

"That's why your toolbox has wheels."

Car dealers are in the category of employers where the best way to handle a shitty one is to go work for their competitor.