For those who enrolled on the Marketplace for health insurance and who received a subsidy, please look over the list below.
1- Those individuals who have health insurance available through an employer are not eligible for a subsidy. Whether the employer provided plan is good or bad, availability of coverage is one of the knock out questions on the Marketplace application. Also, if the plan is available through a spouse that counts as employer based coverage. Remember, it is not whether you choose to enroll or not, it is whether or not coverage is available that makes you ineligible for a subsidized policy.
2- There are rules about the affordability of employer based coverage that determine whether or not an individual qualifies for a subsidy. Whether you feel that the premium at work fits your budget or not is not what counts. If the employee portion of the premium is less than 9.66% of your individual income you cannot qualify for the subsidy.
3- Be aware that there are providers who have determined that they will not provide services to individuals who are enrolled in Marketplace policies. Even if they appear as participating providers in the insurance companies’ directories, they are able to participate only for non-Marketplace contracts. Ask the provider about this before you have services performed. We are hearing that some providers bill their services as “out of network” for Marketplace clients and that can create quite a large balance bill.
I will post more information specific to subsidized health insurance plans as it comes up. Please take this information seriously as those who accept subsidies for which they are not eligible will have to pay that money back at the end of the year.