Friday, September 19, 2014
Inquirer Daily News

Can my company help pay for the insurance of my choice?

Question: Right now I work at company on a part-time basis. I have health coverage from Insurer A and the company has Insurer B.

If I will become a full-time worker, I will get the plan of the company which I do not like.

More coverage
  • Have a question about the healthcare law? Ask our expert
  • I get health coverage through my employer. How does the Affordable Care Act affect me?
  • Can the company pay the equal portion of money that they suppose to pay Insurer B to Insurer A (I want to keep my policy) and a rest of the money if it exist, I will pay by myself to Insurer A?

    Will Obamacare allow this?

    - Mark

    Answer: If you obtain health insurance through your employer, you are limited to the plans it offers. That means you would have to switch your coverage. 

    The Affordable Care Act contains a few exceptions to this rule, but they are quite limited. However, if you fall into one of the narrow circumstances that they cover, you would be able to purchase your own coverage through an insurance exchange and possibly obtain a subsidy to help with the cost if you earn less than 400% of the federal poverty level ($45,960 in 2013). One exception applies if your employer’s coverage fails to meet minimum standards. Another applies if you earn less than 400% of the poverty level and your employer’s coverage costs between 8% and 9.8% of your income. In that case you can also ask your employer for a voucher to help with the cost. A final exception applies if you work for a firm with fewer than 100 employees. However, in that case you would not be eligible for a subsidy, even if your income falls below the threshold.

    If none of these circumstances applies, you can turn down your employer’s coverage and purchase a policy directly from an insurance company outside of an exchange. However, if you do, you will not be eligible for a subsidy and your employer will have no obligation to help you pay for it. 

    Starting in 2017, workers at all firms will be allowed to buy policies through the exchanges, even if their employer offers coverage. However, as with the policies purchased outside of an exchange, subsidies will not be available for those with low incomes, and there will be no employer contribution to help cover the cost.

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    Robert I. Field, Ph.D., J.D., M.P.H. is a professor of law at the Earle Mack School of Law and professor of health management and policy at the School of Public Health at Drexel University. He also writes for The Field Clinic blog. Ask Rob your questions about the new healthcare law.

    Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
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