Ask the Advisor: Health Reform

July 30, 2013

Question from John L. from Noblesville:
I currently get health insurance for my family through my employer. I know changes are coming from health reform, but is there anything particular that I need to worry about?

Response from Lisa Heldman:
Health reform has a lot of folks concerned and confused. The main piece of the legislation that will affect nearly everyone is the individual mandate that requires you to buy health insurance. If you like the insurance that your employer provides, you are considered covered and can stick with that program. You may also be able to switch to publicly available coverage eventually if you choose, but all that is still being figured out.

Your current employer provided health plan qualifies as minimum essential coverage for the ACA’s purposes

Any employer health plan you currently have qualifies as minimum essential coverage. You don’t need to change to a publicly available plan in order to avoid the fee that uninsured people may have to pay for 2014. If you’d like to explore publicly available coverage options, you can, but there are several important things to consider.

With most employer health insurance plans, your employer pays a portion of your premiums. Your employer does not need to make a contribution to your premiums if you switch away from their plan. You should consider this carefully before comparing your current plan to publicly available plans.

If you decide to check out publicly available 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 will depend on what kind of coverage your employer offers. If your job-based coverage is considered affordable and meets minimum value, you won’t be able to get lower costs on premiums or out-of-pocket costs in the marketplace. This is true no matter what your income and family size are.

Your employer can tell you whether the insurance plan it offers meets minimum value and help you determine whether the plan is considered affordable for you. You can also contact your independent insurance agent if you have further questions or if you lose your employer’s insurance plan and need to see what is available.

Have more questions? Give one of our insurance pros a call.