Q: I’m unclear about when a person gets health insurance through their employer and their spouse has the option of joining that plan. Is it true that the employee’s spouse may choose to stay on the plan since the employer contributes toward the coverage? Must the employee’s spouse leave it and shop on the exchange if he or she wants to get a subsidy from the federal government? – Ted from St. Petersburg
A: This question may come up a lot this fall, as a lot of families with employer-based insurance face annual re-enrollment at the same time the federal government rolls out the exchange, also known as the Healthcare Marketplace.
In Florida, 42 percent of all residents get health insurance through an employer-based plan, so you’re in good company. Here are a couple of issues you, your wife and others in this situation should consider:
Most employers that offer health insurance allow workers to add a spouse and children onto their plans. The Healthcare Marketplace won’t likely change that, since companies can negotiate better prices with insurance carriers when they have more people to cover.
The Affordable Care Act doesn’t change the right to decline to be on your wife’s health plan. But consider that employers do cover a portion of the overall cost for that insurance. And a monthly premium you pay on the marketplace or elsewhere could cost more than the plan your wife’s employer offers.
Also, treatments and services offered could vary.
Subsidies to help cover insurance costs are another matter. You can get a subsidy only for insurance purchased on the exchange. Employer-based insurance plans — which offer to cover portions of employee costs — are not eligible.
So if you choose to get individual health insurance on the exchange, remember your annual income dictates if and how much of a subsidy you might receive.
The Kaiser Family Foundation has a great tool to help you get an idea of how much insurance on the marketplace might cost. (http://kff.org/interactive/subsidy-calculator/)