A Reader Asks: When I Retire Can My Husband Get Coverage On The Marketplace?

September 6, 2013

Q. My self-employed husband is covered under my insurance plan at work. I am looking at retirement and the spousal insurance cost for retirees is more than $800 per month, which is 40 percent of my retirement income. Would he be eligible for the exchange? A. He likely is. Almost anyone can buy a health plan on the health insurance marketplaces, also called exchanges, which will open next month. The real question is whether he would be eligible for a premium tax credit to make the plan more affordable.

In general, people who have access to good health coverage that meets standards for affordability and adequacy under the Affordable Care Act aren’t eligible for subsidized coverage on a marketplace. A plan is considered affordable if it costs less than 9.5 percent of income, and adequate if it pays for at least 60 percent of allowed medical costs, on average.

You don’t say whether your husband is 65 or older and eligible for Medicare. If he is, he wouldn't qualify for subsidized coverage on a marketplace if he opts against your retiree spousal coverage.

But assuming he's not eligible for Medicare and doesn't enroll in your retiree health plan, he could qualify for a premium tax credit on the marketplace if your household income is less than 400 percent of the federal poverty level ($62,040 for a couple in 2013).  

In contrast to regular employer coverage, “if you’re eligible for early retiree coverage but choose not to take it, you can choose to get subsidized coverage on the exchange,” says Timothy Jost, a law professor at Washington and Lee University who’s an expert on the Affordable Care Act.

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

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