By Michelle Andrews
Tue, Dec 9 2014
Confusion about whether some types of job-based coverage disqualify consumers from signing up for subsidized insurance through the health law’s marketplaces may lead some people to buy skimpier employer plans instead.
In recent weeks, some assisters who help consumers find coverage say people are being told by their employers that their bare-bones plans – which, for example, may cover preventive benefits only — meet “minimum essential coverage” requirements. That’s the type of coverage most people must have to satisfy the health law’s requirement that they have health insurance.
The problem is that consumers mistakenly think that having access to such coverage means they don’t qualify for subsidies if they want to buy a policy on the exchanges instead.
But that’s not necessarily the case.
Rather, they would be ineligible for subsidies if their employer plan is deemed affordable under the law and pays for 60 percent of allowed medical charges, on average. Coverage is considered affordable if it costs no more than 9.5 percent of an employee’s income for self-only coverage.
Some of the confusion relates to the similar-sounding bureaucratic names for these different health law standards. Minimum value coverage means the plan pays for 60 percent of allowed medical charges, on average.
Minimum essential coverage, which can include a range of things from grandfathered health plans to some of the prevention-only plans being offered by large employers, refers to what large employers must offer to avoid paying penalties for not offering coverage, as well as what individuals must carry to comply with the law’s coverage requirement.
Some consultants have reportedly developed job-based plans that cover very little other than preventive benefits. Unlike small group and individual plans, which are required to provide comprehensive coverage under the health law, no such requirements exist for large group plans.
“It’s hard for consumers to understand how a plan that is lousy in their eyes could somehow prevent them from getting subsidies on the exchange,” says JoAnn Volk, a senior research fellow at Georgetown University’s Center On Health Insurance Reforms.
source : Consumers May Miss Out On Subsidies Due To Uncertainty About Job-Based Coverage
