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Can Wife Insured Through Estranged Husband’s Job Use Exchange?

Filed by KOSU News in Health.
August 30, 2013

We’ve been fielding questions about the rollout of the federal health law. With the health insurance marketplaces, or exchanges, set to open in a little over a month, the questions about how they’ll work are pouring in.

Here’s one with a twist we hadn’t thought of.

I’m not living with my husband, but he still provides health insurance for me through his employer. Will I be eligible to go on the health insurance marketplace if I choose not to have him cover me through his employer?

Almost anyone can buy a plan on the health insurance marketplace, sometimes called an exchange. But tax credits that reduce the premium are only available to people who don’t have access to other coverage that meets the law’s standards for affordability and adequacy.

Coverage is considered affordable if it costs no more than 9.5 percent of income, and adequate if it pays at least 60 percent of allowed medical expenses.

Chances are your husband’s employer health plan meets those standards. If it does, you probably wouldn’t be eligible for subsidized coverage on an exchange, say experts.

If you were legally separated, the situation would likely be different. “They would be considered two separate tax households, and her eligibility for coverage through his employer does not impact her eligibility for the premium tax credit,” says Dania Palanker, senior counsel at the National Women’s Law Center. Tax credits for exchange coverage will be available for people with incomes up to 400 percent of the federal poverty level ($45,960 for an individual in 2013).

If your situation changes next year and you become legally separated or divorced, the online marketplace in your state can help determine at that point whether you’re eligible for subsidized coverage.

Alternatively, if you live in one of the states that has expanded Medicaid coverage to adults with incomes up to 138 percent of the poverty level ($15,856 for an individual in 2013), you could be eligible for Medicaid, says Palanker.

If you’ve got more questions for Michelle, you can send them to [Copyright 2013 Kaiser Health News]

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