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Will health reform help part-time workers get insurance?

Consumer Reports News: April 17, 2013 10:38 AM

Q: I'm a part-time worker from home and my hours are variable, at times more than 40 hours a week but usually more like 25 hours a week. How does Obamacare apply in my situation? I'm a diabetic and support a family of five, so affordable health insurance matters a lot to me.

A: The good news first: Starting in 2014 you and your family will have adequate and affordable health insurance one way or another. The bad news: Figuring out whether you'll be buying it on your own or getting it from your employer is complex and confusing.

Some background. Employers with more than 50 full-time workers (full-time being more than 30 hours a week), must either provide employees with affordable health insurance or pay the government an annual assessment of $2,000 per worker (minus an allowance of 30 "free" employees).

This matters because if your employer doesn't offer you affordable group coverage, you can purchase it on your own through your state's new health insurance exchange, with a subsidy if your family's income qualifies for one. (Your five-person family can have an income of up to $108,000 and still be eligible for a subsidy.) But if affordable coverage is available through your job, you can't get the subsidy. (Here's a blog I wrote about how "affordable" is defined.)

Learn more about how the Affordable Care Act applies to you.

Eligibility for employer coverage is easy enough to figure out if you have a regular full-time, year-round job, or regular part-time hours. But it's not easy at all for variable-hour contract workers like yourself, teachers who get the summers off, employees of seasonal businesses like golf courses and ski resorts, construction workers, etc.

Theoretically, people in those situations might gain and lose eligibility for employer coverage literally month to month. "We'd have employees bouncing between employer-provided coverage and individual coverage from the exchange," said Linda Rowings, compliance director for United Benefit Advisors, an employee benefits advisory group based in Indianapolis, Ind. "This would be nightmarish in terms of administration by the employer and the exchange, not to mention the employee's continuity of care."

So the government has come up with a way to smooth out those peaks and valleys of work hours so employees will know where their health insurance is going to come from for a manageable period of time.

Here's how it will work. Employers will select a period of months in 2013 (it can be anywhere from 3 months to the full year) as a baseline for who is and isn't a full-time employee. (In your case, the employer is almost certainly going to be the company that contracts out your services to its clients.)

Say your employer decides to use the first six months of 2013 as its measurement period. If you averaged less than 30 hours a week during those six months, you won't qualify for group coverage for the first six months of 2014, even if you end up working more than an average of 30 hours a week during that period. Or the reverse: if you average more than 30 hours a week during those six months in 2013, you'll be entitled to group coverage for the first six months of 2014, even if you end up working less than that. At the end of that six-month period, the employer will repeat the process for the next six months, and so on. During any period that you can't get employer health coverage, you'll be able to purchase on your own through your state's exchange.

As 2013 draws to a close, if you haven't heard anything from your employer concerning your health coverage, ask about it, advises Rowings. "Some people will think to themselves, 'Heck, I'll say I'm not eligible for employer coverage and take the subsidy because that's money in my pocket right now.' That's probably not a good strategy," she said. If it turns out you were eligible for employer coverage after all, eventually the government is going to find out and make you repay any subsidy you might have gotten to buy insurance on the exchange.

For more information, see our Health Insurance Buying Guide as well as rankings of health insurance plans.
Got a question for me? Ask it here. Please include the state you live in.

Nancy Metcalf

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