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Can we replace our expensive employer coverage with a marketplace health plan?

Yes, but there's a glitch for your family

Published: October 18, 2013 05:00 PM

Q. My family of three is covered through my wife's job. My wife’s coverage is free for herself, but it’s $1,000 a month for my daughter and me. Can the two of us get coverage through the Health Insurance Marketplace in our state (New Jersey)?

A. This is a complicated question, filled with lots of good news and bad news.

Good news: Yes, you and your daughter can get insurance through your state's health insurance marketplace.

Bad news: Because of a glitch in the law, you won't be able to get financial help to pay for it. As long as your wife’s contribution to coverage for her alone is less than 9.5 percent of your entire household’s income (it’s free, so it obviously meets this standard), it disqualifies everyone in your family from getting financial assistance to purchase health insurance through new Health Insurance Marketplace. If your wife did not have insurance through her job, your family would eligible for at least some financial help with premiums if it had an annual household income of less than about $78,000.

Good news: There is nothing to stop you and your daughter from buying unsubsidized health insurance through the marketplace. It might still be cheaper than what you are paying to be on your wife’s plan.

Health reform countdown: We are doing an article a day on the new health care law until Jan. 1, 2014, when it takes full effect. (Read the previous posts in the series.) To get health insurance advice tailored to your situation, use our Health Law Helper.

Bad news: The New Jersey marketplace is only accessible by going through, the federal site, which is not working at well right now. It’s very difficult to create an account and actually see available plans. Our advice at the moment is to wait another few weeks to register and shop for plans, in hopes that the site will be working better by then.

Good news: The site does have a rudimentary plan preview feature that you can use to get a ballpark idea of what your unsubsidized marketplace premiums might be. I looked for plans in Bergen County, N.J.,  just outside of New York City. The age categories shown that are closest to you and your daughter are for individuals aged 27 and 50 (this matters because marketplace premiums vary by age). The cheapest Silver (midpriced) plan for a 27-year-old is $260 and for a 50-year old, $444, for a total of $704 a month. So it looks like you and your daughter could save about $300 a month insuring yourselves through the marketplace instead of through your wife’s job.

If your income would otherwise qualify you for a subsidy, your wife’s employer would be doing your family a favor by dropping spousal coverage altogether. Employers who offer group health coverage must include dependent children, as that is a requirement of the law. But they don't have to cover spouses. Without an “offer” of employer coverage, you would be able to get an advance tax credit that you can use right away to lower the cost of your premium on the marketplace.

This family glitch was, everyone believes, simply a mistake in the drafting of the law. But apparently the only way to fix it is for Congress to enact a change. Given the events of the last couple of weeks, the chance of that happening seems pretty slim.

Got a question for our health insurance expert? Ask it here. It helps if you include the state you live in.

— Nancy Metcalf

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