ACA "Family Glitch" strikes again

[jpdx]

My spouse and I are currently self-employed and purchase great insurance through the ACA marketplace. We currently qualify for CSR which makes the deductible only $100. Also, our child is on CHIP which covers everything for free.

I may have a good job opportunity on the horizon that comes with employer health insurance, but the timing couldn't be worse. My spouse is about to have a surgery any month now, and the cost would be completely free on our current plan, but may cost a thousands on the new plan. And she really does not want to switch doctors and networks right now. She could stay on the ACA plan, but without subsidies, that would be cost prohibitive.

Is there any way around this? Does the marketplace even know if new employer offers family coverage?

[ixtap]

When is the employer's next open enrollment? If it is in the fall, for coverage starting in January, could she pay a few months on ACA, get the surgery and follow up taken care of, and then switch?

Whatever the Marketplace "knows," you have agreed to notify them of changes to your status.

[ditheca]

Depending on who is hiring, you could explain the situation to your employer, and ask if you can be a contractor for a few months prior to employment.

My own employer (~150ish employees) would consider that kind of request. Probably no-go at a larger company.

[Steeze]

I would agree that the only way to do this ‘right’ is on the employer side.
Try to be a 1099 employee until surgery is over.
Try to schedule the surgery sooner.
Try to postpone employment.
Try to negotiate cost of increased medical expense into starting bonus. Often large companies are able to do a small starting bonus vs. a higher salary.

[reeshau]

The new employer plan would certainly be expensive, as you would start out with a new (likely high) deductible.  It shouldn't be a problem for you to decline the company's health care for your spouse or your whole family, and then join it next year during this year's open enrollment period.  @Steeze 's idea of asking for the cost impact to you as a signing bonus is a good one: explain the difficulty it causes, and point out that you won't be costing the company their part for your wife's care.  (If it is a megacorp, they are likely self-insured, with the insurance company administering the plan but them paying the "insurance part."  If the surgery is major, that may also be an actual cost savings to them, too--but they may struggle to get that message through the bureaucracy)

[Paul der Krake]

Delay employment, speed up surgery, or both.

Whatever you do, don't try to explain ACA rules to your new employer or negotiate a bonus to compensate. You will look foolish at best.

[bacchi]

The new employer plan would certainly be expensive, as you would start out with a new (likely high) deductible.  It shouldn't be a problem for you to decline the company's health care for your spouse or your whole family, and then join it next year during this year's open enrollment period. 

If you have the option for health insurance from an employer, and turn it down, then you can't receive ACA subsidies.

[PDXTabs]

Is there any way around this?

Paper divorce?

[rmorris50]

Why is the surgery “free” in your current ACA plan? Is it because you’ve already satisfied the deductible for the year, or is the ACA plan that awesome?

How much do you lose in subsidies vs what you’d have to pay for the surgery on the new plan?

Ask HR how much time you have to sign up for benefits after you start. It could be 1  to 3 months. It’s hard to imagine you have to drop ACA on day one of your employment. Maybe between delaying your start date and then considering the grace period to sign up for benefits, and speeding up the time of your spouse’s surgery, you can get the surgery covered by your ACA plan still.


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[rmorris50]

Delay employment, speed up surgery, or both.

Whatever you do, don't try to explain ACA rules to your new employer or negotiate a bonus to compensate. You will look foolish at best.

Agree with this. And you don’t want to signal to the company medical costs your family could be incurring on the plan.


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[fuzzy math]

I agree with the previous 2 comments. It seems reasonable to explain that your wife is having surgery and that you'd like to delay starting until that's over so you don't have to take leave during orientation.