Questions Part VI: Other General Questions
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- Questions Part I: Training
- Questions Part II: Permissible Guidance Questions
- Questions Part III: Affordable Care Act and Families
- Questions Part IV: Penalties
- Questions Part V: Premium Tax Credits
- Questions Part VI: Other General Questions
Will doctors be allowed to decline certain insurances that pay less?
Yes. Health insurers that participate in the Marketplace offer private plans, establish their networks and decide what rates they will pay in the same way as they would for any other private plan the insurance company offers.
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Is there any tax benefit from the ACA for employees who take advantage of a VITA site, receive the EITC, and pay a premium towards their employer health insurance?
No. The premium tax credit cannot be applied to your contribution to your employer health insurance. People who are offered employer-sponsored insurance that is affordable and meets a few minimal standards are not eligible for premium tax credits.
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Was the Medicaid expansion implemented to primarily help cover low-income single childless or “dependent-less” adults?
The Medicaid expansion is intended to create a floor of coverage for very poor adults. Medicaid coverage for adults prior to the health care law varied a lot and often depended on whether people had a child living at home or not. In some states, an adult without children in the home could be penniless and still not qualify for assistance. The health law intended to ensure that people with income near or below the poverty level had a low-cost or no-cost health care option. It was implemented to help many kinds of adults. In all states, coverage for children is higher than coverage for adults.
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If an employer is providing insurance but the employee’s premium is too high, can the individual switch to an insurance plan provided in the marketplace?
Yes. If the cost of your individual worker-only policy is more than 9.5% of a family’s income, the plan is considered unaffordable. That individual can then leave their employer’s insurance and enroll in a marketplace-provided insurance plan with the help of the premium tax credit. Note that you must compare the cost of the insurance just for the employee, not for the family, to the family’s income, which would include any spouse’s income as well. So if the contribution cost of your individual employee-only policy is more than 9.5% of your family income, then that’s considered unaffordable.
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Other Comments:
Be cautious in stating that more expensive plans are better. Health insurance selection is a very individual choice. A person may choose a particular plan based on the deductible or on having a specific doctor in their network, or a number of other factors. Not everyone is looking for the same policy. People also shouldn’t get fixated on medal levels. A person or family should choose the plan that best meets their needs.
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Rural Family Economic Success Action Network 