When is non affordable employer coverage an sep

[kstein]

Client makes 40k and employer coverage is 800/mo .

Could this client get subsidy and SEP mid year or are they forced to stay put. I get conflicting from documents and HC.gov calls .

 

[TN_agent]

Is the employer plan year ending or are they just wanting to leave it because of the cost?

 

[kstein]

Just wanting to leave bc the cost.

 

[somarco]

employer coverage is 800/mo

Does that include dependent premium or just for the employee?



Affordable coverage

A job-based health plan covering only the employee that costs 9.56% or less of the employee's household income. If a job-based plan is "affordable," and meets the "minimum value" standard, you're not eligible for a premium tax credit if you buy a Marketplace insurance plan instead.

• The plan used to define affordability is the lowest priced "self-only" plan the employer offers — meaning a plan covering only the employee, not dependents. This is true even if you're enrolled in a plan that costs more or covers dependents.
• The cost is the amount the employee would pay for the insurance, not the plan's total premium.
• The employee's total household income is used. Total household income includes income from everybody in the household who's required to file a tax return.

Affordable coverage - HealthCare.gov Glossary

 

[TN_agent]

Are they sure the employer will let them off the plan? Most cafeteria plan's won't do that mid-year unless there is a special reason.

 

[kstein]

Yes it is $800 for employee only and yes they would let him leave. Looks like hc.gov won't allow an sep so I'm not gonna push it .seems a little weak since plan is renewing 5-1 at higher rates but whatever .