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Affordable Care Act Loopholes May Hurt Montanans

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Photo courtesy of Cult Gigolo/Flickr

The federal health exchanges in Montana open up on October 1. The new exchanges will force many businesses to decide what type of health insurance to provide for their employees, or if they will continue to provide any health insurance at all.

One of Montana’s certified healthcare navigators, Mary Angela Collins with Montana Health Insurance Experts LLC, said there are certain loopholes that business owners and employees need to be aware of.

“Well, one of the things to watch out for is, if a person is offered affordable insurance – and the definition of affordable is that the coverage just for the employee costs less than 9.5 percent of their income – then, they are not eligible for subsidies on the exchange,” Collins said.

The loophole is larger than it may first appear because it could effect dependents of an employee as well. The Affordable Care Act does not consider the ‘affordable’ nature of the costs of dependents. Only the primary holder of the insurance must have costs below 9.5 percent. If a business offers insurance coverage for an individual that is below 9.5 percent, even if coverage for dependents is significantly more expensive, it means that both the individual and any dependents will be refused subsidies on the healthcare exchanges.

“It could be that it’s better to offer [health insurance] just to your employee and not to the family, so that the family can qualify for subsidies later if the family coverage is too expensive,” Collins said. “So that’s just something for employers to calculate. Is it better to offer insurance just to my employees, or to my employees and their dependents and spouses?”

Another big loophole for Montana revolves around the fact that the state did not expand Medicaid. Those that are under 100 percent of the poverty level, but make too much to get Medicaid coverage will also not qualify for subsidies at the exchanges.

Mary Angela Collins:

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