Obamacare Exchanges May Be Good For Some Employees



Employees who are currently not offered health insurance, like part-timers, may be able to purchase an insurance plan via an exchange cheaply — especially if they qualify for a tax credit. The same applies to spouses and children who may not be offered much, if any, coverage under an employer-sponsored plan.

There are also many specific circumstances where employees can avail themselves of better coverage than what’s on the exchanges, or what may be available once employer-mandated coverage begins.


Veterans Medical Coverage

Veterans who are eligible for medical care under the Veterans Administration (VA) system should be encouraged to apply there. The benefits in most cases are equal to most private plans, with lower out of pocket costs. This is also a benefit for both the employer and the employee, because a veteran who is covered by the Veterans Administration medical program complies with the individual mandate and thus eliminates the possibility of a potential individual penalty. The dollars saved could be used to offer other benefits instead, such as dental coverage, which the VA does not offer to the majority of veterans.

Native Americans Coverage

Native Americans who are eligible for care from the Indian Health Services are also exempt from the individual mandate. IHS coverage generally includes vision and dental services. The coverage is at no cost to the individual and may come with additional benefits that extend beyond health services such as gym memberships, financial planning, credit counseling and a host of other programs. Like veterans, Native American employees should be encouraged to take advantage of the IHS services and programs. And the dollars saved be used for other benefits that better suit the individual employee, such as optional short-term disability insurance.

Spousal Coverage

Spousal coverage should be reviewed with an eye to elimination if the spouse is eligible for benefits from another source. The government’s latest interpretation of the ACA confirms it does not require spousal coverage. The spouse is free to obtain coverage through their employer as an employee, or as an individual participant in the exchanges if you find that dependent coverage isn’t an affordable option for your company plan.

How Self-Insured Employers Can Avoid Additional Costs

Obamacare includes a lot of self-funding provisions, such as The Patient-Centered Outcome Research Institute Fee. This fee is generally two dollars per insured person in a self-insurance plan. If you end your plan before October 1, 2013, the fee is limited to one dollar per insured person. For example, where an employee has elected family coverage for his spouse and three children, an employer would pay annually two dollars for the employee, spouse, and children or $10 total for that one employee. For employers who are self-insured, with thousands of employees, this amount would be significant.

Hopefully, we’ve left you with a little more clarity on what this evolving law will mean to your company, and for your HR workload. Remember that “paperwork” and government forms can be handled a lot more speedily with a good HRIS system that includes electronic forms and a document management system. GeniusHR offers that plus much more, including ways to assure your company stays compliant with government rules of all kinds that affect employee administration, such as FMLA.


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