Obamacare: Mini-med plans are going away

My boyfriend works part time for Home Depot and part time for himself as an artist.  I think his state business tax ID number calls him a “crafter”.  Home Depot does offer limited health plans to part-timers, but I think he’d be better off with a catastrophic plan with a large deductible and a larger benefit cap.  I think the plan at his work has something like a $20,000 annual maximum.  What are his options under Obamacare?  Are his options different because he technically is eligible for coverage through his employer?  Could he get premium subsidies to put toward the employer plan?  Will he be able to buy a plan on the exchange?  What about outside the exchange? 

Thinking Ahead In Bar Harbor

Dear Thinking Ahead in Bar Harbor,

Yes, there will be several new options for your boyfriend and some of his current options will go away.

The limited benefit or “mini med” plan offered to your boyfriend does not meet the January 1, 2014 health reform requirements.  (Specifically, they miss the mark for annual benefits: plans have to have unlimited annual benefits.)  In fact, they didn’t meet requirements that started in 2011 but Home Depot, along with hundreds of large companies such as McDonald’s Restaurants, were permitted to continue these plans temporarily.  Their time is up at the end of this year.

So, for starters, you can expect his employer to change its health plan in 2014.  They may also change who can join.  I would guess that they will not allow part-timers to join, since they would have to make the plan “affordable” to him.  Affordable means that enrolling himself (single coverage) would cost less than 9.5% of his income.  I would love to be wrong and learn that his employer was upgrading the plan to unlimited benefits, and making it affordable to part-timers.

If he remains eligible for his employer’s plan and the plan is affordable, then he cannot shop for coverage on the exchange.  If he is not eligible for the group plan or the plan costs more than 9.5% of his income, then he can go to the exchange.

On the exchange, he can choose plans and apply for subsidies to help pay the monthly cost.  Maine’s exchange will be hosted on the healthcare.gov website.  You can visit the site now, set up an account, and get notices when enrollment information is published.  On October 1, plan details are supposed to be available on the site.

Off the exchange, he would not be able to get any subsidies.  I’m guessing that he will qualify for some subsidies to buy a health plan and perhaps to cover his co-pays and deductibles.  As long as his income is less than 400% of federal poverty ($45,960 for a single person), then he could get government help.

Two carriers have filed plans with the state Bureau of Insurance: Anthem and Megalife.  Information on these “off exchange” plans would be on the carrier’s websites, or through their appointed agents/brokers.

Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.