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<p>If you are going buy non-employer coverage, is there any reason to buy off the exchange since all policies have the same mandates now? Is the only difference between on- and off-exchange plans, the choice of service providers?</p>
<p>I think you still can until someone is 26 through your employer or through an exchange but the main idea for the exchange is whether you can get a subsidy and the rule for a subsidy is that you have to add everyone’s income.</p>
<p>Yes, I saw that other phrase, calmom, but it doesn’t answer my question because it says “could” include, not does include.</p>
<p>I’d add that any person who is a dependant on someone else’s tax return is NOT eligible to buy a subsidized policy on the exchange. So the adult child’s dependency status may impact the policy buying choice. Typically that will extent through the year that the child graduates from college. </p>
<p>An adult child up through age 26 who is not claimed as a dependant on his parent’s return would have a choice: either he can buy on his own or he can be included on his parent’s insurance plan. The impact of household size together with the kid’s income on subsidy eligibility may end up being a major factor in that choice. It could cut both ways depending on individual family circumstances.</p>
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<p>Really? That is weird.</p>
<p>Bay, the “could” depends on whether the adult child is earning money. The income only needs to be included if he earns enough to be required to file a tax return. If the kid is unemployed or working at an unpaid internship, then the income wouldn’t need to be included.</p>
<p>I think this is just a rule designed to make things easy for the exchanges to verify IRS financial data.</p>
<p>The actual reason I used the word “could” in the sentence is that clause doesn’t specify whether the parents are buying the insurance for the kid or not. If the 25 year old kid has his own separate insurance, then his income would not be included.</p>
<p>There are multiple plans off exchange. They have to meet minimum ACA requirements.
You can go to the anthem blue cross ca website and see the plans. You can type in your family members ages and see the costs per plan. The pricing is similar to the exchange plans. Maybe a plan has dental. Maybe another plan has better drug coverage. Etc.</p>
<p>So if they are married and unemployed which sadly is probably not all that uncommon. Argh!</p>
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<p>The off-exchange providers are free to sell a wider range of policies with a wider range of options than what might be available on the exchange. Also, companies that do not sell on the exchange can still sell off-exchange. The off-exchange policies have to meet the same bottom line requirements as to minimal essential benefits and actuarial value, but they can vary in different ways. For example, off exchange an insurer might sell a policy that looks like a gold with a slightly higher deductible and lower premiums – it’s legal because it still meets the standard for a silver, but it’s attractive to a consumer because the premium is less. Or the off-exchange policy could throw in adult dental coverage as part of the policy – or it could cover things above and beyond the minimal essential benefits. For example, I noticed that my old Blue Shield policy covered chiropractic, but the new exchange policy doesn’t – so I guess chiropractic is not considered an essential benefit under Obamacare – but maybe an insurer could sell a policy that does include that extra. </p>
<p>I think the market for for off-exchange will be either for lower cost catastrophic for those whose income vs. premium situations render them eligible, and for policies that offer extra perks and benefits for wealthier purchasers. The middle, subsidy-eligible group, will probably want to stay with the exchanges.</p>
<p>Is it possible for a non-subsidy income earner son to combine with two unemployed parents to bring them all into the subsidized exchanges? I’m just curious so don’t answer if it takes work to do so.</p>
<p>If they live in the same house and he claims them as dependents, then I think the answer would be yes. (Or if they meet the IRS requirements to qualify as dependents even if not living with him… I just don’t remember off hand what those are - that would be in Publication 501 at [Publication</a> 501 (2012), Exemptions, Standard Deduction, and Filing Information](<a href=“Publication 501 (2022), Dependents, Standard Deduction, and Filing Information | Internal Revenue Service”>Publication 501 (2022), Dependents, Standard Deduction, and Filing Information | Internal Revenue Service) )</p>
<p>But if they are not his dependents and don’t reside with him, I think not. </p>
<p>If they are in a Medicaid expansion state, then obviously the parents would qualify.</p>
<p>If they are not in a Medicaid expansion state, the penalties for overestimating income to just above 100% of the poverty line are minimal – maximum $600 tax liability in 2015 for the parents when they file taxes. (I’m not advising anyone to lie about their income… I’m just pointing out that the risk/reward calculation might make it an attractive option, especially for people who are actively looking for work and legitimately hope to earn at least poverty line wages in 2014)</p>
<p>If your adult child (under age 26) is not your dependent but is covered under your health plan, then the premium tax credits are split between the two households. There’s an example of this in the 26 CFR regs, page 30393.</p>
<p>I wrote earlier about what happens when kids turn 26, but my info must have been from an employer-provided plan. </p>
<p>Thank you, calmom, for all your research.</p>
<p>I don’t know if this means anything. Just looked up stock prices for Aetna and United Health Group. Since Aug 2009 to present, Aetna 120% increase, United Health Group about 160% while for S&P, 67%. Is there any other reason why Health Industry should outperform?</p>
<p>CF…are you sure about 25 year olds? Our daughter turns 26 in March. DH’s insurance year began October 1. We were told she was able to be covered on that plan until March 31, after which she would need to get her own policy.</p>
<p>We asked if she would be covered until September 30, and were told no.</p>
<p>thumper, check calmom’s 1562 and 1565. She says that policies on the exchanges have to allow young people on the plan for the entire year they turn 26, but off-exchange policies don’t have to follow that rule.</p>
<p>That confuses me, though, because I thought the rule about kids being covered until they turned 26 was a rule that applied to all insurance policies. But maybe it is allowed to be interpreted differently?</p>
<p>Ok…I think we are talking macintosh vs granny smith!</p>
<p>Our kiddo is currently on my husband’s plan. We were told her coverage would end at the end of the month she becomes 26.</p>
<p>I am reading here that kiddos can get exchange coverage until the end of the tax year when the kiddo turns 26. </p>
<p>We are not looking at a family exchange plan. DH and I will continue with his employer plan.</p>
<p>So the question is…is the employer plan required to continue DD until the end of 2014 (she will be 26 towards the end of March, 2014)?</p>
<p>Not sure employers plans and exchanges behave the same way. </p>
<p>We received a letter in August from the employer saying dental and vision will be cut off when D turns 19 in September unless we prove her to be a fulltime student while health will continue until 26. I have no doubt if we continued until 26, they will cut it off in the middle of the year.</p>
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But all insurance policies don’t have the same renewal rules or enrollment periods. </p>
<p>I turn 60 in February. If I could stay on my old plan, then my rate would go up effective that month. But because I will buy on the exchange, I will pay the rate for a 59 year old all year long.</p>
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No. </p>
<p>The law is permissive: a plan can be written to allow coverage until the end of the year, or not. The exchange rules go to the end of the year.</p>
<p>Thank you, calmom.</p>
<p>Our S has until 30 days after he turns 26 to get medical insurance coverage. He will get his from an employer’s group plan. He has been happy to be covered by H’s plan. His turning 26 is a qualifying event for him to purchase under his employer.</p>