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Kaiser Family Foundation

My employer offers a plan with very limited benefits. It only covers preventive services and a few doctor visits each year. I want better coverage. Can I apply for coverage and subsidies in the Marketplace?

You can apply for coverage in the Marketplace and you may qualify for premium tax credits if your employer plan doesn’t meet the Affordable Care Act’s standard for minimum value. If your employer plan only covers preventive services and a few doctor visits, it probably doesn’t meet the minimum value…

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Kaiser Family Foundation

My employer’s plan is grandfathered so it doesn’t cover preventive services. Can I shop for better coverage in the Marketplace if my job-based plan is grandfathered?

You can always shop for coverage in the Marketplace. However, you can only apply for premium tax credits if your job-based plan – whether it is a grandfathered plan or not – is unaffordable or if it doesn’t meet minimum value. Whether your employer’s health plan meets minimum value will…

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Kaiser Family Foundation

The prescription drug benefit under my employer’s health plan only covers generic drugs. Does that mean it doesn’t have minimum value? Can I shop for better coverage and subsidies on the Marketplace?

Whether your employer’s health plan meets minimum value will depend on a number of factors. Some employer plans might be able to meet the minimum value standard even if they don’t provide coverage for brand name prescription drugs.  The Marketplace application includes a form with questions about job-based coverage. You…

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Kaiser Family Foundation

We just had a baby. Before that my spouse and I were each covered under our own health plans at our own jobs, but now we want the family covered under one policy. Can we all switch to my employer plan now?

Yes. Having a baby is one of the special circumstances that allow you to add dependents to your health plan even outside of the regular open season. You have 30 days from the date of your child’s birth to notify your employer and request that your spouse and your baby be…

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Kaiser Family Foundation

I work full time for a small business (fewer than 50 employees). Does my employer have to offer me health benefits?

No, small businesses are not required to offer health benefits to either full-time or part-time employees, or to their dependents. Small businesses are not subject to tax penalties when they don’t offer health benefits. If your small employer doesn’t offer health benefits, you (and your family) can apply for coverage…

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Kaiser Family Foundation

My employer offers a workplace wellness program that increases premiums for employees who don’t participate. The program doesn’t require people to meet health targets or attend classes, but does require people to answer questions about personal health and lifestyle and to grant access to our medical records. Is this allowed?

It is not clear.  Federal law requires that employers cannot ask workers questions about their health or disability status or genetic information except in limited circumstances, including through voluntary workplace wellness programs. When these laws were first passed, regulations and guidance initially defined “voluntary” to mean a program that neither…

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Kaiser Family Foundation

I work part-time for a large employer. Is my employer required to offer me health benefits? What about benefits for my spouse and kids?

No, large employers are not required to offer health benefits to part time employees and there is no penalty for large employers that don’t offer health benefits to part-time employees or their dependents. If you work part-time and you are not offered health benefits, you (and your family) can apply…

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Kaiser Family Foundation

Do I need a referral to go to my OBGYN if I am enrolled in a non-grandfathered plan?

If you are enrolled in a non-grandfathered plan, then you must be allowed to see your OBGYN without a referral. Women in grandfathered plans and Medicaid may be able to schedule a visit with an OBGYN without a referral. Check with your plan.

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Kaiser Family Foundation

I smoke cigarettes and I buy my own health insurance. Can I be charged more because I smoke?

Yes, in most states you can. Insurers are allowed to increase premiums by up to 50% more for people who use tobacco, although many insurers apply a lower surcharge for tobacco use. If you qualify for premium tax credits, this tobacco surcharge will not be covered by the tax credit.…

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.