Family healthcare coverage demands new math

NEW YORK Wed Oct 2, 2013 12:02pm EDT

Information cards are stacked on a table during an Affordable Care Act outreach event for the Latino community in Los Angeles, California September 28, 2013. REUTERS/Jonathan Alcorn

Information cards are stacked on a table during an Affordable Care Act outreach event for the Latino community in Los Angeles, California September 28, 2013.

Credit: Reuters/Jonathan Alcorn

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NEW YORK (Reuters) - Long Island publicist Brian Erni works for a company that would extend health insurance to his wife if he would pay for it. The problem: It costs $900 per month to add her to his plan.

Families across the United States are facing similar situations as many companies plan to trim, eliminate or charge extra for benefits for employees' spouses in 2014, when key parts of healthcare reform take effect.

Previously, a family might have bundled its health insurance under one adult's plan to save money. That is because individual insurance rates on the open market tend to be high and paying the single rate at two different companies may add up to more than the family rate offered by most employers.

Now they will have to figure out the new math on how best to cover family members. It will often add up to sending spouses in different directions for coverage and sometimes to different doctors.

For slightly less than $400 a month, Enri's wife, Lauren Barresi, 26, can now sign up for a bronze-level plan with a $3,300 deductible, according to estimates on ValuePenguin.com. And a quote from private insurance marketplace eHealthinsurance.com shows a comparable offering on the open market would cost more than $600, still less expensive than the employer surcharge.

"The more difficult thing would be to keep track of who can go in for what - if somebody has strep throat, who can affordably go to the doctor and who can't?" says Erni, 28, of St. James, New York.

About 33 percent of companies will add a surcharge for spousal coverage in 2014, according to a report from Towers Watson and the National Business Group on Health. About 5 percent are unlikely to provide any subsidy at all to cover spouses.

Some 18 percent of companies, like United Parcel Service Inc, will only cover spouses who cannot get their own workplace plans. Others are no longer providing benefits to spouses at all, a move that Kroger Co just made for a selection of union workers in Indiana.

Before jumping into one big family plan, families should do some comparison shopping. Here are some scenarios:

TWO WORKPLACE PLANS

For two working spouses, being on different plans might not be that jarring if the offerings are fairly equal.

Financial planner Bryan Bly, 47, has done the math for the past 11 years to see what arrangement is best for him and his wife, 48 - and whose plan is better for their 9-year-old daughter. Except for a brief time when his wife was between jobs, they have gone their own ways on medical coverage, but to join one or the other's dental and vision plans.

They did this even before Bly's employer in Atlanta began two years ago to put a surcharge on medical benefits for spouses who are employed.

"The difference annually was in the hundreds of dollars range," Bly says.

If your employer makes this move to curtail family plans, be prepared to show documentation that your spouse is not otherwise covered and that you are legally married. After initiating a spousal carve-out, Ball State University in Muncie, Indiana, is requiring employees to produce copies of their marriage licenses and sign an affidavit in order to get spousal coverage.

ONE WORKER COVERED

For companies that are adding hefty surcharges or not covering spouses at all, the uncovered spouse will have options on the open market or on the new public health insurance exchanges that opened on Tuesday.

A catch in the Affordable Care Act will disqualify these spouses from subsidies because one member of their household has a workplace plan. "They are referring to it as the family glitch," says Bob Hurley, a senior vice president at eHealth, which runs eHealthinsurance.com. "I suspect policymakers will take a look at this and remove this issue."

In the meantime, uncovered spouses can still get plans, just at full price.

"We think that spouses are going to have good options for care through exchanges or through private insurance," says Brigid Kelly, a spokeswoman for the United Food & Commercial Workers International Union's Local 75, which represents Kroger's workers in Indiana. While the government might not provide any subsidies, she says the union has some funds to help defray the costs.

In Indianapolis, the unsubsidized bronze-level plans cost $250 to $300 a month, with deductibles that start at $4,300, according to insurance broker Nefouse & Associates, which is authorized to sell policies on the state's public exchange.

SCANTY COVERAGE

If you are not happy with your workplace options, you can go out into the market and shop around, just without subsidies. While dependents are still covered under workplace plans up to age 26, families may consider getting them their own coverage, particularly if they are healthy young adults.

Maura Carley, chief executive officer of insurance consultancy Healthcare Navigation LLC, suggests comparing workplace plans with public and private offerings.

"The world is really changing on January 1," she says. "You have to know what your options are."

(Editing by Linda Stern, Lauren Young and Lisa Von Ahn)

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