Is it Right for You?

Almost everyone should be able to get health coverage. The question is, which plan is right for you and your family?

This page looks at whether you might be able to get employer-sponsored coverage. If you can, it is good for you to sign up, because you probably won’t qualify for subsidized individual coverage.

If you can’t get employer-sponsored coverage, consider other options introduced in DB101’s Health Coverage section, such as Medicaid, Medicare, and individual health plans.

Does your employer, your spouse’s employer, or your parent’s employer offer coverage?

Many employers offer health coverage as a job benefit, but others do not. Employers are not required to offer this benefit. Contact your employer’s Human Resources department to check.

If an employer offers health coverage as a job benefit for employees, the employer also has to offer the same health coverage to the employees’ children until they turn 26.

If an employer offers coverage to an employee and the employee’s children, they may also let the employee’s spouse join the plan, but they are not legally required to do so.

If your employer, your parent’s employer, or your spouse’s employer offers health coverage, continue reading this article.

If not, check out DB101’s other health coverage articles.

Can you get the coverage the employer offers?

Many employers offer health coverage for employees and their families only if their employees meet certain requirements. They can include things like:

• The employee must work a certain number of hours each week (called the active work requirement).
  • Example: Your wife’s employer only provides health coverage to employees who work 30 or more hours per week.
• The employee must have worked for the employer for a certain amount of time (called the waiting period). A waiting period cannot be longer than 90 days.
  • Example: Your father’s employer provides health coverage to employees who have worked there for at least 90 days.
• You must sign up during open enrollment.
  • Example: After you are hired, you have to sign up for your employer-sponsored coverage during your first month on the job. If you don’t, you have to wait until the next open enrollment period to sign up for coverage starting next year.

If your employer, your parent’s employer, or your spouse’s employer offers coverage and you can get that coverage, you probably should. Continue reading this article to learn more about it.

If you cannot get the coverage, check out DB101’s other health coverage articles.

Other Options for People Who Can Get Employer-Sponsored Coverage

Depending on your situation, you may still be able to get Medicaid if you are offered employer-sponsored coverage. Also, some family members may find that buying an individual plan on HealthCare.gov is cheaper than the plan the employer offers, even without government subsidies, or that an individual plan may provide coverage for services that are not covered by the employer-sponsored plan.

Medicaid

Medicaid is a major government-funded health program that helps people with low income. If you qualify for Medicaid, you can get it at the same time as you get employer-sponsored coverage. You may qualify for Medicaid if you are in one of these situations:

• Your family’s income is at or below 138% of the Federal Poverty Guidelines (FPG) ($1,800 per month for an individual; $3,697 for a family of four). There are no limits to how much money or other resources you have. In this case, you get Medicaid through the Iowa Health and Wellness Plan (IHAWP), which is the most common way to get Medicaid. You can read more about this in DB101’s Iowa Health and Wellness Plan article.
• You have a disability or are elderly:
  • Medicaid for people with disabilities and seniors may offer additional services, but there are more eligibility requirements, such as being certified disabled, and different income rules. DB101 has an article that explains disability-based Medicaid.
  • Medicaid for Employed People with Disabilities (MEPD) lets people with disabilities who make more money than the income limits for other types of Medicaid get Medicaid coverage. However, you may have to pay a premium for this type of coverage. Learn more about it in DB101’s MEPD article.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,650
	$5,500
	$15,650
	$5,500
	400
	307
Iowa Health and Wellness Plan (138% FPG)
Healthy and Well Kids in Iowa (Hawki) (307% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (400% FPG)
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). Disability-based Medicaid eligibility is not included here. For private plans with subsidies, your monthly premium amount depends on your income.

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Medicaid and Employer-Sponsored Health Coverage

If you qualify for Medicaid, it will always be your best choice, even if you can get employer-sponsored health insurance. That’s because Medicaid has no monthly premium and the copayments for services are usually much lower than copayments required by employer-sponsored plans. Also, Medicaid may cover some services that your employer-sponsored coverage does not pay for.

If you have Medicaid and you want to enroll in a health plan through an employer, or if someone in your household qualifies for Medicaid and could be covered by the employer's health plan, you and your household may qualify for Iowa's Health Insurance Premium Payment (HIPP) program. If you have HIPP, Medicaid pays your plan's premium and the other costs of getting medical care, like the copayments and the deductible. (Note: For Medicaid to pay these extra costs, you must go to a Medicaid health care provider.) You are not enrolled in a Medicaid managed care plan; instead, your employer's health plan is your main health coverage.

You must apply separately for HIPP after you are approved for Medicaid. If the state of Iowa sees that it is cost-effective to pay for your private coverage, you may qualify. Learn more about HIPP and how to apply.

If you don't qualify for HIPP, you can have both types of coverage at the same time, but you will have to pay your employer-sponsored coverage costs yourself.

Medicare and Employer-Sponsored Coverage

When you first become eligible for Medicare, you’ll automatically be enrolled in Medicare Part A. You’ll also be enrolled in Part B, unless you tell Medicare that you have private coverage. If you already have employer-sponsored private coverage that covers the same things Part B covers, you avoid paying Part B’s monthly premium. You can always sign up for Part B later without paying a penalty as long as your private coverage meets certain requirements.

You can also choose not to get Medicare Part D. As long as your current private coverage is creditable, which means that it is at least as good as the Part D benefit, you can sign up for Part D at a later time without paying penalties.

DB101’s Medicare article has more information.