ACA... Some questions.

[leebee]

We are 4 reasonably well-educated adults, trying to weed through the "clear as mud" government websites as well as AI, insurance company, and other websites. We have some questions about ACA for which we either can't find answers, or the answers are conflicting. I'm hoping someone here on the DIS has experience/information that might help us. Here's the scene- and yes, they are OK with me sharing this info:

My sister (60F), who lives in Louisiana, lost her job 18 months ago and hasn't found another (nobody in LA hires old, physically disabled women, even remotely). When her company folded, she went on to her husband's (58M) health insurance. However, his company folded so he is unemployed until Monday. The new job will cover his health insurance premiums in full, but none of hers. She has the choice of either a high deductible plan ($600 per pay period) or a PPO ($1200 per pay period- and I think it's a 2 week pay period, although this seems ridiculously expensive). He will be earning $73K. She is looking into ACA for her medical coverage. SO... we have Questions:

1. Because she CAN get insurance thru her spouse's job, is she still eligible to sign up for ACA?
2. We know that ACA tax credits/subsidies/etc. are based on income. Would that be her income, or the income for their family (so basically, her DH's income)?
3. Does ACA require a "life changing" event for her to be able to sign up? If she goes on the new insurance, can she drop it and swap to ACA or would she have to wait for open enrollment in November?
4. If she qualifies, what are the limitations and restrictions? Can she keep her own doctors? She has several complicated medical issues, so keeping her own doc/surgeons/therapists is important (and it's why she really shouldn't be looking at high deductible plans).

If anyone has answers, experiences to share, or a reliable direction in which to point me, I'd appreciate it.

 

[lanejudy]

She should be able to reach out to her state's marketplace for assistance is determining her options and what might be best.

#1 -- since she is not the employee and there is no cost-sharing of premiums for dependents, she still qualifies for ACA and any tax credits/subsidies
#2 -- I believe it's family income, but please confirm that with someone else
#3 -- losing insurance coverage should qualify as a "life changing event" to enroll mid-cycle; however I don't know that she would be able to start the coverage from her husband's new employer and then drop that mid-cycle and still qualify
#4 -- any limitations or restrictions, whether or not she can keep her current providers, will really depend on the plan she chooses so this is something to check before making that decision.

Just a note since you commented about HDHP and complicated medical issues -- my family has both and it has worked out well for us;. Obviously that will depend on the details of all plans available to your sister as well as any resources she can put into a HSA, but high healthcare needs doesn't automatically rule out an HDHP. Ours actually works for us because of the extensive medical needs and may not be our best option if we didn't have so much healthcare. But each plan is different so she needs to look at the specific plans available to her to make an informed decision.