Joe finally gets the bass boat he’s always wanted but could never afford until now………..
Joe Sixpack struggles to make ends meet. His family health insurance is a second mortgage leaving little money for the better things in life. As a dedicated Texas educator Joe lives from paycheck to paycheck. But Joe has a plan and he’s waiting for the TRS ActiveCare Open Enrollment period to take action. He sees Open Enrollment as an opportunity to escape high cost family coverage.
Joe has learned that in cases where TRS ActiveCare dependent premium exceeds the federal affordability threshold his wife and children can decline TRS ActiveCare coverage, enroll with similar benefits on the ACA Marketplace plan during the Marketplace Open Enrollment period and receive premium tax credits worth hundreds if not thousands of dollars a year.
Joe is not alone. Many TRS ActiveCare families qualify for lower cost dependent health insurance. Segal’s report to TRS ActiveCare officials several years ago shows the average annual employee contribution for family coverage is between $11,928 and $13,896 depending upon plan selection. These plans are, by ACA definition, unaffordable for any family whose annual household income is less than $133,000 or $155,000 respectively.
TRS-ActiveCare plan members can drop coverage anytime during the plan year unless they are tax sheltering their contributions through a Cafeteria Plan.
Since the TRS ActiveCare Open Enrollment period is four months in advance of the ACA Marketplace Open Enrollment period, district employees who are considering options should be made aware of Cafeteria Plan rules. Unless there is a qualifying event, Cafeteria Plan participants are locked into their health insurance choices until the following open enrollment period.
During the TRS ActiveCare Open Enrollment period district employees with family coverage would be wise to determine their best option before making their benefit decisions.
Is TRS ActiveCare their best option or is the ACA Marketplace plan a better choice? That decision is made easy by going here to review Marketplace benefits, rates and subsidy availability.
If it’s determined the best option is the ACA Marketplace plan the employee should be prepared to escape the Cafeteria Plan prison during the TRS ActiveCare open enrollment period. This will free them to move their family from the TRS ActiveCare group plan in December to the ACA Marketplace plan effective January 1 without a gap in coverage. Otherwise as long as they remain in Cafeteria Plan prison, they will not be able to take advantage of other options. They will remain hostage to higher rates for the rest of the plan year.
Meanwhile back at the ranch Joe continues his TRS ActiveCare coverage while his family enjoys affordable coverage through the ACA Marketplace plan. And, best of all, Joe finally gets the bass boat he’s always wanted but could never afford before.
