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I was recently asked if I could help someone who is married to an American, but who himself is not yet legal and will not receive legal status for at least another year. The legal American is the wife, and she currently has insurance through her work that covers both herself and her husband. They want to be able to have a child, but she just went through a very difficult pregnancy and lost the child at birth. They want to try again, but the doctor feels she will need bed rest during the second half of her pregnancy which means she would have to leave her work.
So here is the question, since he is not yet legal, he is not eligible for a ACA subsidy, whereas she would be.
Is there any way she can apply for herself and obtain a subsidy for herself based on her husbands sole income, while her husband buys a plan for himself not on the exchange?
Another question. At what point do you add the baby? Do you have to wait until baby is born? With a possible difficult pregnancy, you want to be sure baby is covered in case of unexpected pre-mature birth. So how would you insure baby is covered?
Last edited by modhatter; 09-10-2015 at 06:18 PM..
So here is the question, since he is not yet legal, he is not eligible for a ACA subsidy, whereas she would be.
Is there any way she can apply for herself and obtain a subsidy for herself based on her husbands sole income, while her husband buys a plan for himself not on the exchange?
Subsidies are based on household income. Afaik, ACA doesn't differentiate household income from legals and nonlegals. Have they been filing joint tax returns?? If so, assume he is using and ITIN.
I was recently asked if I could help someone who is married to an American, but who himself is not yet legal and will not receive legal status for at least another year. The legal American is the wife, and she currently has insurance through her work that covers both herself and her husband. They want to be able to have a child, but she just went through a very difficult pregnancy and lost the child at birth. They want to try again, but the doctor feels she will need bed rest during the second half of her pregnancy which means she would have to leave her work.
So here is the question, since he is not yet legal, he is not eligible for a ACA subsidy, whereas she would be.
Is there any way she can apply for herself and obtain a subsidy for herself based on her husbands sole income, while her husband buys a plan for himself not on the exchange?
Another question. At what point do you add the baby? Do you have to wait until baby is born? With a possible difficult pregnancy, you want to be sure baby is covered in case of unexpected pre-mature birth. So how would you insure baby is covered?
I'm confused. If they already have insurance through the employer then what's the issue?
I'm confused. If they already have insurance through the employer then what's the issue?
She may need to quit work if she gets pregnant which means she loses her insurance, per this:
Quote:
They want to be able to have a child, but she just went through a very difficult pregnancy and lost the child at birth. They want to try again, but the doctor feels she will need bed rest during the second half of her pregnancy which means she would have to leave her work.
I figured you'd answer my question Ariadne. I assume they file a joint return. I know they file returns. I will have to ask for certain. You know it did set me back when confronted with the question. After thinking about it a bit, I assumed she could apply independently based on the family income., but I don't want to take the chance of stating something that I could be wrong on.
What about the baby? How does that work by the way. She did just become pregnant again. At what point does she need to have the baby covered? There is always the possibility that the baby could come early, as it did before, and if there were complications with the baby, you want to make sure you have insurance that covers the baby. Being well past that juncture in life, I have not given that much thought before.
How does that work.?
From what I read, coverage for pregnancy will only be covered during regular enrollment periods between November 1, 2015 through January 31, 2016.. This is to prevent people who become pregnant suddenly buying health insurance to cover the baby's birth. I don't know if her having to quit her job during her pregnancy (though normally a life event), will qualify her for coverage on her pregnancy coverage on a new plan.
I would think it should, as long as she had continuous coverage that included pregnancy in her current plan, but I don't want to assume anything.
I'm confused about the legal status. If they are married and she is a US Citizen, isn't the husband a legal citizen then? Does he have a Green Card? If he has a legal residency in the US, doesn't have to be a citizen yet, he should qualify for subsidies too.
If she has insurance and has a qualifying life event, they should be able to get full coverage via a private plan. The baby would be covered at birth. They have 30 days from birth to get the baby on their plan and then claims are paid retroactively to the date of birth. The information you are reading is for those that do not currently have insurance and are trying to get insurance just to cover the pregnancy.
Does she have short and long-term disability? If so, doctor ordered bedrest is eligible for a disability claim. She could keep her job and her insurance and stay home as needed. If she doesn't have disability yet, she should check with her employer to see if they have coverage. Keep in mind, often there is a waiting period for pregnancy with disability policies, 12 or 18 months is typical to get pregnant, not have the baby, so that is a consideration.
For the subsidy question, yes, she would be able to qualify for a subsidy since the plans they buy off the exchange are individual plans. The baby would then also qualify assuming their income is low enough to do so. The subsidies are based on household income and they must file a joint return to qualify.
I was recently asked if I could help someone who is married to an American, but who himself is not yet legal and will not receive legal status for at least another year. The legal American is the wife, and she currently has insurance through her work that covers both herself and her husband. They want to be able to have a child, but she just went through a very difficult pregnancy and lost the child at birth. They want to try again, but the doctor feels she will need bed rest during the second half of her pregnancy which means she would have to leave her work.
So here is the question, since he is not yet legal, he is not eligible for a ACA subsidy, whereas she would be. Is there any way she can apply for herself and obtain a subsidy for herself based on her husbands sole income, while her husband buys a plan for himself not on the exchange?
Another question. At what point do you add the baby? Do you have to wait until baby is born? With a possible difficult pregnancy, you want to be sure baby is covered in case of unexpected pre-mature birth. So how would you insure baby is covered?
Quote:
Originally Posted by Qwerty
I'm confue sed about the legal status. If they are married and she is a US Citizen, isn't the husband a legal citizen then? Does he have a Green Card? If he has a legal residency in the US, doesn't have to be a citizen yet, he should qualify for subsidies too.
According to the op the husband will not receive legal status for at least another year.
What about the baby? How does that work by the way. She did just become pregnant again. At what point does she need to have the baby covered?
When it is born. Call the Exchange to add the baby to coverage.
Quote:
Originally Posted by modhatter
There is always the possibility that the baby could come early, as it did before, and if there were complications with the baby, you want to make sure you have insurance that covers the baby. How does that work.?
No differently than if it is born at nine months. Report the birth when it occurs.
I was recently asked if I could help someone who is married to an American, but who himself is not yet legal and will not receive legal status for at least another year. The legal American is the wife, and she currently has insurance through her work that covers both herself and her husband. They want to be able to have a child, but she just went through a very difficult pregnancy and lost the child at birth. They want to try again, but the doctor feels she will need bed rest during the second half of her pregnancy which means she would have to leave her work.
So here is the question, since he is not yet legal, he is not eligible for a ACA subsidy, whereas she would be.
Is there any way she can apply for herself and obtain a subsidy for herself based on her husbands sole income, while her husband buys a plan for himself not on the exchange?
Another question. At what point do you add the baby? Do you have to wait until baby is born? With a possible difficult pregnancy, you want to be sure baby is covered in case of unexpected pre-mature birth. So how would you insure baby is covered?
Back in the day, they used to recommend that the insured sign up for family coverage when the mother was about 7 months pregnant, ie, around the time when the baby could be expected to survive if birth came early. That way the baby would be covered for possible birth complications or other medical problems. It used to be that a normal birth and normal care of the newborn were covered under the mother's coverage. Not sure how it all works under ACA policies.
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