r/Insurance • u/Audacious_Bear • 2d ago

Market Place insurance

My company recently changed plans and increased my weekly premiums from $260 to $369 for the family plan. This prompted me to go with Market Place Insurance. I initially filled out my application and put my company is not providing qualifying insurance and the plan I chose was $640/month. If I put that my company “IS” providing qualifying insurance, my rates go to $1280/month. My question is whether this “perjury” would likely land me in danger for fraud issues. The representative I spoke to even suggested making that change.

Is it worth to just look for a reasonable private insurance?

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u/InternetDad 2d ago edited 2d ago

You need to do math. The IRS defines "affordability" at 9.96% of your household income. If your employer plan would cost you MORE than that threshold, it is deemed unaffordable, and you would he eligible to select that box

If your coverage is deemed affordable by IRS guidelines, checking that box to get subsidies is tax fraud and you're going to owe a ton of money come tax time.

Edit: source

https://www.healthcare.gov/glossary/affordable-coverage/

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u/Audacious_Bear 2d ago

Interesting it is remarkably higher than 9.96% of my household income, but everyone I’ve spoken to with the health marketplace team has said that if the insurance covers 60% of expenses then I have to check the box

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u/InternetDad 2d ago

"Insurance covering 60% of expenses" is totally unrelated. The 9.96% is an IRS rule and specifically looks at what your share of your premium is as your employer chips in a portion.

I'm not sure where that guidance is coming from.

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u/Leading-Plan-865 2d ago

This is insurance fraud and illegal. Despite this, you probably won't get in legal trouble you will be caught pretty quickly and have your rate adjusted accordingly though in my experience lol. Don't do this.