Interaction between health exchange and under-65 Medicare coverage
First off, you should contact your health plan administrator as soon as possible.  Different plans may interact differently with Medicare; any advice we could provide here would be tentative at best.  Some of the issues you may face: A person with both Medicare and a QHP would potentially have primary coverage from 2 sources: Medicare and the QHP. No federal law addresses this situation. Under state insurance law an individual generally cannot collect full benefits from each of 2 policies that together pay more than an insured event costs. State law usually specifies how insurance companies will coordinate health benefits when a person has primary coverage from more than one source. In that situation, insurance companies determine which coverage is primary and which is secondary. It’s important to understand that a QHP is not structured to pay secondary benefits, nor are the premiums calculated or adjusted for secondary payment. In addition, a person with Medicare would no longer receive any premium assistance or subsidies under the federal law. While previous federal law makes it illegal for insurance companies to knowingly sell coverage that duplicates Medicare’s coverage when someone is entitled to or enrolled in Medicare Part A or Part B, there has been no guidance on the issue of someone who already has individual health insurance and then also enrolls in Medicare. We and other consumer organizations have asked state and federal officials for clarification on this complicated situation. As such, it likely is up to the plan how they choose to pay - and I wouldn't expect them to pay much if they think they can avoid it.  You may also want to talk to someone at your local Medicare branch office - they may know more about your state specifically; or someone in your state's department of health/human services, or whomever administers the Exchanges (if it's not federal) in your state. Secondly, as far as enrolling for Part B, you should be aware that if she opts not to enroll in Part B at this time, if your wife later chooses to enroll before she turns 65 she will be required to pay a penalty of 10% per 12 month period she was not enrolled.  This will revert to 0 when she turns 65 and is then eligible under normal rules, but it will apply every year until then.  If she's enrolling during the normal General Enrollment period (Jan-March) then if she fails to enroll then she'll be required to pay that penalty if she later enrolls; if this is a Special Enrollment Period and extends beyond March, she may have the choice of enrolling next year without penalty.
I bought Health Insurance for myself after a period without it, and my premiums were not terrible. I was a 27 year old man, living in California, no preexisting conditions, and I paid approximately 90$ a month. This was for a standard Health Insurance plan.  However, when I moved back to NY a little while later, insurance companies wanted almost $500/month for catastrophic coverage.  So, from personal experience, my answer is that price varies widely by state. Different states have different regulations as to what Health Insurance Companies need to cover and at what price. In NY, Health Insurance companies can't charge different rates according to age. Also, in NY, there is a price spiral, where the price is so high, few people buy it, so they have to raise the price because not enough well people are in the pool, so fewer people buy it.... To test it out, go to an online insurance broker, like ehealthinsurace, and put in your proposed information, including that you haven't been covered for a period. This way you will know. &gt; Healthcare prices went through the roof...  That is a Republican talking point myth.   [Health care premiums went up by a higher percentage in the first-half of Bush's presidency than they did under the worst Obamacare year](https://www.alvarezandmarsal.com/insights/private-exchanges-healthcare-costs-and-employee-affordability).  &gt; So are you an idiot or just ignorant?  I'm sure anyone who thinks the world is complicated appears that way to you. HSA rules are different in some regards than deductions allowable under Pub 502 which deals with medical expenses deductible in Schedule A of your tax return. Pub 969 governs HSA's and similar reimbursement plans, and the guidelines are as follows: Insurance premiums. You can’t treat insurance premiums as qualified medical expenses unless the premiums are for: -Long-term care insurance. -Health care continuation coverage (such as coverage under COBRA). -Health care coverage while receiving unemployment compensation under federal or state law. -Medicare and other health care coverage if you were 65 or older (other than premiums for a Medicare supplemental policy, such as Medigap). Since your wife is still being treated like an employee for health benefits, and you are not on COBRA, thus not eligible for a deduction. You may qualify under the unemployment provision depending on the cause of her disability. Moody's came out with an analysis today saying the requirement could be slightly good for for-profit hospitals (Bad-debt charges will decline. The expansion of healthcare coverage under the law will lessen for-profit hospital operators’ exposure to bad debts, which in turn will improve margins and cash flow. However, we expect that the growth rate of Medicare reimbursements will also slow down, offsetting the benefit of lower bad-debt expense and making the overall credit impact of the ruling neutral to slightly positive), negative for pharmaceutical cos. (Pharmaceutical companies will continue to pay for the full adoption of the Affordable Care Act in the form of higher rebates to the government for Medicaid drug costs, discounts to seniors covered under Medicare Part D drug plans and a new industry fee) and slightly negative for medical device firms (Beginning Jan. 1, 2013, US medical-device product sales will be subject to a 2.3% excise tax; the excise tax will be tax-deductible, resulting in an estimated effective tax rate of 1.5% on US device revenues). HCE is defined as being above 120k$ or in the top 20 % of the company. The exact cutoff point might be different for each company. Typically, only the base salary is considered for that, but it's the company's (and 401(k)-plan's) decision. The IRS does not require HCE treatment; the IRS requires that 401(k) plans have a 'fair' distribution of usage between all employees. Very often, employees with lower income save (over-proportionally) less in their 401(k), and there is a line where the 401(k) plan is no longer acceptable to the IRS. HCE is a way for companies to ensure this forced balance; by limiting the amount of 401(k) savings for HCE, the companies ensure that the share of all contributions by below-HCE is appropriate. They will calculate/define the HCE cutoff point so that the required distribution is surely achieved. One of the consequences is that when you move over the HCE cutoff point, you can suddenly save a lot less in your 401(k). Nothing can be done about that. See this IRS page: https://www.irs.gov/retirement-plans/plan-participant-employee/definitions Highly Compensated Employee - An individual who: Owned more than 5% of   the interest in the business at any time during the year or the   preceding year, regardless of how much compensation that person earned   or received, or For the preceding year, received compensation from the   business of more than $115,000 (if the preceding year is 2014;   $120,000 if the preceding year is 2015 or 2016), and, if the employer   so chooses, was in the top 20% of employees when ranked by   compensation. This sounds like a pump and dump, just with a product instead of a stock, and it points to the need to regulate the medical supply industry pricing structure.  Because actual consumers are not involved in the market price, the price can be wildly inflated: Think bottled water after a natural disaster; the price would go up if it weren't for price controls put in place along with State of Emergency decrees.  It's usually not supply that is the issue, it's the inability of the consumer to self-regulate demand by either limiting use or finding other sources to fill demand.  Our Health system is not one that the consumer has any control over, and so control must be mandated. "While acknowledging that the Affordable Care Act (aka Obamacare) had much success in providing coverage to low-income Americans—particularly through the law's expansion of Medicaid—Commonwealth Fund President David Blumenthal, M.D., said the U.S. healthcare system is still not working as well as it could for Americans, and it works especially poorly for those with middle or lower incomes.""  ""Underscoring this point, the Commonwealth Fund's analysis noted that ""in the U.S., 44 percent of lower income and 26 percent of higher income people reported financial barriers to care."" In the U.K., these percentages are seven and four.""  Want to bet that a good chunk of those 44% were in states that didn't expand Medicaid?" "For the person being hired this is a tricky situation. Specially with the new laws. There is no real magic number that can be applied as a lot will depend on what benefits you want, and what is actually available. This will really shift the spectrum quite a bit.  Under the affordibal care act, everyone has to have insurance or pay a ?fine? (were really not sure what to call this yet) but there are two provisions that really mess with the numbers you look at as an employee.  First, the cost of heath care has skyrocketed. So the same benefits that you had 5 years ago now cost maybe 10-15 times as much as they used to. This gets swept under the rug a bit because the ""main costs"" of insurance has only increased a tiny amount. What this actually comes down to is does your new ACA approved heath plan cover exactly the benefits you need, or does it cut corners.  Sorry this is complicated, and I don't mean it to come off as a speech against the ACA so I will give an example. My wife has RA, she really has it under control with the help of her RA doctor. This is not something she ever wants to change. Because she has had RA from the age of 15, and because it's degenerative, she doesn't want to spend 5 years working with a new doctor to get to the same place she is with her current doctor.  In addition, the main drugs she takes for RA are not covered under any ACA plan, nor are the ""substitutions"" that her doctor makes (we are trying to have kids so she has to be off the main meds, and a couple of the things this doctor has tried has been meds that reduce inflammation, are pregnancy safe, but are not for the treatment of RA) You now have to take into effect rather the cost of health insurance + the cost of the things now not covered by the heath insurance + the out of pocket expenses is worth the insurance.  Second the ACA has set up provisions to straight up trick those people that have lower income and are not paying close attention. When shopping for insurance, they get quotes like ""$50 a month"" or ""$100 a month"". The truth is that the remainder of the actual cost is deducted from their tax returns. This takes consideration, because if you thing your paying $50 a month for insurance but your really paying $650 then you need to make sure your doing your math right. Finally, you need to understand how messed up things are right now in the US with heath care. Largely this goes unreported. I'm not really sure why. But in order to do this I will have to give examples.  For my wife to see a specialist (her RA doctor) the co-pay is $75. So she goes to the doctor, he charges her $75 and bills the insurance $200. The insurance pays the doctor $50. With out insurance, the visit costs $50.  At first you want to blame the doctor for cheating the system, but the doctor has to pay for hours of labor to get the $50 back from the insurance company. From the doctors perspective it's cheaper to take the $50 then it is to charge the insurance company. And by charging the insurance company he has no control over the cost of the co pay. He essentially has to charge more to make the same money and the patient gets the shaft in the process. Another example, I got strep throat last year. I went to the walk in clinic, paid $75, saw the doctor got my Z-Pack for $15, went home crawled in bed and got better. My wife (who still had separate insurance from before the marriage) got strep throat (imagen that) went to the same clinic, they charged her $200 for the visit ($50 co-pay) and $250 for the z-pack ($3 co-pay). The insurance paid the clinic $90 for the visit and $3 for the drugs. Again the patient is left out in this scenario. In this case it worked better for my wife, unless you account for the fact that to get that coverage she had to pay $650/month.  My point is that when comparing costs of heathcare with insurance, and without out insurance, its often times much cheaper for the practices to have you self pay then it is for them to go through the loops of trying to insurance to make them whole. This creates two rates. Self pay rates and Insured rates. When your trying to figure out the cost of not having insurance then you need to use the self pay rates. These can be vastly different.  So as an employee you need to figure out your cost of heath care with insurance, and your cost of heath care without insurance. Then user those numbers when your trying to negotiate a salary. The problem is that there is no magic number to use for this because the cost will very a lot. For us, it was cheaper to not have insurance. Even with a pre-existing condition that takes constant attention, it's just better if we set aside $500 a month then it is to try to pay $750 a month. That might not hold true for everyone. For some people or conditions it may be better to pay the $750 then to try to handle it themselves.  So for my negotiations I would go with x+$6,000 without insurance or x+$4,500 with insurance.  Now as an employer it's a lot simpler. Usually you have a ""group plan"" that offers you a pretty straight $x per year per person or $y per year per family. So you can offer exactly that. Salary - $x or Salary - $y. AS a starting point. However this is where negotiations start.  If your offering me $50,500 and insurance, I would rather just have $57,000 and no insurance. Of course your real cost is only $55,000 cause you don't care about my heath care costs only about insurance costs. So you try to negotiate down towards $55,000 and no insurance. But that's not good enough for me. So I either go else where and you loose talent, or I accept $50,500 and insurance (or somewhere in between)."