The federal government recently fixed the definition of “affordable,” so it also looks at enrolling the whole family, not just the employee. As a result, many family members of the employee may now qualify for financial help when they enroll on the Marketplace.
Did you know?
A family of four in Florida with an income of $53,000 could save more than $5,000 on health coverage with financial assistance.2
- Determining if the plan is “affordable” is now based on the cost to cover the entire family.
- The definition of “affordability” for the employee has not changed. It still looks at whether self-only coverage is less than a percentage of household income.
- If one of the plans the employer offers is considered “affordable,” the employee and any eligible dependents cannot get financial help for a Marketplace plan.
- If a family has to pay more than a certain percentage of household income (9.12% in 2023) for the employer-sponsored plan, they may be eligible for financial help buying a Marketplace plan.
- Eligible family members can enroll in a plan during the Marketplace Open Enrollment Period from November 1 to January 15. This year, there’s a Special Enrollment Period that runs up to February 10. Otherwise, they may be able to enroll during the year when the employees are offered health coverage choices or if they qualify for a Special Enrollment Period to enroll in a Marketplace plan.
Key Things to Consider
If you have access to a family member’s group coverage, but you’re uninsured, here are some things you need to think about when looking into a Marketplace plan:
- The amount of financial help is based on the household income and number of family members. You’ll need to consider this compared to the additional cost of adding your family to the employer group plan.
- Two separate plans would mean two separate deductibles and out-of-pocket maximums.
If you’re currently covered through an employer-based plan, you may also need to consider these things as your current plan may be very different from what’s available on the Marketplace:
- Plan types such as HMO or PPO
- Out-of-pocket expenses
- Provider networks
- Network referrals
Make sure you have all facts about this change to see if you or your family may now qualify. You may want to talk with an insurance agent or health navigator to find out if you qualify. They can help you determine if your coverage is unaffordable based on the new rules, determine any financial help you may qualify for, and help you understand which health plan options in the Marketplace are available to you.