Now there’s more help.
In 2023, the federal government changed the definition of “affordable.” Now, employer coverage for the whole family can’t be more than 8.39% of your household’s income, .As a result, family members of the employee may now qualify for financial help when they enroll on the Marketplace.
Did you know?
Parents in their 50s with 2 teenagers can earn $139,000 and only have a monthly payment of $10 after financial help.1
- Coverage for your whole family can't be more than 8.39% of your household's income. If it is, family members may qualify for help when they enroll in a Marketplace plan.
- If one of the plans the employer offers is considered “affordable,” the employee and any eligible dependents may not get financial help for a Marketplace plan.
- The definition of “affordability” for family members is based on the lowest cost plan to cover the entire family, regardless of how many of them would enroll in coverage.
- The definition of “affordability” for the employee has not changed. It still looks at whether self-only coverage is less than a certain percentage of household income.
- Eligible family members can enroll in a plan during the Marketplace Open Enrollment Period from November 1 to January 15. Otherwise, they may be able to enroll during the year when 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 costs
- Provider networks
- Specialist 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’re eligible. 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.
1Based on American Rescue Plan subsidies for a Bronze plan in Monroe County, FPL and benchmark premiums in other Florida counties for 2024.