QUESTION

My spouse has access to job-based coverage, but it is unaffordable for me to enroll with him. Our household income is too high to qualify for premium tax credits. What are my options to find affordable coverage?

Individuals with no coverage | Coverage Outside the Marketplace Individual Responsibility Requirement (Individual Mandate)
ANSWER

You are experiencing something people call the “family glitch.” There are several options for people who do not qualify for premium tax credits. It may still be worth looking for coverage on HealthCare.gov, even if you do not currently qualify for premium tax credits; there, you can shop for coverage that provides the Affordable Care Act’s protections, including a comprehensive set of benefits and limits on your annual out-of-pocket costs. However, in many states, if you are looking for a silver-level plan (which covers, on average, 70 percent of health care costs), you may find that the premium is more affordable if you buy it outside the marketplace. To access these plans, contact your state’s Department of Insurance for a list of reputable brokers that can help you shop for minimum essential coverage.

If your income fluctuates and you become eligible for premium tax credits mid-year, you may also qualify for a special enrollment period to shop for coverage and enroll in tax credits or claim them as a tax refund when you file your taxes for the year.

There may be other coverage options available outside of the marketplace that do not provide the Affordable Care Act’s protections. These include plans that are not traditional health insurance products, including short-term, limited duration insurance, association health plans, health care sharing ministries, and Farm Bureau plans. If an insurer or entity does not provide a Summary of Benefits and Coverage that indicates coverage is minimum essential coverage, be aware that the plan may have significant coverage limitations, particularly for pre-existing health conditions and even for basic medical care. Always insist on getting plan documents to review prior to buying a plan.

Individuals with no coverage
Individuals with coverage
Coverage for small employers
Post enrollment issues