QUESTION

I heard a new rule will let my spouse and children enroll in a Marketplace plan with subsidies if the cost to enroll in my employer’s plan is unaffordable. How do we find out if the new rule applies to our family?

Individuals with coverage | Individual and Marketplace Health Coverage | Coverage for Employees of a Large Employer | Coverage for Employees of a Small Employer |
ANSWER

Your spouse and children may be eligible to buy a Marketplace plan with subsidies if your offer of employer-sponsored insurance is considered "unaffordable" based on the premium for family coverage. The Marketplace considers your coverage unaffordable if the cost of coverage for a family premium under your employer plan is more than 8.39 percent of your household income in 2024 (for 2023, it was 9.12 percent of household income). If you are eligible for premium tax credits and/or cost-sharing subsidies, you can get a rough estimate of how much you’ll save on Marketplace plan premiums by visiting HealthCare.gov and completing the brief cost estimator form. You can find out the exact amount you would pay by completing the Marketplace application and picking a plan.

Keep in mind that if you decide to decline employer-sponsored coverage for your family during the plan’s annual open enrollment period, you will not be able to enroll them later if you learn that they aren’t eligible for Marketplace subsidies. You may therefore choose to enroll your family in your employer’s plan and then cancel that plan once you know they will enroll in a Marketplace plan. To avoid double coverage, you should confirm with your employer that they will allow you to revoke enrollment in the employer's family plan. If you decide to disenroll your family from your employer plan, ask your employer for proof of the disenrollment so you have documentation of that decision should the Marketplace request it. (IRS Revenue Procedure 2023-29)

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