QUESTION

I want to add my spouse and/or children to my employer-sponsored plan but I can’t afford the family premium. Can my spouse buy a more affordable plan on the health insurance marketplace?

Individuals with coverage | Coverage for Employees of a Large Employer
ANSWER

It depends. If the premium for self-only coverage in the lowest cost plan offered by your employer is less than 9.56 percent of your household income in 2018, no one in your family who is eligible to join your employer’s plan can qualify for a premium tax credit, no matter how expensive the premiums are for a family plan. However, if family members forgo coverage because the employer plan premiums are too expensive, they may not be subject to the requirement that individuals purchase health insurance (the individual responsibility requirement or mandate). Specifically, if the premiums for family coverage through your employer’s plan are more than 8.05 percent of your household income in 2018 (8.16 percent in 2017), your family members will not be subject to a penalty for not enrolling in coverage. Your children may also be eligible for your state’s Children’s Health Insurance Program, depending on your income and the eligibility rules of your state. (26 U.S.C. § 36B; 26 U.S.C. § 5000A).

Individuals with no coverage
Individuals with coverage
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