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 no coverage | Coverage Outside the Marketplace |
ANSWER

Potentially yes. If your offer of employer-sponsored insurance is considered "unaffordable" based on the premium for family coverage, your spouse and kids may be eligible for marketplace premium and/or cost-sharing subsidies. The marketplace considers your coverage unaffordable if the cost of coverage for a family premium under your employer plan is more than 9.12 percent of your household income in 2023 (for 2022, it was 9.61 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 your children may be eligible for your state’s Children’s Health Insurance Program (CHIP), depending on your income and the eligibility rules of your state. Once you know what your family is eligible for, compare the premiums and out-of-pocket costs for your plan options. It may be that buying two different plans – the employer plan for your spouse, and a marketplace plan for you and/or your children – with two premiums and two deductibles, would cost your family more than paying the family premium for your spouse’s employer plan and having just one family deductible to meet.

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