The Navigator Resource Guide has not been updated for 2025 Open Enrollment. For more current information please visit:
cms.gov/marketplace/in-person-assisters/information-partners.
QUESTION

I’m 59, my wife is 55, and our kids are 24, 17, 15, and 13. What age premium will we be charged for health insurance in the Marketplace?

Individuals with no coverage | Comparing Plans: Benefits and Costs |
ANSWER

For Marketplace plans, family premiums will reflect the composition of family members, their ages and their tobacco use. To compute a “family premium,” insurers will add together a separate premium for each adult age 21 and older. In addition, insurers can charge a separate premium for up to three children under age 21. In your example, your family premium will reflect three adult premiums and three child premiums. Outside the Marketplace, not all plans must follow the same rules for family premiums. (42 U.S.C. § 300gg; 45 C.F.R. § 147.102.)

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