Affordable Care Act: covered at work, but what about spouse and kids

My employer pays my insurance but not for my spouse and two children. Can they get affordable health insurance through the online marketplace?

Lois in Ohio

Dear Lois,

If your employer’s plan costs you less than 9.5% of your income to cover yourself AND the plan offers coverage for your spouse and children, then they cannot get subsidized coverage on the online marketplace. This is known as the “family glitch”: your spouse and children’s coverage on your employer’s plan is not required to be affordable. It only has to be available.

Note: if you earn more than 400% of Federal Poverty, then the 9.5% cap does not apply to you. You cannot get subsidized coverage in any case, if you are a “high earner”. Four hundred percent of Federal Poverty for a family of four is $94,200 in 2013.  You can look up your income on Families USA’s chart.

One more detail: if your children are legal adults, then you are not required to cover them on your employer’s plan. In addition, if your children have coverage offered to them by their own employer, your plan may be allowed to refuse to cover them. You should ask your plan administrator.

If your employer does not offer coverage to family members, then they can go to the online marketplace and qualify for government subsidies. Some employers are discontinuing their offer for spouse coverage. UPS made headlines this summer for its decision to drop spouses. It might be worth verifying that your employer plans to continue spouse coverage.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.