ACA Coverage Gap: What You Need to Know

The Affordable Care Act (ACA) has helped millions of Americans gain access to health insurance, but there are still some gaps in coverage. One of the most significant gaps is the “family glitch.”

The family glitch occurs when an individual is offered affordable health insurance through their employer but their family is not. This can happen even if the family’s income is low enough to qualify for subsidies under the ACA.

As a result of the family glitch, many families are forced to either pay for unaffordable health insurance or go without coverage altogether. This can have a devastating impact on their health and finances.

How the Family Glitch Works

To understand how the family glitch works, you need to know how the ACA calculates subsidies. Subsidies are available to individuals and families with incomes between 138% and 400% of the federal poverty level (FPL). The amount of the subsidy is based on the cost of the second-lowest-cost silver plan in your area.

If you are offered affordable health insurance through your employer, you are not eligible for subsidies, even if your family’s income is low enough to qualify. This is because the ACA considers employer-sponsored health insurance to be affordable if the employee’s share of the premium is less than 9.5% of their household income.

However, the affordability calculation is based on the individual plan, not the family plan. This means that even if the family plan is unaffordable, the employee is not eligible for subsidies if the individual plan is affordable.

The Impact of the Family Glitch

The family glitch has a significant impact on many families. According to a study by the Kaiser Family Foundation, the family glitch affects about 5 million people. Of those, about 2.3 million are children.

The family glitch can have a devastating impact on families’ health and finances. Families who cannot afford health insurance are more likely to go without care, which can lead to health problems. They are also more likely to accumulate medical debt, which can ruin their credit and make it difficult to get a job or housing.

What Can Be Done About the Family Glitch?

There are several things that can be done to address the family glitch. One option is to expand Medicaid to all low-income adults. This would provide health insurance to millions of people who are currently uninsured.

Another option is to create a new subsidy program for families who are not eligible for subsidies under the ACA. This program could be based on the family’s income and the cost of health insurance.

Finally, Congress could pass legislation to fix the family glitch. This legislation could change the way that affordability is calculated or it could create a new subsidy program for families who are not eligible for subsidies under the ACA.

If you are affected by the family glitch, there are a few things you can do:

Contact your state’s Medicaid agency. You may be eligible for Medicaid even if you are not eligible for subsidies under the ACA.
Shop for health insurance on the Health Insurance Marketplace. You may be able to find a plan that is affordable for your family.
Contact a licensed health insurance agent. An agent can help you find the best plan for your family and help you apply for subsidies.