ACA Health Insurance for Self-Employed Spouses: The Family Glitch and Your Options

The Family Glitch

The Affordable Care Act (ACA) is designed to make health insurance more affordable for all Americans. However, a provision known as the “family glitch” can make it difficult for spouses of employees who receive affordable health insurance through their employers to get affordable coverage through the Health Insurance Marketplace.

The family glitch occurs when an employee’s health insurance is considered “affordable” for the employee only, but not for the employee’s spouse. This means that the spouse is not eligible for a premium tax credit to help pay for health insurance on the Marketplace.

The Impact on Self-Employed Spouses

The family glitch can have a significant impact on self-employed spouses. Without a subsidy, the cost of health insurance on the Marketplace can be unaffordable. This can lead to spouses going uninsured or underinsured, which can have serious consequences for their health and financial well-being.

Options for Self-Employed Spouses

If you are a self-employed spouse and your spouse has affordable health insurance through their employer, you have several options for getting health insurance:

COBRA: COBRA allows you to continue your spouse’s employer-sponsored health insurance for up to 36 months after you lose coverage. However, COBRA can be expensive, and you will have to pay the full cost of the premiums.
Health Insurance Marketplace: You can purchase health insurance on the Health Insurance Marketplace. However, you will not be eligible for a premium tax credit if your spouse has affordable health insurance through their employer.
Medicaid: Medicaid is a government health insurance program for low-income individuals. If you meet the income requirements, you may be eligible for Medicaid.
Association Health Plans: Association Health Plans (AHPs) are group health insurance plans that are offered by trade associations, professional societies, and other organizations. AHPs may offer more affordable coverage than individual health insurance plans.
High-Risk Pools: High-risk pools are state-run programs that provide health insurance to individuals who have pre-existing medical conditions. High-risk pools can be expensive, but they may be the only option for some individuals with serious health conditions.

It is important to weigh the pros and cons of each option carefully to find the best solution for you and your family.