Can You Get ACA Subsidies Even with Employer Coverage?
Navigating health insurance options can be confusing, especially when it comes to the Affordable Care Act (ACA). One common question is whether you can qualify for ACA subsidies if you have health coverage through your employer.
Affordable Employer Coverage
Under the ACA, employers with 50 or more full-time employees must offer affordable health coverage to their employees. Affordable coverage means that the employee’s share of the premium is less than 9.12% of their household income.
Employer Affordability vs. Family Affordability
In the case described in the post, the employer offered affordable self-only coverage but not affordable family coverage. Even though the employee’s portion of the family premium exceeded 9.12% of their income, the employer could still claim that they offered affordable coverage based on the self-only premium.
Family Glitch Fix
In the past, this “family glitch” prevented families from receiving ACA subsidies even if the employer-sponsored family coverage was unaffordable. However, the Inflation Reduction Act of 2022 fixed this glitch. As of 2023, families are now eligible for ACA subsidies regardless of the affordability of employer-sponsored family coverage.
Qualifying for ACA Subsidies
To qualify for ACA subsidies, you must:
Be a U.S. citizen or legal resident
Not be incarcerated
Not have access to affordable employer-sponsored coverage (see above)
Meet income requirements (up to 150% of the federal poverty level for 2023)
Applying for ACA Subsidies
You can apply for ACA subsidies through the Health Insurance Marketplace (HealthCare.gov). You will need to provide information about your household income, family size, and employer coverage.
Conclusion
If you have employer-sponsored health coverage that is not affordable for your family, you may be eligible for ACA subsidies. The Inflation Reduction Act has made it easier for families to qualify for these subsidies, which can significantly reduce the cost of health insurance. If you think you may qualify, contact a licensed agent to help you apply.
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