Health Insurance for Spouses and Dependents: Understanding Your Options Under the ACA

If you’re married and your spouse has recently obtained employment that provides health insurance, you may wonder what your options are for health insurance coverage. The Affordable Care Act (ACA) offers various provisions to ensure that individuals and families have access to affordable and comprehensive health insurance. In this blog, we’ll explore the topic of health insurance for spouses and dependents under the ACA, particularly focusing on a common scenario where one spouse prefers to remain on their existing health insurance plan while their spouse switches to the employer-provided plan.

What is the ACA’s Family Glitch?

The ACA’s family glitch refers to a provision that previously allowed families with access to employer-sponsored health insurance to still qualify for premium subsidies on health insurance purchased through the Health Insurance Marketplace (also known as Obamacare). This glitch meant that families could save money by having one spouse enroll in employer-sponsored insurance while the other spouse and dependents enrolled in subsidized Marketplace plans. However, the family glitch was eliminated in 2017, meaning that families can no longer qualify for premium subsidies if they have access to affordable employer-sponsored health insurance.

Understanding Your Options

In the scenario where one spouse prefers to remain on their existing health insurance plan while the other spouse switches to the employer-provided plan, there are a few key factors to consider:

1. Employer-sponsored plan affordability: Determine if the employer-sponsored health insurance plan is considered “affordable” by the ACA. This is based on the plan’s cost relative to your family’s income. If the plan is deemed affordable, you may not qualify for premium subsidies on Marketplace plans.

2. Marketplace plan coverage and costs: If the employer-sponsored plan is not affordable, you may be eligible for premium subsidies on Marketplace plans. However, you should compare the coverage and costs of the Marketplace plans with the employer-sponsored plan to make an informed decision.

3. Network coverage: Consider whether your preferred OBGYN is in-network with the employer-sponsored plan. If not, you may want to explore other options, such as staying on your existing health insurance plan or negotiating with your spouse’s employer to add your OBGYN to the plan’s network.

4. Out-of-pocket expenses: If you switch to the employer-sponsored plan and your preferred OBGYN is not in-network, you may face higher out-of-pocket expenses for prenatal care and delivery. You should carefully weigh these costs against the potential savings from the employer-sponsored plan.

Making an Informed Decision

Ultimately, the decision of whether or not to stay on your existing health insurance plan or switch to the employer-sponsored plan depends on your individual circumstances and preferences. It’s important to carefully consider the factors discussed above and consult with a licensed health insurance agent or broker to make an informed choice that meets your family’s health and financial needs.