Impact of Marriage on ACA Marketplace Plan Coverage and Costs

Getting married can introduce significant changes to your life and finances, including the impact on your health insurance coverage under the Affordable Care Act (ACA). In this blog, we’ll explore the specific scenario of how marriage can affect your ACA Marketplace plan eligibility and premiums.

Changes in Marketplace Premium Costs After Marriage

When you get married, your household income increases, and this can impact your eligibility for premium tax credits and the cost of your ACA Marketplace plan. As in the example provided, the individual’s premiums increased from $0 to $217 per month after marriage due to the combined income with their spouse.

Premium Tax Credits and Income Eligibility

Under the ACA, individuals and families with lower incomes may qualify for premium tax credits, which can significantly reduce the monthly cost of health insurance. However, as your income increases, your eligibility for these credits may decrease or disappear altogether, as seen in the example.

Options for Maintaining Coverage After Marriage

If your Marketplace premium costs become too high after marriage, you may consider the following options:

– Shopping for a different Marketplace plan: There may be other plans on the Marketplace with lower premiums that still meet the minimum essential coverage requirements. Consider comparing plans and contacting licensed insurance agents for guidance.
– Exploring off-Marketplace plans: Some insurers offer plans outside of the Marketplace that may have lower premiums. However, ensure these plans meet the essential health benefits required by the ACA.
– Enrolling in a spouse’s employer plan: If your spouse has employer-sponsored health insurance, you may be able to join their plan. However, adding a spouse can sometimes be costly, especially if the employer plan has a high premium.

Avoiding the Penalty

If you choose not to maintain health insurance coverage, you may be subject to a penalty when you file your taxes. The penalty is based on your income and the number of months you were uninsured. You can use the IRS’s penalty estimator tool to get an estimate of your potential penalty.

To avoid the penalty, you can consider the following options:

– Enrolling in a short-term plan: You may qualify for a short-term plan if you do not meet the requirements for Marketplace plans. However, these plans do not provide comprehensive coverage and have limited benefits.
– Joining a health-sharing ministry: These organizations offer a form of health coverage that is not considered insurance but may exempt you from the penalty. However, they have specific rules and limitations.
– Paying the penalty: If you cannot find affordable coverage, you may choose to pay the penalty as part of your tax return.

Conclusion

Getting married can impact your ACA Marketplace plan costs and eligibility. By understanding the available options and exploring ways to maintain coverage or avoid the penalty, you can make an informed decision to ensure you have the health insurance you need without breaking the bank. Remember, it’s essential to seek professional guidance from licensed insurance agents to find the most suitable solution for your specific circumstances.