Navigating Health Insurance When Your Spouse Has Employer Coverage

Being uninsured can be a major worry. The Affordable Care Act (ACA) provides a safety net for individuals who do not have access to affordable employer-sponsored health insurance. However, if your spouse has employer coverage, you may be wondering if you can still qualify for your own ACA health plan.

In this blog, we will explore this specific topic raised by users. We will discuss the changes to the ACA that affect individuals with employer-sponsored coverage and provide guidance on your options for obtaining health insurance.

Understanding the Family Glitch

Prior to 2023, there was a loophole in the ACA known as the “family glitch.” This loophole allowed individuals with access to employer-sponsored coverage for themselves to be considered ineligible for subsidies on ACA plans if adding dependents to the employer plan would make the coverage unaffordable.

Changes Under the ACA in 2023

The ACA has been updated to address the family glitch. Under the new rules, if adding your spouse and/or dependents to your employer-sponsored health plan would make the coverage unaffordable, you may still be eligible for ACA subsidies.

Determining Affordability

To determine affordability, the ACA uses a formula that compares the cost of the employer-sponsored plan to your household income. If the cost of the employer-sponsored plan exceeds a certain percentage of your household income, you may be eligible for ACA subsidies.

Affordable Care Act (ACA) Subsidies

ACA subsidies are available to individuals and families who meet certain income and household size requirements. These subsidies can significantly reduce the cost of your health insurance premiums, making coverage more affordable.

Qualifying for ACA Coverage

To qualify for ACA coverage with subsidies, you must meet the following requirements:

Be a U.S. citizen or legal resident
Not be incarcerated
Not be eligible for Medicare or other government-sponsored health insurance
Have an annual household income below a certain threshold

Applying for ACA Coverage

If you are eligible for ACA coverage, you can apply during the annual open enrollment period, which typically runs from November to January. You can apply online at HealthCare.gov or by contacting a licensed agent.

Seeking Professional Help

Navigating the complexities of health insurance can be challenging. If you have questions about your eligibility for ACA coverage or need assistance applying for subsidies, it is recommended to seek the help of a licensed agent. They can provide personalized guidance and ensure that you get the coverage that meets your specific needs.