When the Affordable Care Act (ACA) was introduced, it did not allow dependents of employees who were offered an employer based health plan to enjoy the health insurance savings offered by the ACA.  If the employee-only health coverage was considered affordable, the employee and their family members were ineligible for financial assistance with the Health Insurance Marketplace, even if the cost of employer family coverage was considered unaffordable.  This is referred to as the “family glitch.”

Because of a change to the law in December 2022, there is now a fix to the Family Glitch and it allows us to help employees save thousands of dollars on their dependent health coverage.

With this new rule, if employer offered family coverage exceeds the affordability threshold, the employee’s dependents may qualify for a subsidy/tax credit through the Marketplace, which could dramatically reduce the cost of their health coverage.

If the calculator above shows that you or your dependents may qualify for health insurance savings, click here for an instant health insurance quote.

An employer based health plan is considered “affordable” if your part of the monthly premium (in the lowest-cost plan available from the employer) is less than 9.02% of your total household income in 2025.  Employee only coverage is considered to be affordable if it does not cost more than 9.02% of the household income in 2025.  If an employer offers family coverage (including employee plus spouse), the coverage is considered affordable if the employee’s required contribution for the family coverage does not exceed 9.02% of household income. 

The affordability threshold is based on the employee’s required contribution for the lowest-cost minimum value coverage plan that the employer offers.  The employee may choose a more expensive plan than the lowest cost plan available, so you may need to check with your employer for the cost of the lowest-cost minimum value plan available.

Family coverage includes coverage for the employee’s tax family, including spouse filing jointly and dependents.  Other family members (i.e. adult children up the age of 26 or non-dependent domestic partners) may be offered employer health insurance coverage, however, if they are not on the employee’s tax return, then they would not be included in the affordability test.  Do not include the cost of covering those not in your ‘tax household’ for the purposes of this calculator.

Household income includes all income from everyone in the tax household; this usually includes the tax filer, their spouse (if legally married), and their dependents.  When including members of your tax household, if you plan to claim someone as a tax dependent for the year of coverage, then you should include their income in the household income.

Tax filer + spouse + tax dependents = tax household

A health plan meets the minimum value standard if both of these apply: It’s designed to pay at least 60% of the total cost of medical services for a standard population, and its benefits include substantial coverage of physician and inpatient hospital services.

An Advance Premium Tax Credit (APTC), also known as a subsidy, is a tax credit you can take in advance to lower your monthly health insurance payment (premium).  When you apply for coverage in the Health Insurance Marketplace, you estimate your expected income for the year.  If you qualify for a premium tax credit based on your estimate, you can use the credit in advance to lower your premium.

If at the end of the year you have taken more premium tax credit in advance than you’re due based on your final income, you may have to pay back some or all of the excess (depending on your income level) when you file your federal tax return.  If you have taken less than you qualify for, you will receive the difference back.

See how much savings you qualify for!

ACA stands for the Affordable Care Act, which is the comprehensive health care reform law that was enacted in March 2010.  ACA is also known as Obamacare.  

The Health Insurance Marketplace is the federal exchange platform where you can enroll for health insurance coverage.

To get a personalized quote, click here

If the dependents qualify for savings, but the employee does not, then the employee who has health coverage on an employer plan will remain on that health plan, and the dependents will enroll in an ACA plan on the Health Insurance Marketplace.

The Open Enrollment Period (OEP) is November 1st to January 15th of each year. 

This is the designated time period each year when individuals & families can enroll in or make changes to their health insurance plan through the Health Insurance Marketplace. 

If you enroll between November 1st and December 15th and pay your first premium, coverage will start on January 1st.  If you enroll between December 16th and January 15th and pay your first premium, coverage will start on February 1st. 

A Special Enrollment Period (SEP) is a time outside of the annual Open Enrollment Period (OEP) when you can sign up for health insurance.  You qualify for a Special Enrollment Period if you have had certain life events, including losing health coverage, moving, getting married, having a baby or adopting a child, or if your household income is below a certain amount. 

Depending on the type of life change, you may have 60 days before and 60 days after that event to enroll in a new plan.

Click here to see if you qualify for a Special Enrollment Period. 

If you do not qualify for a Special Enrollment Period with the Affordable Care Act (Obamacare) Marketplace, but you still need health insurance coverage until you can enroll for January 1st coverage, you still have options.  You may be able to enroll in a Short Term Medical plan.  Call us to learn more.