Marketplace Health Plans and Premiums

I want to enroll in a Marketplace family plan to cover myself, my spouse, and our four young children. How will my family premium be calculated?

Family premiums will reflect the composition of family members, their ages and their tobacco use. To calculate a “family premium,” insurers will add together a separate premium for each adult age 21 and older. In addition, insurers can charge a separate premium for up to three children under age 21. Assuming your four children are under 21, your family premium will reflect two adult premiums and only three child premiums. Note though that premiums are the same for kids up to age 14 but start to increase after that.

Additionally, if you or your spouse use tobacco, your insurer may apply a tobacco surcharge, which can increase the tobacco user’s separate adult premium in the family premium calculation by up to 50%.

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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