Employer-Sponsored Health Coverage

My employer offers health benefits to me and my family. The company pays the entire cost of my coverage but contributes nothing toward the cost of covering my family. We can’t afford to enroll my spouse and kids. Can they get coverage and subsidies in the Marketplace instead?

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Yes, they can.   People who are eligible for employer-sponsored coverage, can still qualify for Marketplace premium tax credits if the employer-sponsored coverage is considered unaffordable.

The affordability test will look at the cost of self-only coverage for you, and at the cost of family coverage for your spouse and kids.  Because your employer pays 100% of the premium to cover you only, you will not be eligible for premium tax credits.  However, if the premium contribution you would have to pay to cover your spouse and kids under your employer plan is more than 8.39% of your household income in 2024, their coverage would be considered unaffordable and they could qualify for premium tax credits through the Marketplace.

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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The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California.