Help Paying Marketplace Premiums: When Other Coverage Is Available

My family and I are offered health benefits through my job, but we can’t afford to enroll. My employer pays 100% of the premium for workers, but contributes nothing toward the cost of adding my spouse and kids. Can we try to find a better deal in the Marketplace?

You can always shop for coverage on the Marketplace, but your family members won’t be eligible for tax credits to help pay the premium. When people are eligible for employer-sponsored coverage, they can only qualify for Marketplace premium tax credits if the employer-sponsored coverage is considered unaffordable. Coverage is considered unaffordable only if your cost for coverage for yourself, alone, under the employer plan is more than 9.86% of your income in 2019. The cost of adding your spouse and children to family coverage is not taken into consideration.  So although you may feel your family coverage is unaffordable in practical terms, it is considered technically affordable.  Sometimes this situation is referred to as “the family glitch.”

Browse more questions in the Employer-Sponsored Health Coverage section.

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.