Has this happened to you? As an employee you have been offered coverage through your company health plan, and the employer is paying a portion, up to 100% of your coverage, and that coverage is also open to your spouse and children – but they had to pay as much as 100% of the premium. Affordability of employer health insurance for family members was based on the cost to enroll only the employee, regardless of the cost of family coverage. Even if the cost to enroll family members was significantly more than the cost to enroll the employee, the coverage was still considered “affordable” for the family members, making them ineligible for financial assistance through marketplaces like Pennie. That hit many people’s bank accounts very hard each month. In 2023 that has changed for the better!
The New Solution
Under this new rule, starting with 2023 coverage, family employer plans will only be considered “affordable” if the actual cost to enroll each member of the family is within the ACA affordability standards. In other words,
...when employer coverage for family members costs too much, the family members may qualify for financial assistance through Pennie, instead of being forced to pay full price.
Pennie’s application has been updated to include a new question for all members of a tax household with an offer of family coverage through a spouse or parent’s employer. Each tax dependent will be asked to provide the premium of the lowest cost family plan (employee + spouse + other dependents). Pennie will then determine for each family member whether that employer coverage is affordable to determine whether each person may be eligible for savings through Pennie. The employer coverage may be affordable for some family members but not others, resulting in only some family members being eligible for financial savings.