When purchasing health insurance, whether it is through an employer plan or through Pennie or directly through an insurer, it is sometimes hard to understand where the term “affordable” fits into the “Affordable Care Act”.  When a family has an individual who is covered through an employer plan and other members of the family were able to get coverage through that plan (even if they had to pay full price – which is most often the case anymore) then no one in the family qualified for an Advanced Premium Tax Credit through Pennie, or the Federal Marketplace.  That is now changing!


Under new federal rules, Pennie can now provide savings to more Pennsylvanians!

Learn more below:

What happened? 

In October, the Biden administration finalized a rule changing how affordability is calculated for family members with an offer of health insurance through their spouse or parent’s employer.

What was the problem?

Until now, 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.

This so-called “family glitch” forced family members to choose between two expensive options, the employer family plan or a full price marketplace plan.

What is 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.

Communication to the Impacted Population at Pennie: 

Pennie will be emailing and calling those customers and applicants who previously indicated on their application they had an offer of family coverage from their spouse or parent’s job. These customers will be asked to update their application to provide the additional information about the cost of employer-sponsored coverage, to determine if they may be newly eligible for financial savings.

The “family glitch fix” question will be available to all Pennie customers who submit a new 2023 application, or who update their existing 2023 application, ensuring they get access to the financial savings they qualify to receive.