ACA Family Glitch Is Fixed

Staff article
November 22, 2022

Employee's Families Can Now Get ACA Subsidies

We all want to do what is best for our employees and their families. However, sometimes due to circumstances outside our control, their options might be limited. That’s why we’re happy to inform you that thanks to closing a loophole in the ACA, depending on eligibility, your staff’s families will have access to more affordable care and subsidies. Below are a few of the changes.

The ACA family glitch fix will be in effect as of 2023. So, when families apply for 2023 coverage during the open enrollment period in the fall of 2022, the new rules will be used to determine whether anyone in the household qualifies for a premium subsidy.

If a family must pay more than a certain percentage of household income (9.12% in 2023) for the employer-sponsored plan, they will potentially be eligible for premium tax credits in the marketplace. The same would also be true if the coverage offered to the family does not provide minimum value. So, if an employer offers, for example, separate coverage to family members that are affordable but that doesn’t provide minimum value, the family members would potentially still be eligible for a subsidy to buy a marketplace plan.

There will be a separate affordability determination for the employee (based on self-only coverage), and for family members (based on the total cost of family coverage). So, depending on how an employer subsidizes the cost of family coverage, it’s possible that coverage could be considered affordable for the employee but not for family members. In that case, the family members would potentially be eligible for a premium tax credit in the marketplace, but the employee would not.(

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