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If I have insurance through my employer, can my spouse get coverage through the exchange?

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Image: rocketclips / stock.adobe.com

If I have insurance through my employer, can my spouse get coverage through the exchange?

Q. I have insurance, with a small fee, through my employer.  However, my husband is unemployed and to cover him on my insurance is almost $500.  Can he get insurance through the marketplace even though he’s eligible to enroll in coverage through my company?

A.  Yes, but he cannot get a subsidy to help pay for health insurance in the marketplace.  If you have access to an employer-sponsored plan that is deemed affordable, you cannot get a subsidy to help pay for an individual policy instead.

The IRS has ruled that an employer plan is “affordable” if the cost for employee-only coverage (for the least-expensive plan available from the employer) does not exceed 9.61% of household income in 2022 (the Build Back Better Act would reduce this threshold to 8.5% of household income).  This is true regardless of the total amount that must be paid to cover dependents on the policy, and it was not affected by the American Rescue Plan’s extensive improvements to the subsidy structure in 2021.

And although the Build Back Better Act would reduce the affordability threshold, it would not change anything about the fact that the affordability determination is based on only the cost to cover the employee, without regard for the cost to add family members.

You mentioned that your coverage is provided for a small fee — as long as it’s not more than 9.61% of your household income (or 8.5%, if the Build Back Better Act is enacted), your husband would not be eligible for a marketplace subsidy on an individual plan. This is known as the family glitch, and there are several million Americans who are unable to access affordable health insurance because of it.

However, depending on his age and the type of coverage he wants, he might find that he can get an individual plan for less than $500, even without a subsidy. He can shop in the marketplace or off-exchange (directly through a health insurance carrier or a broker) and see what’s available in your state. If he doesn’t mind a relatively high deductible, a Bronze plan might be a good way to lower his premium costs. The average full-price premium for health plans sold in the exchanges nationwide was about $575/month in 2021, but that includes areas where premiums are more expensive than average, as well as plans at higher metal levels.

And average benchmark premiums have decreased for 2022, so he might have more affordable options. The open enrollment period for 2022 coverage continues through January 15, 2022 in most states, although some states have different deadlines.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Jeff Brown
Jeff Brown
11 months ago

Hi Im currently on my spouses insurance ..I just got a job that offers insurance .. I Am being told if my employer offers insurance that I Must take it with them and Take myself off my Spouses plan ? Or I have to pay extra to stay on her insurance .That this was part of the ( Obama Care )..True or False ..Thoughts ???

Louise Norris
Editor
10 months ago
Reply to  Jeff Brown

Employers do have the right to impose a surcharge if a spouse has an option to enroll in their own employer’s health plan but they choose to be covered as a spouse instead. However, that has nothing to do with the ACA (Obamacare). Here’s more about this: https://www.healthinsurance.org/faqs/my-husbands-employer-offers-good-health-insurance-for-our-family-is-it-true-that-because-of-obamacare-employers-may-start-dropping-spouses-from-their-plans/

N Owens
N Owens
7 months ago

My husband and I live together but have been separated for the past 2 years (not legally) I lost my job due to Covid was on Co bra 2021 under the Resue Act which both ended in September. I have not had insurance since. My husband pays all the bills but will not help financially with anything specific for me. He has free insurance through his company for him he could put me on it but it’s expensive and he refuses. His income is to high to qualify for aide. I have both untreated emotional, Bipolar 1 and numerous physical issues nothing major but im unable to work as a Fitness Coach which is what I’ve done for 10 years. I have zero income except for friends and family helping when they can. I have overdrawn bank accounts delinquent loans my financial situation has been on a downward spiral he refuses to help. I had intended on cashing my $9000 retirement out to stay afloat but hes required to sign it (community property) he up and refused to do that as well. Ieven offered to give him half of ut and he said his lawyer advised against it and instead keeps offering me these horrible proposals to stay out of court. I’m 49 we have been married since 2005 and together since I was 27 hes 62 and im his 3rd wife. I just need help I want to be independent I need a doctor and I have no desire to “screw him over” but im shocked and hurt by all of this to the point of barely hanging on some days. I know I need a lawyer but I’m desperate just to go see a doctor. I paid for my own Kaiser Insurance prior to loss of job fior 5 years through City of Irvine continuing Cobra was not an option.

Louise Norris
Editor
7 months ago
Reply to  N Owens

I’m so sorry you’re in this challenging situation. I agree that you need a lawyer as soon as possible. My only advice on health coverage is to reach out to your state’s Medicaid office to see if they might be able to enroll you in Medicaid. If you’re planning to divorce by the end of the year and file your own 2022 tax return (ie, no longer a joint return), you may be able to enroll in Medicaid for 2022 based on just your own income. If you’re in a state that has expanded Medicaid under the ACA (that includes DC and 38 states), Medicaid is available to adults with low incomes, regardless of other circumstances/assets, etc.

Jennifer
Jennifer
3 months ago

My husband lost his job in December of 2021 with it we lost our coverage. He found a new job but the new insurance does not cover spouses (only children). I can not work at the moment due to health and taking care of my son. We are VERY behind on bills and have maxed credit cards due to the months of his unemployment (no unemployment benefits) I am currently on state insurance which I despise. Am I even able to get health coverage for less then 300 dollars a month?

Louise Norris
Editor
3 months ago
Reply to  Jennifer

When you say state insurance, is your coverage Medicaid? If you’re eligible for Medicaid, you’re not eligible for a premium subsidy (premium tax credit) in the exchange/marketplace. So if you were to purchase your own health plan, you’d have to pay full-price. Depending on where you live and how old you are, that could certainly be $300/month.

Thelma
Thelma
1 month ago

I work in South Carolina 9 months out of the year. I have the health insurance with my job. Will they cover spouse in another state.

Louise Norris
Editor
1 month ago
Reply to  Thelma

You would need to ask your employer about this. If they offer spousal coverage, you should be able to add your spouse. But if they’re in another state, you’ll want to find out whether the health plan has in-network providers in the state where your spouse resides. If not, the coverage might only be useful in the event of an emergency. In that case, it might make more sense to get a different policy for your spouse, based in the state where they live.

Pardeep Garg
Pardeep Garg
9 days ago

I have health insurance from marketplace. My spouse got new job and his employer also offer group health insurance. Can i have both health insurance. if yes, do I need to notify marketplace and spouse’s employer about it? I have heard about primary and secondary insurance. who will decide which insurance is primary and which one is secondary. Do I need to provide both health insurance to all hospitals?

Louise Norris
Editor
6 days ago
Reply to  Pardeep Garg

If you have a premium tax credit (subsidy) through the marketplace, you will no longer be eligible for that subsidy once you’re eligible for the employer-sponsored health plan.

There are occasionally exceptions to this, but in almost all circumstances, employer-sponsored coverage is considered affordable and provides minimum value, which means marketplace subsidies are not available. There are some rule changes coming in 2023 that will make some spouses eligible for premium subsidies in the marketplace, but in any case, the subsidy is never available if you also enroll in the employer’s plan. So if you keep the marketplace coverage, you’ll have to pay full price for it.

If you do want to pay full price for the marketplace plan and also enroll in the employer’s plan, you can do that. Whether and how they’ll coordinate benefits in that situation would be up to the employer’s plan. So you’d want to check with them to see whether they can coordinate benefits with a self-purchased plan (coordination of benefits is much more common when each spouse has employer-sponsored coverage).

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