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

Q. I have health 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 health insurance through the Marketplace even though he’s eligible to enroll in coverage through my company?

A.  Yes, he can. And depending on your household income, he may qualify for a subsidy to help pay for health insurance in the Marketplace, due to new rules that took effect in 2023.

Before 2023, access to an employer-sponsored plan that was deemed affordable for the employee (regardless of the cost to add family members) meant that all family members who were eligible to be covered under that plan were ineligible for subsidies in the Marketplace.

But starting in 2023, the Marketplace conducts two affordability tests in this sort of scenario: One for the employee, and one for the whole family. If the employee’s coverage is considered affordable but the family coverage is not, the family members are potentially eligible for subsidies in Marketplace. This will depend on the cost of the family members’ Marketplace coverage relative to the total household income. Here are some scenarios showing how this works.

In 2024, employer-sponsored health insurance is considered affordable if the employee’s share of the coverage (for the lowest-cost, comprehensive plan the employer offers) would be more than 8.39% of household income.

Our calculator can help you determine whether your employer’s offer of family coverage is considered affordable. If it’s not, our subsidy calculator can help you determine whether he’d qualify for a Marketplace subsidy.

Even if your husband isn’t eligible for a Marketplace subsidy, he might find that he can get a full-price individual plan for less than $500, depending on his age and the type of coverage he wants. 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.

Keep in mind that enrollment in individual market coverage is only available during open enrollment (November 1 to January 15 in most states) or due to certain qualifying life events.

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.