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

  • By
  • contributor
  • October 21, 2013

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 $400.  Can he get insurance through the marketplace even though it is offered 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 does not exceed 9.5 percent of household income.  This is true regardless of the total amount that must be paid to cover dependents on the policy.  You mentioned that your coverage is provided for a small fee – as long as it’s not more than 9.5 percent of your household income, your husband would not be eligible for a marketplace subsidy on an individual plan.  You can read more about this here.

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 $400, 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.