The "Family Glitch" Fix

​New rule fixes Affordable Care Act "Family Glitch"

Increasing the number of individuals eligible for Marketplace coverage in 2023. Until now under the Patient Protection and Affordable Care Act (ACA), employer sponsored coverage was considered affordable for all family members to whom an employer's offer extends if the premium for the employee's self-only coverage was considered affordable. The premium required to cover family members was not considered. 

Beginning plan year 2023

If an individual has an offer of employer-sponsored coverage that extends to their family members, the affordability of employer coverage for those family members will be based on the family premium cost, not the self-only premium cost. Family members will be eligible for financial assistance on the Marketplace if the employee's family premium cost is considered unaffordable and their income is within the limits. ​

Family Marketplace Eligibility

For 2023, an employer-sponsored plan is considered affordable if it does not exceed 9.12 percent of household income. ​

Options for covering your family

• ​Split Coverage (Employer and Marketplace): Employee could enroll in the affordable employer coverage, while their family members enroll in a Marketplace plan with advanced premium tax credits (APTC) / Cost Sharing Reductions (CSR) if otherwise eligible.
• Employer Coverage Only: Whole family could enroll in the employee's offer of employer-sponsored coverage. While someone is enrolled in employer coverage, they aren't eligible for financial assistance on a Marketplace plan.
• Marketplace Coverage Only: Employee could decline the affordable employer coverage, and the whole family could enroll in a Marketplace plan. They will pay full price for the employee's portion of the Marketplace plan premium, while other family members' portions would be lowered by using APTC and/or CSRs if they are otherwise eligible.