Now Get a Government Subsidy!

Have you or your family been offered health insurance at work? In the past, if the insurance was “affordable” for the employee, the whole family was blocked from getting any kind of subsidy. With the new rules, that family MAY now qualify for a subsidy.

Affordability is not based on the cost to cover just the employee but family members too. If the family has to pay more than 9.12% of their household income, they may qualify for a subsidy.

What do I do if I’ve been offered health insurance at work?

If you have been offered Health Insurance coverage at work…what do you do? Take it, in most cases. Prior to accepting your group coverage at work, call our office for information to see if you qualify for a subsidy, or call your HR department at you or your spouse’s work.

If it’s NOT “affordable”, you can continue to enroll and apply for a subsidy. Call us for assistance.

If it IS affordable, you can look at plans “Off Exchange” (without a Government subsidy). Again, in most cases, it’s best to enroll with your employer.

You can’t have an employer offering health insurance to you AND receive a subsidy if it’s considered “affordable”. If you ignore this rule, you will find yourself paying back the IRS for the entire subsidy. If you receive a subsidy you were not supposed to have, you’ll have to pay it back on next year’s tax return. It is VERY important you are honest and accurate when stating your income as well as health insurance options offered at yours or your spouse’s work.

Affordable Health Insurance Within Reach for More Families

About half of the U.S. population gets their health insurance through their employer. This provides a wonderful benefit to the employee, because a minimum of 1/2 (50%) of the total cost of that health plan for the employee must be covered by the employer (if the employer offers group health insurance to their employees). In many cases, employers pay more than 50% of their employees’ premium, and the rest is paid by the employee.

When you combine what the employer pays, and what the employee contributes out of their paychecks, this makes the overall dollars spent on a health plan higher. This generally will give the employee a much better health insurance policy than they normally would if the employee had purchased it on their own.

Across the country, employers cover an average of 83% of the employees’ health insurance costs. Many employers, however, do NOT contribute anything towards the spouse and kids’ portion of the health insurance premium (Employers are not required to help pay for the spouse and children). But because of certain rules and regulations, employers are required to OFFER this insurance to the spouse and kids, but they are NOT required to PAY for the spouse and kids. They must offer it, but they don’t have to pay for it.

This makes the amount of premium an employee would need to pay to cover their spouse and kids extremely expensive. This is because the spouse and kids are full price (the employer is NOT contributing to their insurance). Some employers will contribute to spouse and dependents, it’s all up to the employer.​

continued below ⇓

What Is the Family Glitch?

So, here’s the rub. Up until 2023, for the past few years since the Affordable Care Act was passed in 2010, if an employee was “offered” health insurance through their employer-based plan, in almost all cases, the spouse and children would be BLOCKED from qualifying for a government “subsidy” (government helps pay). It didn’t matter if the employee enrolled into the employer’s health insurance or not, they would still be blocked from a subsidy. The options for this family were: they could pay full price for their employer group plan for the spouse and kids, enroll in a private plan for spouse and kids, or enroll into a Marketplace plan for the spouse and kids (but they would be paying full price). Only a very small percentage of these Nevadan’s spouses and kids’ could qualify for a subsidy, because the employee’s plan was considered “unaffordable”.

The reason they could not get a subsidy is because the employer’s health plan was considered “affordable” to the employee, and the employers affordable health plan to that employee would BLOCK their spouse and kids from qualifying for a government “subsidy”. This was the “Family Glitch”.

This was the “Family Glitch”