Understanding The ACA Family Glitch Fix

What Is The ACA Family Glitch?

 

The Affordable Care Act (ACA) “family glitch” refers to how the affordability of an employer-sponsored health plan was previously determined. Prior to 2023, affordability was based on only the cost for the employee ― the cost to add family members to the plan was not taken into consideration. The affordability determination now applies to all members of the family eligible to be added to the employer-sponsored health plan.

 

Individuals only qualify for subsidies through the Exchange if they are not eligible for affordable employer-sponsored health insurance. So if a family’s employer-sponsored coverage offer was considered “affordable” based on the cost to cover the employee and the coverage provided minimum value, the entire family was ineligible for Marketplace coverage and subsidies.

How Many People Were Impacted By The Family Glitch?

 

Approximately 5 million people were impacted by the family glitch.1 Many families likely chose employer-sponsored coverage because it was the most affordable option for them due to the family glitch.

 

 

Has The Family Glitch Been Fixed?

 

The federal government issued a final rule in October 2022, fixing the family glitch beginning in 2023. 

 

With the family glitch fixed, many individuals and families have the option to buy health coverage through the Marketplace and are eligible for subsidies to help pay their monthly plan premiums.

 

 

How Does The Family Glitch Rule Change Work?

 

The new rule expands access to affordable coverage for families. Now, the affordability of an employer-sponsored health plan is determined by the monthly premium for family coverage — rather than the employee-only monthly premium.

 

If a family has to pay more than a certain percentage of household income (9.12% in 2023) for their employer-sponsored health plan,2 that family may be eligible for premium tax credits through the Marketplace. 

 

If you or your family did not previously qualify for financial help due to the family glitch, you can review your options to understand if you now qualify for subsidies.

 

 

What Are My Family’s Options If We Were Affected By The Family Glitch?

 

If you were impacted by the family glitch prior to 2023, you may have more health coverage options:

  1. Keep your entire family on an employer-sponsored health plan.

  2. Stay on your employer-sponsored health plan and purchase Marketplace coverage for your spouse and child dependents.

  3. Purchase Marketplace coverage without subsidies for yourself and purchase Marketplace coverage with subsidies for your spouse and child dependents.

When you compare different health insurance costs for you and your family, be sure to also review the eligibility of your dependents. Keep in mind that, if you choose both an employer-sponsored plan for yourself and a Marketplace plan for your family, you will have two different networks, different prescription drug coverage, and two separate deductibles to meet.



What Plans Are Available On The Marketplace If The Family Glitch Fix Lets Me Switch?

 

Individual and family health insurance plans are available on the Marketplace, including plans with Anthem. The Health Insurance Marketplace was established by the ACA to help individuals access affordable health insurance.



Get Help Navigating The Family Glitch Fix

 

Count on our experience and support to enroll in health coverage. We can help you choose a health insurance plan with Anthem and guide you through the process.

 

 

References

 

Whitehouse.gov FACT SHEET: Biden Harris Administration Proposes Rule to Fix “Family Glitch” and Lower Health Care Costs

Healthcare.gov Glossary - Affordable coverage

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