Family Glitch Fix: More Families Eligible for Subsidies on the HealthCare.gov Marketplace

November 15, 2022 | Posted in Healthy Initiatives, Financial Stability, Health |

Since the first Marketplace Open Enrollment period after the passage of the Affordable Care Act, many families have missed out on financial assistance for Marketplace plans due to what many referred to as the “family glitch.” Under this rule, an offer of employer-based coverage was considered “affordable” for an entire family if it met the definition of affordability for the individual offered the coverage. Due to this rule, many families who could not afford to enroll their entire family on their employer-based coverage also missed out on subsidies that would make a Marketplace plan affordable for those family members.

Thankfully, the U.S. Treasury Department issued a new rule in October right before Open Enrollment for 2023 Marketplace plans began. Under this rule change, affordability is now determined based on the cost of adding the entire household to the employer-offered plan. If the cost of employer coverage is more than 9.12% of household income, it is considered unaffordable, and family members can receive subsidies when they sign up for a Marketplace plan.

“Our message to families who have previously been unable to afford a Marketplace plan because one member of the family had an employer offer of coverage is to come see us before December 15. You may be eligible for financial assistance that can significantly reduce the cost of health insurance for your entire family,” says Kori Hattemer, Director of Prosper Programs at Foundation Communities.

Foundation Communities is the largest nonprofit Marketplace enrollment assistance program in Central Texas, with more than 100 certified Navigators for Open Enrollment. Since 2013, our Health Coverage program has helped more than 45,000 Central Texans enroll in affordable health insurance. For the current Open Enrollment period, which runs from November 1, 2022 to January 15, 2023, the Foundation Communities team of Navigators is providing free enrollment assistance by phone and in-person at our two Prosper Centers. To have coverage that starts on January 1, 2023, community members must enroll by December 15, 2022.

Anyone who needs health insurance can visit ProsperHealthCoverage.org or call 512-381-4520 to schedule an appointment. They can also walk into either of Foundation Communities’ two Prosper Centers in Austin during program hours. Since Open Enrollment for 2023 plans started on November 1, Foundation Communities has helped more than 1,000 community members enroll in health insurance, with thousands more appointments available before the December 15 and January 15 deadlines.