The search for affordable family health insurance can get complicated given the intricate rules that determine eligibility for coverage, at times creating households where some relatives remain uninsured – while others can tap private and public plans.
Challenges arise because eligibility guidelines can vary from one family member to another, depending on age, household income, family size and citizenship status. Sometimes someone with a job-based plan has different rules than the rest of the family, or the children qualify for subsidized coverage, but the parents don’t.
“These situations put many families in a bind,” says Christine Barber, a senior policy analyst at Community Catalyst, a national health advocacy organization based in Boston.
What many consumer advocates call the “family glitch” occurs when the employer-based plan only provides affordable coverage to the employee. Under the Affordable Care Act, job-based plans are deemed affordable if the cost of coverage does not exceed 9.5 percent of household income.
But what happens if the family can’t afford the additional expense of covering a spouse and children under the employer-sponsored plan?
These dependents can shop for coverage in the federal and state-run health insurance marketplaces created by the federal law. But they can’t apply for tax credits because the government’s affordability requirement is based only on the cost of coverage for the individual employee, not on the cost of coverage for the family.
“The whole family becomes ineligible for marketplace tax credits, because one member has an offer of affordable individual coverage through an employer,” Barber says. “Some family members may go without insurance because they can’t find an affordable plan.”
Nearly 4 million non-working dependents live in families where a working family member has access to affordable employer-sponsored coverage but the family does not, according to a 2011 analysis by the Kaiser Family Foundation.
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Jeffrey R. Ungvary President