For individuals who are offered employer coverage, whether they’re able to get a subsidy depends on whether what is offered by their employer is considered “affordable.” Specifically, their employee contribution towards employer-sponsored health coverage must be less than 9.12% of their household income (as of 2023; this number changes every year, so be sure to double check the current calculation).
Prior to the 2023 Open Enrollment period, if a worker’s individual coverage offer was considered affordable, the entire family was considered to have “affordable” employer coverage — even if adding a spouse or kids to the plan drove up the price way above the 9.12% threshold. This was called the Family Glitch and affected millions of people nationwide. Thankfully, new rules mean that if the coverage for the individual worker is under the threshold, but coverage for the household exceeds 9.12% of household income, other household members are considered not to have an affordable offer of coverage and can shop for coverage with subsidies.
Individuals and agents who use HealthSherpa to shop and apply for coverage are asked a series of questions to help them find subsidies and plans to meet their needs. Part of the application process includes questions that assess whether or not workers’ offers of individual and family coverage are affordable. When using HealthSherpa to apply for a client who is offered employer-sponsored coverage, be sure to have the employee-only and the family cost of coverage available to ensure you can get an accurate subsidy determination. You will need that information to enter into the Employer Sponsored Coverage section of the user flow as seen below:
Please note, HealthSherpa quoting does not calculate whether their contribution is found affordable or not. You will need to complete the application to determine available subsidies.
For more information, please see Healthcare.gov’s explanation of the rules.