ACA “Family Glitch” Increases Health Care Costs for Millions of Low- and Middle-Income Families

By Christina Goe* and Dania Palanker

The Biden administration and Congress can make health insurance more affordable for millions of families by eliminating the so-called family glitch, which prohibits family members from enrolling in marketplace plans with lower premiums and cost sharing because one member of the family has an offer of “affordable” employer coverage. The family glitch deprives millions of people of access to affordable coverage.

Here’s how it works: under the Affordable Care Act (ACA), individuals receive subsidies to reduce premium costs for health plans purchased through the marketplace. In addition, the lowest-income enrollees are eligible for cost-sharing reductions that lower deductibles and copayments. But these benefits are not available to individuals who are eligible for affordable employer coverage. For families, affordability — for everyone, including eligible spouses and children — is determined based on the employee’s coverage. Even if the employer’s contribution is for the employee only, those costs are used in calculating affordability for the entire family.

In a new post for the Commonwealth Fund’s To the Point blog, Christina Goe and CHIR’s Dania Palanker delve into the costs of the family glitch to low- and middle-income families. You can read the full post here.

*Christina Goe is a health care policy consultant and former general counsel of the Montana Department of Insurance.

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The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.