By: Zach Reat, Director of Health Initiatives, Ohio Association of Foodbanks
A new US Department of the Treasury regulation finalized in October 2022 has changed the rules used to determine whether an offer of employer-sponsored coverage is considered affordable for the spouse and dependents of the employee. These changes, known as the ‘Family Glitch Fix’ make many more people eligible for the premium tax credit (PTC), which can be used to purchase coverage through the Marketplace (Healthcare.gov).
Before this new regulation took effect, the affordability of employer-sponsored coverage for a family was based on the cost of employee-only coverage. If the cost of employee-only coverage was deemed affordable (under 9.6% of the family’s total income), then no one in the household could qualify for a premium tax credit. With the new finalized regulation, the affordability test will now include the cost of the family coverage that is offered. A brief published by The Kaiser Family Foundation on April 7, 2021 estimated that 5.1 million people were impacted by the family glitch. Starting in plan year 2023, those individuals will now have new, potentially more affordable options on the Marketplace. This will truly be life-changing for some.
Here is a scenario that played out for navigators across the state before the family glitch fix: A married couple with an offer of employer coverage and a household income of $30,000 per year was not eligible for Medicaid. To get a premium tax credit on the Marketplace, the cost of self-only, employer-sponsored coverage had to be more than $240 per month, based on their income. In this scenario, if the working spouse was offered a self-only plan through their employer for less than $240 per month, the entire household was ineligible for tax credits through the Marketplace, regardless of the cost of family coverage. With the new ‘family-glitch’ fix, this married couple would be eligible for premium tax credits (PTC) and could shop for affordable coverage on the Marketplace.
The Ohio Association of Foodbanks (OAF) receives a grant from the Federal Centers for Medicare & Medicaid Services to provide health insurance navigator services throughout the state. Navigators are federally trained and licensed by the Ohio Department of Insurance to help people understand their coverage options, apply for financial help, and use their health insurance. All services are unbiased and completely free of charge. Services are available in-person, online, over the phone, and in multiple languages. If you, your employees, or others you know might benefit from the family glitch fix, schedule your appointment today by calling (833) 628-4467 or visiting GetCoveredOhio.org so that you don’t miss the January 15th deadline to get insured!
For more information, contact Zach.
About Ohio Association of Foodbanks (OAF) The Ohio Association of Foodbanks is Ohio’s largest charitable response to hunger, representing Ohio’s 12 Feeding America foodbanks and their 3,600 member hunger relief agencies, including food pantries, soup kitchens, homeless shelters, and supplemental feeding programs. Our mission is to provide food and other resources to people in need and to pursue areas of common interest for the benefit of people in need.
This publication is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2.33 million with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.