What happens if I get a job that offers insurance after enrolling in ACA?

Can I get ACA coverage if I’m covered by my spouse’s plan?

Yes, you can choose to purchase an ACA health insurance plan even if you’re covered by your spouse’s employer-provided plan, but there are some important factors to consider regarding costs, eligibility for subsidies, and the benefits of maintaining dual coverage. Here’s what you need to know if you’re considering getting ACA coverage while being covered by your spouse’s plan.

1. Can You Purchase an ACA Plan While on a Spouse’s Plan?

Yes, you are allowed to purchase an ACA health insurance plan even if you are already covered by your spouse’s health insurance. There is no rule preventing you from having dual coverage. However, purchasing an ACA plan while being covered by your spouse’s plan may not be cost-effective or necessary for most people.

2. Eligibility for ACA Subsidies

One of the key factors to consider is whether you will be eligible for premium tax credits (subsidies) to help lower the cost of an ACA plan. Your eligibility for these subsidies depends on whether your spouse’s plan is considered affordable under the ACA’s rules.

A. Affordability Rule

• If your spouse’s employer-provided plan is deemed affordable and meets minimum value standards, you will not be eligible for subsidies in the ACA Marketplace.

• Affordable coverage means that your spouse’s contribution for self-only coverage (not including family coverage) is less than 9.83% of your household income.

• If the coverage is considered affordable, you can still purchase an ACA plan, but you would have to pay the full premium without any subsidies.

B. If Your Spouse’s Plan Is Unaffordable

If your spouse’s plan is considered unaffordable (costs more than 9.83% of your household income) or it does not meet minimum value standards, you may qualify for subsidies to reduce the cost of an ACA plan. In this case, you can:

• Decline the employer plan and purchase an ACA plan with financial assistance to help cover premiums and out-of-pocket costs.

• Stay on your spouse’s plan but purchase an ACA plan without subsidies if desired.

3. Why You May Not Need Both

For most people, maintaining dual coverage—being covered by both your spouse’s employer plan and an ACA plan—usually isn’t necessary. Here’s why:

A. Higher Costs

• You’ll need to pay premiums for both your spouse’s plan and the ACA plan if you decide to keep both, which can significantly increase your overall healthcare costs.

• Without subsidies, an ACA plan can be expensive, and having both plans may not provide additional value compared to sticking with one plan that meets your needs.

B. Duplicative Coverage

• Dual coverage doesn’t usually improve your benefits, as both plans would overlap. When you have two plans, one is considered primary (usually your spouse’s plan) and the other is secondary (the ACA plan). The primary plan pays first, and the secondary plan may cover any remaining costs. However, this often results in higher premiums without meaningful benefits.

C. Network and Benefit Considerations

• If your spouse’s plan doesn’t offer access to certain doctors or services that are important to you, an ACA plan might be an option if it provides a better network. However, before purchasing an additional plan, weigh the potential benefit of the ACA plan against the cost.

4. When You Might Want an ACA Plan

There are some situations where having an ACA plan in addition to your spouse’s employer plan may be beneficial, such as:

• Different healthcare needs: If your spouse’s plan doesn’t meet your specific medical needs, or if the network of doctors and hospitals is limited, an ACA plan might offer better options.

• Spousal coverage doesn’t include dependents: If your spouse’s plan doesn’t cover dependents, you may explore getting an ACA plan for yourself or your children.

• Affordability: If your spouse’s employer-provided family plan is unaffordable and you qualify for ACA subsidies, you may choose to get an ACA plan for yourself or other family members.

5. How to Compare Costs and Benefits

Before deciding to purchase an ACA plan while being covered by your spouse’s plan, consider the following:

• Compare premiums: Look at the cost of staying on your spouse’s plan versus purchasing an ACA plan. If your spouse’s plan is affordable and provides adequate coverage, keeping just one plan might be more economical.

• Out-of-pocket costs: Review the deductibles, copayments, and coinsurance for each plan to understand what you’ll pay for care under both plans.

• Network and coverage: Ensure the network of doctors and hospitals meets your needs, and compare the benefits of both plans to avoid unnecessary costs.

Key Takeaways:

• You can buy an ACA plan even if you are covered by your spouse’s employer plan, but you’ll likely lose eligibility for subsidies if your spouse’s plan is considered affordable.

• Having both plans may lead to higher costs without significantly improving coverage, as most benefits will overlap.

• If your spouse’s plan is unaffordable or doesn’t meet your medical needs, you may benefit from switching to or adding an ACA plan.

For help comparing your spouse’s employer plan with ACA options and understanding your subsidy eligibility, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.