Family members with an unaffordable offer of family health insurance coverage from a spouse or parent’s employer may now qualify for financial assistance through Virginia's Insurance Marketplace. In October 2022, the Biden administration changed what “affordable” means for job-based family health insurance. As a result, more families in Virginia will now be eligible for financial assistance (advance premium tax credits, or ‘APTC’) to enroll in Virginia's Insurance Marketplace coverage. Starting with 2023 coverage, health coverage through a family member’s job will only be deemed “affordable” if the actual cost to enroll each family member is affordable. When employer coverage for all family members is not affordable (for 2023, more than 9.2 percent of household income) the family may qualify for financial assistance to help purchase coverage through Virginia's Insurance Marketplace.
Employees seeking coverage for themselves, or family members will need to submit a Virginia's Insurance Marketplace application to find out whether they and/or their family members qualify for financial assistance on a plan through Virginia's Insurance Marketplace. If family members are enrolled in job-based health insurance coverage through a spouse or parent’s employer but want to see whether they qualify for financial assistance on a Virginia's Insurance Marketplace family plan, they should fill out and submit a Virginia's Insurance Marketplace application.
Individuals and families enrolled in job-based coverage should not drop their job-based coverage prior to submitting a Virginia's Insurance Marketplace application. Those with job-based coverage should submit a Virginia's Insurance Marketplace application, then wait to hear from Virginia's Insurance Marketplace on whether they qualify for financial assistance on a Virginia's Insurance Marketplace plan.
Virginia's Insurance Marketplace encourages anyone interested in learning whether they or their family members qualify for financial assistance to submit a Virginia's Insurance Marketplace application or to resubmit a Virginia's Insurance Marketplace application to see if they may be newly eligible. If an individual submits a Virginia's Insurance Marketplace application and finds out they or their family qualify for financial assistance to purchase a Virginia's Insurance Marketplace family plan, they will need to disenroll from employer coverage and enroll in coverage through Virginia's Insurance Marketplace
Once an individual has confirmed their family is eligible for financial savings AND has enrolled in Virginia's Insurance Marketplace family coverage, they should let their employer know they are declining (or “opting out” of) the employer coverage.
(Note: The policies governing eligibility for financial assistance are set by the federal government, and not the Commonwealth of Virginia or Virginia's Insurance Marketplace).