Financial Assistance for Family Health Insurance Coverage in Virginia
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 updated the definition of “affordable” for job-based family health insurance. As a result, more families in Virginia may now be eligible for advance premium tax credits (APTC) to enroll in Virginia's Insurance Marketplace coverage.
New Affordability Rules
Starting with 2023 coverage, health insurance through a family member’s job is only considered “affordable” if the actual cost to enroll each family member is affordable. If employer coverage for all family members is not affordable (for 2025, more than 9.02% of household income), the family may qualify for financial assistance to help purchase coverage through Virginia's Insurance Marketplace.
Applying for Financial Assistance
Employees seeking coverage for themselves or their family members need to submit a Virginia's Insurance Marketplace application to determine whether they qualify for financial assistance. Family members already enrolled in job-based coverage but who want to check Marketplace eligibility should also submit an application.
Important: Individuals and families should not drop their current job-based coverage before submitting a Marketplace application. Wait to receive confirmation from Virginia's Insurance Marketplace about eligibility for financial assistance before making any changes.
Next Steps if Eligible
Virginia's Insurance Marketplace encourages anyone interested in financial assistance to submit or resubmit an application to see if they are newly eligible. If an individual discovers they qualify for financial assistance for a Marketplace family plan, they will need to:
- Disenroll from their employer coverage.
- Enroll in coverage through Virginia's Insurance Marketplace.
Once enrolled in Marketplace coverage, individuals should inform their employer that they are declining (or “opting out” of) employer-provided coverage.
Note: Eligibility policies for financial assistance are determined by the federal government, not the Commonwealth of Virginia or Virginia's Insurance Marketplace.