ACAACAIndexSubsidy rules, calculated
Employer coverage

Employer affordability for a spouse and dependents

Use the post-family-glitch rule to test the cost of covering employee plus family members separately from employee-only affordability.

Ruling
A spouse or dependent's affordability test uses the employee's cost for the lowest-cost minimum-value employer plan that covers the employee and those family members. The employee's own test still uses self-only coverage.

Run two affordability tests

The employee can be blocked by affordable self-only coverage while family coverage is unaffordable for a spouse or dependents. Identify the exact tier needed to cover the relevant family members and use the indexed percentage for the plan year.

Minimum value still matters

Affordability is not the only test. The offered plan must provide minimum value for the relevant analysis, and actual enrollment in employer coverage generally prevents PTC for the same person and month.

Decision example and mistake

Self-only coverage is affordable, but adding a spouse makes the contribution exceed the family-member affordability threshold. The spouse may qualify for Marketplace savings while the employee does not. Applying the self-only premium to everyone is the mistake.

Price the coverage tier for the family member

Identify the employee contribution for the lowest-cost minimum-value option covering the employee plus the spouse or dependents being tested. Run that family-member affordability calculation separately from the employee's self-only test. The result can block the employee while leaving a Marketplace credit path for one or more relatives.

Repeat the calculation when a child ages off, a spouse gains another offer, or the employer changes contribution tiers during the coverage year.

Filing and enrollment checks

  • Use the exact tier needed for the family members under review.
  • Do not substitute the employee-only premium for the family test.
  • Report a material offer or contribution change to the Marketplace.

Continue with

Employer coverage affordability and the 2026 premium tax creditMinimum value: the employer-plan test behind PTC eligibilityACA tax household versus the people who need coverage

Authorities used for this guide