Employer Coverage

What is the “Family Glitch”?  

Under the Affordable Care Act, people who have an offer of Minimum Essential Coverage generally can’t qualify for financial assistance towards a Marketplace health insurance plan. Minimum Essential Coverage is any health insurance coverage that meets minimum value and affordability standards, including coverage offered through an employer. In order to determine whether someone qualifies for financial assistance, CoverME.gov must assess whether the coverage offered to the individual or the household is affordable. 

The “Family Glitch” refers to a federal regulation that required Marketplaces to only consider the cost of an employee-only plan when determining if an offer of employer coverage was affordable. The cost to add any additional family members was not taken into consideration. This meant that even if the coverage for the other family members did not meet affordability standards, based on the cost to cover just the employee, the family still could not qualify for financial assistance through CoverME.gov.

When did this go into effect? 

A federal rule change made more consumers eligible for financial assistance starting in 2023, even if someone in their family has an offer of insurance through their employer. When families apply for coverage, the rules will be used to determine whether the family qualifies for financial assistance. If a family has to pay more than a certain percentage of their household income for the employer-sponsored insurance, or if the insurance does not meet minimum value standards, they may be eligible for financial assistance towards a CoverME.gov plan. If, for example, coverage is affordable for the employee but not for family members, the family member may be eligible for financial assistance even though the employee would not qualify.  

What does this mean for my household?  

To see if this new rule affects you and your family’s eligibility for financial assistance, you should sign into your CoverME.gov account to review your account and update your information if needed. If you have any questions, you can reach out to us at 1-866-636-0355.  

You can also use the CoverME.gov Affordable Employer Coverage Tool to determine whether an offer of coverage is affordable for an employee as well as any family members. 

You can also use our Find Local Help tool to find a certified broker or Maine Enrollment Assister near you.  

Want more information?  

For more information about the “Family Glitch” fix, including information on how to update a financial assistance application on CoverME.gov, please see the guide linked below.  

Family Glitch