ACA Health Insurance for Families: Covering Spouses, Kids, and Dependents

Enrolling a family in Marketplace coverage raises questions that single applicants never face. Who goes on the application? How do deductibles work when several people share a plan? What about the kids? This guide walks parents and guardians through the key points.

One Application for the Whole Household

You can apply for coverage for your household on a single Marketplace application. You list everyone who is part of your tax household, and you can choose to apply for coverage for some or all of them. Not everyone has to be on the same plan, but many families choose one plan so they share a network and a deductible.

The application asks for each person's information and an estimate of your household income for the year. That estimate helps determine whether you qualify for help paying premiums.

Children May Qualify for Medicaid or CHIP

A Marketplace application also screens household members for Medicaid and the Children's Health Insurance Program (CHIP). Depending on your income, your state's rules, and the size of your household, a child may qualify for one of these programs even if the parents do not. If the Marketplace thinks someone qualifies, the application is generally passed to the state agency. It is a good reason to include children on the application rather than leave them off.

Covering Young Adults

Plans that cover dependents must generally make coverage available to children until they turn 26, even if they are married, no longer live with you, or are not claimed as a tax dependent. A young adult can also choose a separate plan of their own.

Family Deductibles and Out-of-Pocket Limits

Family plans have two layers of cost sharing:

• An individual deductible and out-of-pocket maximum, which applies to each person.
• A family deductible and out-of-pocket maximum, which applies to the household as a whole.

In many plans, once the combined family spending reaches the family limit, the plan starts paying for everyone. Individual limits can also kick in earlier for one person who has high costs. Look at both numbers, because a plan with a low premium and a high family deductible can cost more when several people need care.

What About Children's Dental and Vision?

Pediatric dental and vision care are among the essential health benefits that Marketplace plans must make available for children. Dental coverage is sometimes sold as a separate plan, and you may need to add it. Check whether dental is included in the medical plan or offered on its own before you decide.

Affordability of Employer Coverage for Family Members

If someone in your family is offered employer coverage, its cost can affect whether other family members can get help paying for Marketplace coverage. Under current rules, the affordability test for family members is based on the cost of family coverage rather than only the employee's own coverage. Rules in this area have changed in recent years, so confirm the current approach on HealthCare.gov.

Timing Matters

Most families enroll during Open Enrollment. Our guide to Open Enrollment dates and deadlines explains the deadlines that decide when coverage starts. If you lose other coverage or have a major life change, you may qualify for a Special Enrollment Period.

A Checklist for Parents

1. List everyone in your household and their dates of birth.
2. Estimate your household income for the coming year.
3. Gather Social Security numbers or immigration document numbers.
4. Check each plan's family deductible, out-of-pocket maximum, and network for your children's doctors.
5. Check whether pediatric dental is included.

Sources and Further Reading

• HealthCare.gov: Coverage for families
• HealthCare.gov: Children's Health Insurance Program
• HealthCare.gov: Coverage for young adults under 26