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Saving with the ACA When Your Spouse's Employer Plan is Too Expensive

 

Many families face the tough choice of sticking with an employer-sponsored health insurance plan that's eating into the budget or exploring alternatives.

 

Under the Affordable Care Act (ACA), if your spouse's job-based coverage is deemed "unaffordable," you can turn to the Health Insurance Marketplace (Healthcare.gov) for more budget-friendly options.

 

This often means significant savings through premium tax credits and other subsidies, especially for families with moderate incomes. Here's how it works in 2025:

 

 1. Understanding Affordability Thresholds

   - The ACA defines an employer plan as "unaffordable" if the employee-only premium exceeds 10% of your household income for the year (this threshold is adjusted annually for inflation

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   - Importantly, for *family* coverage, affordability is based on the *employee-only* premium—not the full family cost. If that single premium is over the threshold, the entire family plan is considered unaffordable, opening the door to Marketplace subsidies.

   - Example: For a family of four earning $80,000 annually, the affordability cap would be about $7,216/year ($601/month) for employee-only coverage. If it's higher, you're eligible for relief.

 

 2. Accessing Marketplace Savings
   - Premium Tax Credits:

 

These reduce your monthly premium directly. Based on income (100-400% of the federal poverty level, or roughly $30,000-$120,000 for a family of four in 2025), credits can cover 50-100% of the premium for a silver plan, potentially dropping costs to $0 for lower-income families.

   - Cost-Sharing Reductions:

 

If your income is 100-250% of poverty ($30,000-$75,000 for a family of four), these lower deductibles, copays, and out-of-pocket maxes on silver plans—saving thousands annually.

   - Families often save 20-50% or more compared to unsubsidized employer plans. For instance, a family paying $1,200/month for employer family coverage might drop to $400/month (or less) on a subsidized Marketplace plan.

 

 3. Steps to Switch and Save

 

If you are paying too much for the family plan under your spouse employment, you are eligiible to special enroll today. The quote takes 30 seconds, and enrollment less than 7 minutes.
  

This flexibility has helped millions of families redirect savings toward essentials like education or retirement. To see your potential savings, check a quote on the button below.