The Final Rule addresses the “family glitch” in the Affordable Care Act by basing the affordability of employer-sponsored coverage for a family member on the cost of family coverage, rather than self-only coverage.
This means that some dependents who have or have eligibility for a premium tax credit or for group health plan coverage may now be eligible for premium tax credits to purchase a subsidized Marketplace plan and may switch their coverage as a result, if permitted by plan rules.
Starting in 2023, family members who currently do not meet the qualifications for premium tax credits may become eligible when purchasing health insurance through the Health Insurance Marketplace. This change does not affect the employer mandate penalty.
Producers can help members who may be newly eligible for premium tax credits or refer them to another health insurance agent/broker qualified to sell health insurance plans through the Marketplace for more assistance.
Group producers who want to help members get individual coverage must meet certain requirements, including registration, training completion, and agreement signing.
Agility Producer Support