Marriage and the Affordable Care Act

Last week’s Supreme Court decisions made it a historic week for our great Country.  The latest challenge to State-based subsidies in the Affordable Care Act was defeated AND the Court affirmed that the Constitution guarantees a right to same-sex marriage.  That is some pretty significant ground to cover, and whether you are for or against these rulings, you cannot deny that meaningful change has come.

While change has made many things much easier (see – Ruling changes financial plans for same-sex couples), there are a few idiosyncrasies to be aware of, relative to the ACA and tying the knot:

  • Eligibility for spouse’s group plan – If your spouse has access to affordable, minimum-value health coverage through his/her employer, you are NOT eligible for a subsidy through the Exchange regardless of income.  This means even if you already have a subsidized health plan, when you marry someone who is able to add you to his/her policy as a spouse, you lose your subsidy. Some call this the family/marriage “glitch”. It would be nice to see this fixed at some point!
  • Combined income means revised subsidy determination – When individuals get married, their definition of affordability under the law changes and so does their subsidy determination.  Unfortunately, married people do not get as much help as singles at the lower income levels. To use an example, Bob and Steve are both 40 years old and both earn $25,000/year. Unmarried, they each qualify for a subsidy of $153/month (or $306/month combined).  That combined subsidy reduces to $192 when the couple gets married.  That is almost a 40% reduction in their subsidy. The impact is even more profound when additional dependents are in the mix, when incomes are lower AND when ages are higher.
  • Qualifying life event – Do not forget that marriage is one of the triggering events for a Special Enrollment Period. This is a time outside of the open enrollment period during which you and your family have a right to sign up for health coverage. In the Marketplace, you qualify for a special enrollment period 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage. Job-based plans must provide a special enrollment period of 30 days.

These laws were written with the intention of making life easier/better for all.  But, we are responsible to know the rules and when/how they apply to us.  If you need any help navigating these waters, don’t ever hesitate to ask.


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