Family members with an unaffordable offer of family health insurance coverage from a spouse or parent’s employer may now qualify for financial assistance through Pennie. In October 2022, the Biden administration changed what “affordable” means for job-based family health insurance. As a result, more families in Pennsylvania will now be eligible for financial assistance (advance premium tax credits, or ‘APTC’) to enroll in Pennie coverage. Starting with2023 coverage, health coverage through a family member’s job will only be deemed “affordable” if the actual cost to enroll each family member is affordable. When employer coverage for all family members is not affordable (for 2023, more than 9.2 percent of household income) the family may qualify for financial assistance to help purchase coverage through Pennie.
Employees seeking coverage for themselves, or family members will need to submit a Pennie application to find out whether they and/or their family members qualify for financial assistance on a plan through Pennie. If family members are enrolled in job-based health insurance coverage through a spouse or parent’s employer but want to see whether they qualify for financial assistance on a Pennie family plan, they should fill out and submit a Pennie application.
Individuals and families enrolled in job-based coverage should not drop their job-based coverage prior to submitting a Pennie application. Those with job-based coverage should submit a Pennie application, then wait to hear from Pennie on whether they qualify for financial assistance on a Pennie plan.
Pennie encourages anyone interested in learning whether they or their family members qualify for financial assistance to submit a Pennie application, or to resubmit a Pennie application to see if they may be newly eligible. If an individual submits a Pennie application and finds out they or their family qualify for financial assistance to purchase a Pennie family plan, they will need to disenroll from employer coverage and enroll in coverage through Pennie.
Once an individual has confirmed their family is eligible for financial savings AND has enrolled in Pennie family coverage, they should let their employer know they are declining (or “opting out” of) the employer coverage.
(Note: The policies governing eligibility for financial assistance are set by the federal government, and not the Commonwealth of Pennsylvania or Pennie).