Shopping for health insurance when you have a family adds complexity — more people means more providers to keep in-network, more medications to check, and more decisions about plan design. Here’s how family health coverage works on the individual marketplace.
Individual vs. Family Deductibles
Most family plans have both an individual deductible and a family deductible. The individual deductible is the amount any single family member must meet before insurance starts paying for their care. The family deductible is the aggregate amount all family members’ costs must reach before insurance pays for everyone — even those who haven’t met their individual deductible.
Example: $1,500 individual / $3,000 family deductible. If one child has a $2,000 medical event, the individual deductible stops at $1,500 — but the family deductible is now $1,500 closer to being met for everyone else.
Embedded vs. Aggregate Deductibles
In an embedded deductible structure, each family member has their own individual deductible that must be met before the family deductible applies to them. In an aggregate structure, no individual gets coverage until the combined family deductible is met. For families with one high-cost member, embedded deductibles are generally more protective.
ACA Age Rating for Families
Under the ACA, carriers can charge more for older family members based on age — but children under 21 are capped. Also, a family premium for a plan counts only three children under 21, regardless of how many children you have. Adding a fourth or fifth child doesn’t increase your premium further.
Who to Include on the Plan
You can include legally married spouses and dependent children under 26 on your family plan. The marketplace will assess your household income for subsidy purposes, which includes the income of all household members filing jointly.
Separate vs. Joint Plans
Sometimes, especially for families with different healthcare needs, it makes sense to put different family members on different plans. This requires running detailed cost comparisons.
Shopping for family coverage? Garden State Benefits helps families find plans that work for everyone on the policy.