Q. Do all members of a family have to buy the same level health plan on the exchange? For example, can I get a silver plan and my husband a bronze one? Do married couples have to sign up for the same plan in order to qualify for tax credits?
A. You and your husband can sign up for different level plans on the health insurance marketplace—bronze, silver, gold or platinum—and still qualify for tax credits to help pay premium costs that are available to people with incomes up to 400 percent of the federal poverty level (currently $62,040 for a couple). If family members buy different plans, the tax credit will be split between them instead of reducing the premium for one family plan.
But there are important details to consider when making your decision, say experts.
If you buy two individual plans instead of one family plan, you’ll have to satisfy two separate deductibles, says Elaine Saly, a health policy analyst at Families USA, an advocacy organization.
“If families buy multiple individual plans, they’ll likely pay more out of pocket,” she says.
In addition, cost-sharing subsidies that reduce copayments, deductibles and other out-of-pocket costs for people with incomes up to 250 percent of poverty ($38,775 for a couple) are only available to those who buy silver-level plans. That could affect a couple buying different level plans.
“They could be losing access to cost-sharing reductions,” says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.
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However, advocates suggest that people with chronic conditions who expect to have high health care costs consider paying a higher premium for a more comprehensive platinum level plan, even if other family members opt for cheaper coverage. Since those plans generally must cover 90 percent of medical costs, patients’ out-of-pocket limits may be significantly lower, making them a better financial deal in the long run.
The right answer will be different for different families, so it’s important to consider different cost and coverage scenarios when you apply online, say experts.