For years, many families were stuck paying sky-high premiums because one family member’s job offered coverage — even if it was unaffordable for everyone else. That’s what became known as the “family glitch.”

What Was the Family Glitch?

Under the old rule, if one person in your household had “affordable” job-based coverage, the rest of the family couldn’t qualify for a Marketplace subsidy — even if adding dependents made the premium unaffordable.

That left many families in a tough spot: too much income for Medicaid, but no financial help on the Marketplace.

What Changed

Starting in 2023, the government finally fixed the glitch.
Now, Marketplace subsidies are based on:

• The cost of employee-only coverage and

• The cost of family coverage through that employer plan

If family coverage costs more than about 9.96% (in 2026) of your household income, you may qualify for Marketplace subsidies instead.

When It Still Doesn’t Work

The glitch fix helps many families, but not all.
If your spouse has an employer plan and chooses to stay on it, but you’re offered “spouse-only” coverage that’s under the affordability limit, you still might not qualify for Marketplace help.

This is one area where it’s easy to get confused — and where working with a licensed agent makes a big difference.

What You Can Do

If your family coverage through work feels unaffordable, don’t assume you’re stuck.
Contact our team for a no-cost review — we’ll calculate the affordability threshold and tell you if you now qualify for Marketplace help under the new rule.

📞 904-654-5450 | 🌐 www.merebenefits.com
#simplyforyourbenefit

#9 — How to Compare Marketplace Silver Plans: Not All Silver Is Equal

If you’ve ever wondered why two Silver Marketplace plans have such different prices, you’re not imagining things — not all Silver plans are created equal.

Here’s how to make sense of it this Open Enrollment season.

Silver = Middle Ground (But With Big Variations)

Silver plans are designed to balance monthly cost and coverage level — but what makes them special is that they’re the only tier that qualifies for Cost Share Reductions (CSRs) if your income is under 250% of the Federal Poverty Level.

That means if you qualify, your Silver plan could have:

• Lower deductibles

• Lower out-of-pocket maximums

• Lower copays and coinsurance

But here’s the catch: the richer version of your Silver plan is only available if you choose the Silver plan through the same carrier that applies the CSR.

Silver at a Glance

What to Look Out For

• Confirm the plan is on the Marketplace, not “off-exchange.”

• Don’t just compare premiums — look at deductible and max out-of-pocket.

• If your income qualifies, stay within Silver CSR options for the best overall value.

The Takeaway

Two Silver plans may look the same on paper — but their coverage levels can be worlds apart.
Our team can help you identify whether you qualify for CSR benefits and choose the right plan before January 15.

📞 904-654-5450 | 🌐 www.merebenefits.com
#simplyforyourbenefit