Everyone on the tax return
Household size for subsidy purposes is a tax concept, not a headcount of who needs a plan.
Who we help · Families
Two adults, two kids, one deductible you can live with
Family plans have two deductibles and two out-of-pocket maximums: an individual one and a family one. Knowing which applies when is the difference between a manageable year and a nasty surprise in March.
How do I cover everyone without a five-figure worst case?
On most family plans, each person has an individual deductible, and the family deductible is met by the combined spending of everyone on the plan. Embedded deductibles mean one person can satisfy their individual amount and start getting benefits even if the family total is nowhere near met. Non-embedded, or aggregate, deductibles mean nobody gets benefits until the whole family number is met. That single design choice is worth more than most brochure features.
Children in Tennessee may qualify for CoverKids, the state's CHIP programme, at income levels well above adult eligibility. That can mean the kids are covered separately and the parents take a smaller, cheaper plan. We check it before we quote a family plan, because it is often the better answer.
We also check the family glitch rules when one parent has an employer offer. Since the 2023 rule change, affordability for family members is tested against the cost of family coverage rather than employee-only coverage, which opened Marketplace subsidies to households that were previously locked out.
Paediatrician and any specialists
Including the ones you only see twice a year.
Employer offer details, if any
Bring the cost of employee-only and of family coverage. Both numbers matter now.
Planned care
Braces, a birth, a surgery on the calendar. These change which metal level wins.
Prescriptions for every member
Including inhalers, ADHD medication and anything seasonal.
Where it goes wrong
The mistakes we see most often
- 01
Aggregate family deductibles. If nobody can use the plan until the family number is met, a cheap premium is not cheap.
- 02
Paediatric dental is included in Marketplace plans, but adult dental almost never is.
- 03
A child aging off a plan at 26 is a qualifying life event with a 60-day window, not an automatic renewal.
- 04
Adding a newborn is a qualifying life event, and coverage can be backdated to the date of birth if you report it in time.
Questions from families clients
No. If they qualify for CoverKids, they can be covered there while the adults take a Marketplace plan. It is frequently the cheaper and better-covered route.
Each family member has their own deductible inside the family deductible. Once a person meets theirs, their care starts being covered even if the family total is not met.
Birth opens a Special Enrolment Period. You have 60 days, and coverage can generally be effective from the date of birth. Do not wait for the birth certificate.
Twenty minutes usually settles it
Bring your prescriptions, the doctors you want to keep and a rough income number. We do the rest.
Our help is free to you. We are paid by the carrier you choose, and the premium is the same whether you use us or enrol on your own.