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Who To Include In Your Household When Determining Subsidy Eligibility

The yes and no's on who you can include in your household to determine your eligibility for health care subsidies

If you have decided to enroll in the ICHRA Health Care Plan your company is sponsoring, there are a few guidelines on whom you can and can not include when determining your subsidy eligibility.

Follow these basic rules when including members of your household:

  • Include your spouse if you’re legally married.

  • If you plan to claim someone as a tax dependent for the year you want coverage, do include them on your application.

  • If you won’t claim them as a tax dependent, don’t include them.

  • Include your spouse and tax dependents even if they don’t need health coverage.

See the limited exceptions to these basic rules in the chart below.  For more information, visit https://www.healthcare.gov/income-and-household-information/household-size/

Relationship Include in the household? Notes
Dependent children, including adopted and foster children Yes Include any child you’ll claim as a tax dependent, regardless of age.
Children, shared custody Sometimes

Include children whose custody you share only during the years you claim them as tax dependents.
Non-dependent child under 26 Sometimes Include them only if you want to cover them on your Marketplace plan.
Children under 21 you take care of Yes Include any child under 21 you take care of and who lives with you, even if not your tax dependent.
Unborn children No Don’t include a baby until it’s born. You have up to 60 days after the birth to enroll your baby.
Non-dependent child or other relative living with you No Include them only if you claim them as tax dependents.
Dependent parents Yes Include parents only if you claim them as tax dependents.
Dependent siblings and other relatives Yes Include them only if you claim them as tax dependents.
Spouse Yes Include your legally married spouse, whether opposite-sex or same-sex. In most cases, married couples must file taxes jointly to qualify for savings.
Legally separated spouse No

Don’t include a legally separated spouse, even if you live together.
Divorced spouse No Don't include a former spouse, even if you live together.
Spouse, living apart Yes Include your spouse unless you’re legally separated or divorced. Click here if you are not legally separated or divorced.
Spouse, if you’re a victim of domestic abuse, domestic violence, or spousal abandonment Not required

In these cases, you don’t have to include your spouse. See rules for victims of domestic abuse, domestic violence, or spousal abandonment.
Unmarried domestic partner Sometimes

Include an unmarried domestic partner only if you have a child together or you claim your partner as a tax dependent.
Roommate

No

Don’t include people you just live with — unless they’re a spouse, tax dependent, or covered by another exception in this chart.

• What if I'm single without dependents?
     • If you aren’t claimed as a tax dependent by someone else and have no tax dependents
       yourself: Count only yourself in your household.
     • If you are claimed as a tax dependent by someone else: You’re counted as part of their
       household, not your own.

• How do I know which dependents' income to include on my application?
     • You should include the income of all dependents on your application.

       Note: Some dependents' income may not be counted if they're not required to file a federal
       income tax return for the year you want coverage. But include their income anyway. Your
       application will automatically exclude their income if they aren’t required to file.

• Do my spouse and I have to file taxes jointly to get marketplace savings?
     • Yes, with certain exceptions.
             • If you’re married and will file a joint federal tax return for the year you want coverage:
                You’re eligible for a premium tax credit and other savings if you qualify based on your
                income and other factors.
             • If you’re married and will file separately for the year you want coverage: You can enroll in
                a Marketplace plan together but you’re not eligible for a premium tax credit or other
                savings, and you may have to complete a separate application.
             • If you’re married and plan to file as head of household for the year you want coverage:
                You can say you’re married, and won’t file a joint return, on your Marketplace application.
                If you meet other criteria, like living separately from your spouse, we’ll then ask if you’re
                planning to file as head of household. You’re eligible for a premium tax credit and other
                savings if you’re planning to file as head of household and you qualify based on your
                income and other factors. See IRS rules for filing as head of household.
             • See the next question for an exception for victims of domestic abuse and spousal
                abandonment.

• Do I have to file federal taxes and apply for insurance with my spouse if I’m a victim of domestic
   abuse, domestic violence, or spousal abandonment?
     • No, you don’t have to file jointly — and you can still qualify for a premium tax credit and other
       savings.

       If you’re living apart from your spouse and are a victim of domestic abuse, domestic violence,
       or spousal abandonment and want to enroll in your own health plan separate from you abuser
       or abandoner, you can say you’re “unmarried” on your Marketplace application without fear of
       penalty for mis-stating your marital status.

       This will let you (and possibly your dependents) qualify for premium tax credits and other
       savings based on your income.
 
• Why do I need to include people in my household who don’t need insurance?
     • Marketplace savings are based on expected income for all household members, not just the
        ones who need insurance.
        If anyone in your household has coverage through a job-based plan, a plan they bought
        themselves, a public program like Medicaid, CHIP, or Medicare, or another source, include
        them and their expected income on your application.

        When you apply you can state which household members need coverage.
 
• What if I’m a dependent on someone else’s tax return and want to get Marketplace insurance myself?
     • You won’t qualify for a premium tax credit and other savings based on your income. You can
        buy a Marketplace plan but would have to pay full price.