NYSDA Publications

IRS Issues Final Rule on Determining Health Insurance Affordability for Family Coverage

Per the notice below, the United States Internal Revenue Service (IRS) has changed the health insurance affordability determination rules for family coverage for the 2023 health insurance coverage plan year.

Affordability of Employer Coverage for Family Members of Employees

On October 11, 2022, the IRS released a final rule that changes the way health insurance affordability is determined for members of an employee’s family, beginning with Plan Year (PY) 2023 coverage.  Beginning in 2023, if a consumer has an offer of employer-sponsored coverage that extends to the employee’s family members, the affordability of that offer of coverage for the family members (of the employee) will be based on the family premium amount, not the amount the employee must pay for self-only coverage.  The final rule is effective for PY2023.  The change will be reflected in the online application through the HealthCare.gov enrollment platform and Enhanced Direct Enrollment certified partner applications during the PY2023 Open Enrollment period beginning November 1, 2022.  State-based Marketplaces not using the HealthCare.gov enrollment platform are also working to implement this change, but may have different implementation timelines.  To view the IRS final rule, go to: https://www.federalregister.gov/public-inspection/2022-22184/affordability-of-employer-coverage-for-family-members-of-employees.


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