What Is a Household for Marketplace Health Insurance and Who Should Be Included in Your Application?
Who Is Usually Included in Your Household?
Shanti
9/23/20263 min read
What Is a Household for Marketplace Health Insurance and Who Should Be Included in Your Application?
One of the most important parts of applying for health insurance through the Health Insurance Marketplace is determining who should be included in your household.
Many people assume that a household includes everyone who lives in the same home. However, for Marketplace purposes, it works a little differently. In most cases, your household is based on your tax household, not simply on the people who live under the same roof.
Who Is Usually Included in Your Household?
When completing a Marketplace application, you generally need to include:
• Yourself
• Your legal spouse
• Anyone you plan to claim as a tax dependent on your federal tax return
• In certain situations, children under age 21 who live with you and are in your care
It is important to understand that you may need to include someone in your household even if that person does not need Marketplace health insurance.
For example, if your spouse has health insurance through an employer but you are applying for Marketplace coverage, you will generally still need to include your spouse’s information on your application.
Is Everyone Who Lives With Me Part of My Household? No
Simply living at the same address does not automatically make someone part of your Marketplace household
For example, a roommate or relative who lives with you but is not your spouse or tax dependent generally would not be included in your household simply because you share the same home.
What About Parents?
If your parents live with you, living together alone does not necessarily make them part of your Marketplace household.
If you claim a parent as a tax dependent on your federal tax return, the situation may be different, and you may need to include that parent on your Marketplace application.
What About Children With Shared Custody?
When parents are separated and share custody of a child, an important factor is generally which parent will claim the child as a tax dependent for that tax year.
Because of this, a family’s tax situation can affect how the Marketplace application should be completed.
What If a Household Member Has Other Health Insurance?
Having other health coverage does not necessarily mean that the person should be removed from your household.
For example, a household member may have coverage through Medicare, Medicaid, CHIP, or an employer sponsored health plan.
That person may still need to be included on the Marketplace application. The application will allow you to indicate which household members are actually applying for Marketplace coverage.
Whose Income Should Be Reported?
The Marketplace considers household information and expected annual household income when determining eligibility for financial assistance.
For this reason, correctly identifying household members and accurately reporting income are very important.
Special rules may also apply to the income of tax dependents. For example, whether a dependent is required to file a federal tax return can affect how that person’s income is counted toward household income.
If We Are Married, Do We Need to File a Joint Tax Return?
In most cases, married couples must file their federal tax return as Married Filing Jointly to qualify for the Premium Tax Credit.
People who file as Married Filing Separately generally do not qualify for this financial assistance, although exceptions may apply in certain circumstances.
Why Is It Important to Report Your Household Correctly?
Your household size and household income can affect important factors such as your eligibility for the Premium Tax Credit, the amount of financial assistance you may receive, and your monthly health insurance premium.
For this reason, you should not determine your Marketplace household simply by looking at who lives in your home.
In many situations, you can begin with this basic formula:
Tax Filer + Spouse + Tax Dependents = Marketplace Household
However, every family’s situation can be different, and additional rules may apply.
If you are unsure who should be included in your Marketplace application, it is important to carefully review your household and tax situation before submitting your application.
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