Life-Saving Credits for Coverage

Holly’s entire family, including herself, her husband, 11-year-old daughter and 19-year-old stepson had been covered for more than a decade by her husband’s employer-sponsored insurance (ESI). The family came to rely on this insurance for all their needs, as Holly’s employer does not offer health insurance. “Our insurance coverage is vital to our family — I have chronic conditions that require regular doctor visits and medication, my daughter has regular doctor and therapy appointments, and my stepson also has chronic conditions that require expensive medications and regular therapy to manage.”

When Holly’s husband was unexpectedly laid off in January 2024, her first thought was about how to make sure the family had health coverage to meet their needs, on top of the stress of the household income being reduced by about two-thirds. So, Holly went to kynect, the state-based marketplace, and put in her information to search for a plan. There was some initial trepidation at the beginning of the process, “I wasn’t sure how to put in some of the information about how our household income had changed, but the person I spoke with on the phone was really helpful and walked me through the process,” Holly said.

The family was eligible for a qualified health plan (QHP) with advance premium tax credit (APTC), a refundable credit that helps families and individuals to afford premium payments for plans purchased through the Marketplace. This allowed them to afford a really good plan — one that was comparable to what they had and was even better than some of the high-deductible plans that they’d had over the years. Before her husband was laid off, their household income was around $200,000 annually. Out of his paycheck, they paid about $800 for their family plan with his ESI. When he lost his job, their income became $65,000 — which is a pretty steep cut. With the help of $1,500 in APTC, they now pay a little under $300 a month for an Anthem Silver plan and dental coverage.

“I was impressed that I started the process to get our family coverage in the middle of January and was able to get our coverage sorted out so that our family did not have a gap in coverage. My husband’s employer-sponsored plan ended on January 31, and our QHP coverage began on February 1.”

“There would be no “affording” health coverage without the APTC. We have house payments, a car payment, a student loan, utilities, groceries… if we had to pay full price, or even the $800 that we paid when my husband was employed, we wouldn’t be able to keep our heads above water. For now, it is lean and we are making it work on just my income and our savings as he looks for another job, but we are meeting our needs. I freak out if I think about what happens if the savings runs out before he gets a job, and I’m afraid if health insurance becomes a casualty in the battle to keep our heads above water. It isn’t a happy place to be, and that’s why I am SO grateful this was an option for us. It is literally saving our lives because we can continue to take our medications and go to the doctor.”

Being able to afford health insurance and having health coverage was a major concern for this family, like so many others across the United States. It was Holly’s most immediate fear when her husband lost his job, before any of the other financial impacts on the family.

While her husband interviews for new positions, Holly says that she “cannot possibly be more grateful that we had this opportunity to have quality insurance that meets our needs, and that we received APTC that made it affordable for us, even in our new financial circumstances.”