Every fall, HR emails land in inboxes across America: "It's open enrollment season. Review your benefits." Most employees click through the same options they chose last year. Most families stay on the employer plan. And most brokers — the advisors paid to guide them — say nothing about what changed in 2023.
What changed: the federal government quietly fixed a decade-old flaw in the Affordable Care Act called the "family glitch." For most families, this fix went unannounced. For some, it could mean thousands of dollars a year in savings they are legally entitled to but currently leaving unclaimed.
What was the family glitch?
Under ACA rules from 2014 through 2022, whether a family could access marketplace subsidies depended entirely on whether the employee's self-only employer coverage was "affordable" — defined as below a set percentage of household income. It did not matter what the family plan actually cost.
An employee with a $200/month self-only premium was deemed "covered," and their spouse and children were locked out of marketplace subsidies — even if adding them to the employer plan cost $1,400/month more.
The numbers
| Metric | Figure | Source |
|---|---|---|
| Americans affected by the family glitch | 5.1 million | KFF |
| IRS projected take-up among newly eligible | ~20% | IRS final rule |
| Average annual savings per person who switches | $400+ | Urban Institute |
| Affordability threshold (2026) | 9.96% of household income | IRS |
Run the numbers
PROTOTYPE TOOL
Family Health Insurance Affordability Test
Determine if your employer plan is truly your best option through 3 easy steps
- Enter your estimated household Modified Adjusted Gross Income for 2027
- Enter each parent's family premiums for the other family members who requires insurance
- Check if you qualify for subsidies and understand your options through the Marketplace
What changed in 2023?
The IRS finalized a fix effective January 2023. Now, affordability is tested separately for the employee and for the family. If the family tier of an employer plan costs more than the annual threshold — 9.96% of household income in 2026 — family members can access premium tax credits in the marketplace, even while the employee stays on the employer plan.
Two different plans. One household. Fully legal.
So who told the 5 million affected families?
Almost no one.
Based on IRS projected take-up of roughly 20% among newly eligible families, an estimated 80% of affected households have not taken action. This is not a failure of government communication. It is a structural silence built into how employer benefits are sold.
The benefits broker advising your HR team is paid by the employer — not by you. Their fee depends on keeping the group plan whole. A broker who walks into an HR meeting and says "your employees' families might be better off on the marketplace" is a broker who loses the account. So the conversation never happens.
Employers have their own incentives to stay quiet. Group plan premiums are risk-pooled. Healthier, younger family members leaving for the marketplace raises average risk — and over time, rates. There is no legal obligation to proactively inform employees of marketplace eligibility. A off-ramp exists. Employers can simply choose not to build it.
What this looks like in practice
Consider a household at $100,000 Modified Adjusted Gross Income ("MAGI"), married filing jointly, with two working parents who were both offered employer coverage. If the family tier at Parent A ("Plan A")'s employer costs $1,800/month (payable by the employee) — that is 18% of household income, well above the 9.96% threshold. Under the new rules, the children and other parent may qualify for marketplace subsidies. But if no one runs the affordability test, the family will never know.
This is exactly the problem that AI-assisted benefits tools can begin to solve.
"The math is not complex. The data inputs — household income, employer premium, family size — are knowable. What has been missing is a neutral party with the incentive to actually surface the answer."
Brokers are not neutral. Employers are not neutral. The marketplace itself has no way to reach families still sitting inside employer plans.
What to do before the upcoming 2027 open enrollment
The law changed. The savings are real. The silence around it is a feature, not a bug — of a system that was never designed to put your family's interests first. If you are a dual-income household, if your family tier premium feels high, if you have never compared your employer plan cost to the ACA affordability threshold — run the numbers before you click re-enroll using the Family Health Insurance Affordability Test.