Covering a family
Covering a family, including the parts nobody explains
Figures on this page checked . Medicare and marketplace numbers reset every year — if you are reading this long after that date, call and we will tell you what moved.
If you were told no before 2023, ask again
For years, a spouse and children were locked out of premium tax credits whenever the working parent had an employer plan that was affordable for that parent alone — no matter what adding the family cost. A modest employee-only premium disqualified the whole household even when covering everyone cost many times as much.
That test changed
Affordability for a spouse or a child is now measured against the cost to cover the whole family, not the employee alone. Families who were correctly told they did not qualify before 2023 may qualify now, and many have never rechecked.
This is the first thing we look at for a household where one parent has job-based coverage. It costs nothing to check and it is the single most common piece of outdated advice still circulating about family coverage.
Households can split across plans, and often should
There is no rule that a family has to be on one policy. A common and entirely legitimate arrangement in Colorado:
- One parent stays on an employer plan, because the employer pays most of the premium for that person.
- The other parent takes a marketplace plan, with credits if the household qualifies.
- The children go on Health First Colorado or CHP+, if their household income qualifies them.
Children have their own eligibility, assessed against the same household income that may put the adults well outside Medicaid range. Parents routinely buy family marketplace coverage without ever learning their children qualified for something cheaper and more complete.
The tradeoff is real and we will name it: separate plans mean separate deductibles, separate networks, and more administration. For some families the simplicity of one plan is worth paying for. We work out both and let you choose.
CHP+ and Health First Colorado for children
CHP+ is Colorado’s coverage for children whose families earn too much for Health First Colorado but not enough to comfortably buy private insurance. It covers children age 18 and under, and pregnant people.
Eligibility runs to household income under 260% of the federal poverty level, which is a good deal higher than most parents assume. Applicants have to be Colorado residents, not eligible for Health First Colorado, and without other health insurance.
In plain terms
“We earn too much for anything like that” is the sentence that costs families the most. The threshold is a percentage of the federal poverty level and it rises with household size, so a family of five qualifies at an income a family of two would not. Apply and let the state decide rather than deciding for it.
Applications go through Colorado PEAK or your county human services office. Connect for Health Colorado will also screen for it when you apply for a marketplace plan, which is one more reason to apply there rather than directly with a carrier.
Grove Benefit Advisors, LLC is a certified broker with Connect for Health Colorado and is not a government agency or the marketplace itself. Plan availability, networks, and pricing vary by county. Any savings figure shown here is illustrative; final eligibility for a premium tax credit is determined by Connect for Health Colorado on your application.
Children's dental is required. Buying it is a separate step
Federal law lists pediatric services, including oral and vision care among the essential health benefits every plan must cover. Parents reasonably read that as “dental is included” and then find out at the first cleaning that it is not.
The gap is in how it is sold. A health plan can satisfy the requirement without carrying pediatric dental itself when stand-alone dental plans are available on the same marketplace — which means the benefit exists, and you have to buy it as a second policy alongside the medical one.
Check before you assume, both ways
Some marketplace plans do include pediatric dental. Some do not, and expect you to add a stand-alone dental plan. Buying both when you needed one is a waste; buying neither is a surprise at the dentist. This is a two-minute check and we do it as a matter of course.
Adult dental is not an essential health benefit at all. If the grown-ups in the house want dental coverage, that is always a separate purchase and it is priced accordingly.
Children up to 26, and what happens after
A plan that offers dependent coverage has to keep an adult child on it until they turn 26. That holds whether they live with you, are married, are in school, or are financially independent.
Two things worth planning for. Aging off at 26 opens a special enrollment period for the young adult, and it is easy to miss while everybody assumes somebody else is handling it. And a child on your plan who lives in another state may find the network does not follow them, which matters most for a student.
A young adult with their own low income often qualifies for substantial help on their own marketplace application — sometimes more than staying on a parent’s plan is worth. That is worth comparing in the year before they turn 26 rather than the week after.
A new baby, and the deadline attached to one
A birth, an adoption, or a foster placement opens a special enrollment period, and coverage can be backdated to the date of the event rather than starting the following month.
The deadline is the part that gets lost in the first weeks with a newborn. Report it as soon as you reasonably can — the window runs from the birth, not from when the paperwork arrives or from when anybody has slept.
Adding a child also changes your household size, which changes the income thresholds every one of these programs uses. A family that did not qualify for help in March may qualify in October for that reason alone.
Questions about covering a family
My employer's plan is cheap for me but expensive for my family. Are we stuck?
Not any more, and this is the change most worth knowing. Until 2023, affordability was tested against the employee-only premium, so a cheap self-only rate disqualified the whole household from premium tax credits regardless of what family coverage cost.
Since then, affordability for a spouse or child is measured against the cost of covering the family. Households that were correctly told no before 2023 may qualify now. If nobody has rechecked yours since then, that is a free phone call with real money attached.
Can my kids be on a different plan from us?
Yes, and it is often the better arrangement. Children are assessed for Health First Colorado and CHP+ on their own, against the same household income that may leave the adults ineligible, and CHP+ reaches households earning more than most parents expect.
The cost is administrative — separate deductibles, separate cards, separate networks to keep track of. We price both arrangements and tell you what the simplicity is costing you, then you decide.
Is children's dental included in our plan?
It depends on the plan, which is not the answer most people expect. Pediatric dental is an essential health benefit, but a medical plan can satisfy the requirement by leaving it to a stand-alone dental plan sold on the same marketplace.
So some plans include it and some expect you to buy a separate dental policy. Check before you enroll rather than at the first appointment. Adult dental is never included — it is always a separate purchase.
Our daughter turns 26 next year. What do we need to do?
Plan for it about three months ahead. Losing coverage at 26 opens a special enrollment period for her, and the risk is that everybody assumes somebody else is handling it until the coverage has already ended.
It is also worth running her own numbers. A young adult with a modest income frequently qualifies for enough help that their own marketplace plan costs less than what the family plan was costing to carry them — and it comes with a network where they actually live.