The Marketplace asks who is in your household. It sounds like a question about your house. It is a question about your tax return, and the difference is where most application errors come from.
The rule
Your Marketplace household is your tax household: the person filing, a spouse if filing jointly, and everyone claimed as a dependent — whether or not they live with you, and whether or not they want coverage.
Two consequences follow, and they are the ones people miss.
Someone can be in your household and not live with you. A student away at college whom you still claim. A child in a shared-custody arrangement whom you claim this year.
Someone can live with you and not be in your household. An adult child who files their own return. A parent living with you whom you do not claim. A partner you are not married to and do not claim — they apply as their own household, and frequently do better that way.
Why it matters
Both halves of the calculation depend on it. Household size is part of how eligibility is worked out, and household income means the income of everyone in that tax household — not just the applicant’s.
Get the household wrong and both numbers are wrong, which usually shows up at tax time rather than at enrollment.
The cases that trip people up
Unmarried couples. You are two households unless one claims the other as a dependent. Each applies separately, with their own income. This is frequently better than people expect, and it is not optional — it follows from how you file.
Married but filing separately. With narrow exceptions, a married couple must file jointly to receive a premium tax credit. If separate filing is likely, raise it before enrolling.
Adult children. If you claim them, they are in your household even if they live elsewhere. If they file their own return, they are not, even if they are in the spare room.
Shared custody. The parent who claims the child for the tax year counts them. If that alternates, it changes from year to year, and the application should follow the claim.
A dependent parent or relative. If you claim them, their income counts in your household income. That surprises people, and it can move the calculation appreciably.
Someone with other coverage. A household member with an offer of affordable employer coverage, or on Medicare, Medicaid or CHIP, is still counted in the household for size and income — they just do not need a Marketplace plan themselves.
Mixed households are normal
It is entirely common for one household to end up across two or three programmes: children on CHIP, one adult on an employer plan, another on a Marketplace plan with a credit.
That is not a mistake and it is usually the right answer. It is also the case most likely to be got wrong on a first attempt, because each programme has its own rules.
If your household looks like that, get help with the application rather than guessing. There is a separate guide on mixed eligibility.
Before you apply
Write down, for the coming year: who will be on your tax return, what filing status you expect, and roughly what each of them will earn.
Those three answers settle the household question. If any of them is uncertain — a marriage planned, a child about to file for themselves, a parent about to move in — say so on the call rather than picking the tidiest option.
Where to get help
HealthCare.gov explains the household rules and the Marketplace Call Center will walk them with you on 1-800-318-2596, TTY 1-855-889-4325, free, at any hour.
Navigators and certified application counselors do this in person at no charge and are not paid by insurance companies — localhelp.healthcare.gov.
We do it too, at no cost to you. Household questions are exactly the sort of thing worth ten minutes on the telephone before you fill anything in.
General information, not advice
This guide describes how Marketplace coverage generally works. It is not advice about your situation, and rules and figures change — verify anything that matters to a decision against HealthCare.gov or the Marketplace Call Center on 1-800-318-2596 (TTY 1-855-889-4325), both free.
Heartland Coverage Partners LLC is not the Health Insurance Marketplace, not HealthCare.gov, and not connected with or endorsed by the United States government. We do not offer every plan available in your area.
