Definition of Family

There is no universal definition of "family" within the Affordable Care Act. Therefore, family gets defined at various levels:

  • Marketplace plans that offer family coverage to different-sex married couples must offer the same coverage to same-sex married couples.
  • You and your spouse can apply for financial assistance together, as long as you are legally married and file your federal taxes jointly. Married couples must file joint federal income tax returns to be jointly eligible for financial assistance.
  • Following the Obergefell decision at the US Supreme Court, state Medicaid and Children's Health Insurance Programs must consider married same-sex couples a family when determining eligibility for these programs.

Below are questions to help you figure out how different plans and your state define family. These questions will also help you to understand what documentation you might need in your state to purchase a plan that covers your entire family.

  1. Does this plan offer coverage for married couples?
  2. Can I cover my same-sex partner on this health plan?
    1. Can I cover my partner if we are not legally married or in a legally recognized union (like a civil union or a domestic partnership)?
      • If we're not legally married or in a recognized union, will this plan cover me, and my same-sex partner/spouse, and all of our children? What kind of documentation is accepted by the plan as proof of our relationship?
      • If we choose not to be married or in a recognized union in a state that recognizes marriage/unions between same-sex couples, are we still able to buy insurance coverage as one family?
    2. Given my family composition (spouse/domestic partner/unmarried partner/children/etc.), is my family eligible for either federal or state subsidies to assist with the cost of purchasing insurance through the marketplace?
      • If so, do we have to be legally married? What documents are needed?
      • If my partner/spouse is a foreign national, are we eligible for a subsidy?
      • Are there tax ramifications for having my same-sex spouse/partner on this plan?
  3. What's the definition of family under my state's applicable laws? Which families qualify?
    1. Can I cover our children, even if I am not a biological parent and have not adopted?
    2. Am I considered a step-parent under my state’s laws?
      • Can I cover my partner/spouse's children if I am a stepparent?
    3. If my family cannot be covered under one comprehensive family plan, how do I apply for a tax credit to cover the cost of having to purchase multiple plans?
    4. Other than children, can I include other family members or members of our household (such as my or my partner/spouse's parent)?
  4. What kind of documentation do I need to apply for coverage for members of my family (marriage certificate, domestic partner registry, birth certificate, etc.)?

Questions in red are ones that assisters may not be able to answer because this kind of information is not gathered consistently from healthcare providers. However, we included them because we know that these kinds of questions can make a critical difference in creating a trusted relationship with your healthcare provider.