How to Choose Health Insurance for Your Family

Choosing health insurance for a family is more complex than picking a plan for yourself. You are balancing the needs of multiple people with different health requirements, different doctors, and different prescriptions. You are juggling premiums, deductibles, and out-of-pocket maximums that apply to the whole family. And you are trying to find the best value without sacrificing the coverage your family actually needs.

This guide walks through every major consideration for choosing family health insurance. Whether you are comparing employer plans, shopping on the ACA marketplace, or wondering if splitting the family across multiple plans makes sense, you will find the information you need to make a confident decision.

Employer Plans vs. Marketplace Plans for Families

Most families get health insurance through one of two main sources: an employer-sponsored plan or the ACA marketplace. Each has advantages and drawbacks.

Employer-Sponsored Family Coverage

Employer plans are the most common source of health insurance for families in the United States. Your employer typically covers a significant portion of the premium, often 70 to 83 percent of the employee's share and 65 to 75 percent of the dependent share. This makes employer coverage one of the most affordable options available.

However, the cost to add family members can vary widely. Some employers charge the same rate to add a spouse and children, while others use tiered pricing: employee-only, employee-plus-spouse, employee-plus-children, and employee-plus-family. The difference between employee-only and family coverage can be $500 to $1,500 per month in additional premiums.

Key advantages of employer family plans:

• Premiums are paid pre-tax through payroll deduction, reducing your taxable income
• Employer contributes a significant portion of the premium
• Simple enrollment through your HR department
• Often includes dental and vision as optional add-ons

ACA Marketplace Family Coverage

Marketplace plans are a strong alternative for families without employer coverage or when employer family coverage is expensive. You can enroll during the annual open enrollment period or during a Special Enrollment Period triggered by a qualifying life event like marriage, birth of a child, or loss of other coverage.

The biggest advantage of marketplace plans is access to premium tax credits and cost-sharing reductions. These subsidies can make family coverage very affordable, especially for households with moderate incomes. All marketplace plans cover essential health benefits including pediatric dental and vision for children under 19.

Key advantages of marketplace family plans:

• Income-based premium tax credits can dramatically reduce monthly costs
• Cost-sharing reductions on Silver plans lower deductibles and copays
• Pediatric dental and vision included as essential health benefits
• Guaranteed issue regardless of health status

The Family Glitch Fix

For years, a loophole known as the family glitch prevented family members from qualifying for marketplace subsidies if the employee had access to affordable employer coverage, even if the cost of adding the family to the employer plan was unaffordable. The Biden administration fixed this in 2022 by changing how affordability is assessed. Now, affordability is determined separately for family members based on the cost of family coverage, not just the employee's self-only premium.

This means a family where the employee's self-only employer premium is affordable but the family premium is not can now have family members enroll in subsidized marketplace coverage while the employee stays on the employer plan. This single change made marketplace coverage accessible to millions of family members who were previously locked out of subsidies.

Understanding Family Deductibles and Out-of-Pocket Maximums

Family health plans have a unique cost structure that works differently from individual plans. Understanding how family deductibles and out-of-pocket maximums function can save you from costly surprises.

How the Family Deductible Works

A family plan has two deductible numbers: an individual deductible and a family deductible. Typically, the family deductible is two to three times the individual deductible. Each family member has their own individual deductible. Once a single person meets their individual deductible, the plan starts paying for that member's covered services. At the same time, every family member's medical expenses count toward the family deductible.

Once the total family deductible is met by the combined expenses of all members, the plan begins paying for everyone, even members who individually spent little. For example, if the individual deductible is $3,000 and the family deductible is $6,000, and one family member has $6,000 in medical expenses, the deductible is satisfied for the entire family for the rest of the year.

Embedded vs. Aggregate Deductibles

There are two types of family deductible structures. An embedded deductible means each family member has their own individual deductible within the family plan. Once any one person meets the individual deductible, that person's claims are covered, regardless of whether the family deductible has been met. An aggregate deductible has no individual deductibles. The entire family deductible must be met before the plan pays for anyone. Aggregate deductibles can be harder on families where only one or two members need significant care.

Most employer plans and many marketplace plans use embedded deductibles. High-deductible health plans paired with HSAs more commonly use aggregate deductibles. Check your plan documents to understand which structure applies.

Pediatric Coverage: What Families Need to Know

Children have unique healthcare needs, and the ACA ensures that family plans provide comprehensive pediatric coverage.

Essential Health Benefits for Children

All ACA-compliant plans must cover pediatric services, including dental and vision care for children under 19. This is an essential health benefit, meaning it cannot be excluded from any marketplace plan. Pediatric coverage includes well-child visits, immunizations, developmental screenings, dental exams and treatments, and annual vision exams with corrective lenses.

Preventive Care at No Cost

Under the ACA, preventive care for children is covered at 100 percent with no out-of-pocket cost, regardless of whether you have met your deductible. This includes:

• Well-baby and well-child visits from birth through adolescence
• All recommended childhood immunizations
• Developmental and behavioral screenings
• Vision screenings
• Hearing screenings
• Obesity screening and counseling
• Fluoride supplements and dental sealants

Dental and Vision for Kids

Pediatric dental and vision are required essential health benefits on all marketplace plans. For dental, this typically means coverage for preventive care, basic restorative work, and some major services for children. For vision, it typically includes one annual eye exam and one pair of glasses or contact lenses.

On the marketplace, pediatric dental may be embedded in the health plan or offered as a standalone add-on. If you purchase a standalone dental plan for your children, the premium counts toward your total out-of-pocket costs for the year. Note that while pediatric dental and vision are required, adult dental and vision are not essential health benefits and must be purchased separately.

CHIP: The Children's Health Insurance Program

CHIP provides health coverage for children in families that earn too much to qualify for Medicaid but may struggle to afford private insurance. It covers children up to age 19 and, in some states, pregnant women.

CHIP eligibility varies by state, but many states cover children in families earning up to 200 to 300 percent of the federal poverty level. Some states set the threshold even higher. CHIP coverage is comprehensive and includes doctor visits, hospital care, prescriptions, dental care, vision care, mental health services, and more. Premiums are very low, and many states charge no premium at all.

You can apply for CHIP year-round with no open enrollment restriction. When you apply for marketplace coverage on HealthCare.gov, the system automatically checks whether your children qualify for CHIP or Medicaid based on your household income. If they qualify, you can enroll them in CHIP while parents get marketplace coverage.

Strategies to Save on Family Health Insurance

Family health insurance can be expensive, but there are several strategies that can reduce your costs without sacrificing quality coverage.

Split the Family Across Plans

Thanks to the family glitch fix, it may be cheaper to keep one spouse on their employer plan and enroll the rest of the family on the marketplace with subsidies. If both spouses have employer coverage available, compare the cost of each employer's family plan against a combination of one employer plan and marketplace coverage for the other family members.

Enroll Children in CHIP or Medicaid

If your children qualify for CHIP or Medicaid, enrolling them saves you the cost of adding them to an employer or marketplace plan. CHIP and Medicaid provide comprehensive coverage including dental and vision at very low cost. Parents can maintain their own coverage separately through an employer or the marketplace.

Use an HSA with a High-Deductible Health Plan

If your family is generally healthy and you can handle a higher deductible, a high-deductible health plan paired with a Health Savings Account offers tax advantages that reduce your overall healthcare costs. For 2026, families can contribute up to $8,550 to an HSA. Contributions are tax-deductible, growth is tax-free, and withdrawals for qualified medical expenses are tax-free. The lower premiums of an HDHP combined with HSA tax savings can be the most cost-effective approach for families with low to moderate healthcare usage.

Choose the Right Metal Tier

On the marketplace, the right metal tier depends on your family's expected healthcare usage and income.

• Bronze: Best for healthy families who rarely visit the doctor beyond preventive care. Lowest premiums but highest deductibles.
• Silver: Best for families who qualify for cost-sharing reductions. If your income is between 100 and 250 percent of the federal poverty level, a CSR-enhanced Silver plan significantly lowers deductibles and copays.
• Gold: Best for families with ongoing healthcare needs, regular prescriptions, or expected procedures. Higher premiums but lower out-of-pocket costs when you use care.
• Platinum: Best for families with high medical expenses. The highest premiums but the lowest out-of-pocket costs when you need care.

Maximize Preventive Care

All ACA plans cover preventive care at no cost. For families, this includes well-child visits, immunizations, screenings, annual physicals for adults, women's preventive services, and more. Using these free services catches health issues early, before they become expensive to treat. Making sure every family member gets their annual preventive visits is one of the easiest ways to get value from your insurance.

What to Look for When Comparing Family Plans

When evaluating family health plans, consider these factors in addition to the monthly premium.

• Provider network. Make sure your family's pediatrician, OB-GYN, specialists, and preferred hospital are all in-network. Check every family member's providers, not just your own.
• Prescription drug coverage. Review the plan's formulary for every medication your family takes. Check which tier each drug is on, as this determines your copay or coinsurance.
• Deductible structure. Understand whether the plan uses embedded or aggregate deductibles. This affects how quickly the plan starts paying when only one family member needs significant care.
• Out-of-pocket maximum. This is the most you will pay in a year before the plan covers 100 percent. For families with significant medical needs, a lower out-of-pocket maximum provides more financial protection.
• Maternity and newborn care. If you are planning to have children, check the plan's maternity coverage in detail. All ACA plans cover maternity, but copays, hospital stay coverage, and postpartum care vary.
• Mental health services. Children and teenagers may need counseling, therapy, or psychiatric care. Verify that the plan covers these services with reasonable copays and that mental health providers are available in-network.
• Total estimated annual cost. Add up premiums, estimated deductible spending, copays for expected visits, and prescription costs. The plan with the lowest premium is not always the cheapest when you factor in out-of-pocket expenses.

Life Events That Change Your Family's Coverage

Family life is full of changes that affect health insurance. These qualifying life events trigger a Special Enrollment Period that allows you to change your coverage outside of annual open enrollment.

• Having a baby or adopting a child. You have 60 days to add the child to your plan, switch plans, or enroll if you were uninsured.
• Getting married. You can combine coverage or switch to a family plan.
• Getting divorced. A spouse losing coverage through the divorce can enroll in marketplace coverage or COBRA.
• A child aging off your plan. When your child turns 26, they lose eligibility for your plan and can enroll in their own marketplace coverage.
• Losing other health coverage. If a spouse or child loses employer coverage, you can add them to your plan or seek marketplace coverage.
• Moving to a new state or coverage area. A move may change your plan options and networks, triggering a new enrollment opportunity.

The Bottom Line

Choosing health insurance for your family requires looking beyond the monthly premium. Consider the total annual cost including deductibles and out-of-pocket spending. Check that your family's doctors, specialists, and medications are covered in-network. Understand how family deductibles work and whether the plan uses an embedded or aggregate structure. Make sure pediatric dental and vision are included for your children.

Do not assume you have to put everyone on the same plan. Compare the cost of an employer family plan against splitting the family between employer coverage and a subsidized marketplace plan. Check whether your children qualify for CHIP, which provides comprehensive coverage at very low cost. And if your family is generally healthy, consider a high-deductible health plan with an HSA to maximize tax savings.

The right family plan is the one that protects everyone in your household at a cost you can manage. Take the time to compare options during open enrollment, review your family's specific healthcare needs, and use the tools on HealthCare.gov to see what subsidies you qualify for. Your family's health and financial security are worth the effort.