Can You Get Marketplace Savings If Your Employer Offers Health Insurance?
Before canceling your current insurance, confirm your eligibility and the start date of your new coverage.
Shanti
11/5/20261 min read
Can You Get Marketplace Savings If Your Employer Offers Health Insurance?
If your employer offers health insurance, you may assume you cannot qualify for financial assistance through the Health Insurance Marketplace. However, eligibility depends on the cost and coverage of the plan offered.
When Is Employer Coverage Considered Unaffordable?
For plan years beginning in 2027, if your share of the premium for your employer’s lowest cost plan that meets minimum value standards exceeds 10.22% of your household income, you may qualify for Marketplace savings if you meet the other eligibility requirements.
This calculation uses your share of the insurance premium. It does not include your deductible, copayments, or other medical expenses.
A Simple Example
Suppose your annual household income is $60,000. In that case, 10.22% of your income equals $6,132 per year, or $511 per month.
If your monthly share for employee only coverage under your employer’s lowest cost qualifying plan exceeds $511, you may qualify for financial assistance with Marketplace insurance.
Choosing a more expensive employer plan does not, by itself, make you eligible for savings.
Can Your Family Qualify for Marketplace Savings?
Yes. For the employee, affordability is based on the cost of coverage for the employee alone. For family members, affordability is based on the cost of family coverage.
This means your employer’s insurance may be affordable for you but unaffordable for your spouse and children. In that situation, your family members may qualify for Marketplace savings even if you do not.
What Information Do You Need Before Making a Decision?
Ask your employer for your share of the premium for the lowest cost individual and family coverage options, whether the plan meets minimum value standards, and when the plan year begins.
The Marketplace will review this information along with your estimated household income when determining eligibility.
Financial assistance is not automatic. You must also meet other eligibility requirements. You cannot receive Marketplace premium tax credits for months when you are enrolled in employer coverage.
Before canceling your current insurance, confirm your eligibility and the start date of your new coverage.
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