ACA Minimum Value Eligibility for Remote Employees

If you’re fortunate enough to work remotely from home, you may encounter unique challenges when it comes to finding affordable health insurance. One such challenge is determining your eligibility for a premium tax credit (PTC) under the Affordable Care Act (ACA).

The ACA’s PTC is designed to make health insurance more accessible for low- and middle-income individuals and families. To qualify for a PTC, you must first meet certain eligibility requirements, one of which is that your employer does not offer you health insurance that meets the ACA’s “minimum value” standard.

What is the Minimum Value Standard?

The minimum value standard is a measure of the actuarial value (AV) of a health insurance plan. AV is a percentage that represents the share of covered expenses that a health plan is expected to pay on average. A plan with an AV of 60%, for example, is expected to pay 60% of covered expenses, on average, leaving you to pay the remaining 40%.

For 2023, the minimum value standard is 60%. This means that an employer-sponsored health plan must have an AV of at least 60% in order to be considered “minimum value” coverage.

How to Determine if Your Employer-Sponsored Plan Meets the Minimum Value Standard

If you’re not sure whether your employer-sponsored health plan meets the minimum value standard, you can ask your employer for a copy of the plan’s Summary of Benefits and Coverage (SBC). The SBC is a standardized document that provides a summary of the plan’s benefits and costs. The SBC should include the plan’s AV.

What if Your Employer-Sponsored Plan Does Not Meet the Minimum Value Standard?

If you receive health insurance through your employer and the plan does not meet the minimum value standard, you may be eligible for a PTC. To claim the PTC, you must complete the IRS Form 8962, Premium Tax Credit. You can find the Form 8962 and instructions on the IRS website (www.irs.gov).

Seeking Help with Premium Tax Credits

If you need help with your PTC application or have questions about your eligibility, you can contact the Marketplace Call Center at 1-800-318-2596. You can also visit the Marketplace website (www.healthcare.gov) for more information about the PTC and other ACA programs.