Can I Still Qualify for PTC if I Have Minimum Essential Coverage Through My Employer?

If you’re offered minimum essential coverage (MEC) through your employer, you may be wondering if you can still qualify for the premium tax credit (PTC) through the Health Insurance Marketplace. The answer depends on whether the employer-provided coverage meets certain standards.

What is Minimum Essential Coverage?

MEC is health insurance that meets certain minimum requirements, such as providing preventive care and covering essential health benefits. MEC can include employer-sponsored plans, individual plans purchased through the Marketplace, and certain government programs like Medicaid and Medicare.

What is the Premium Tax Credit?

The PTC is a tax credit that helps low- and moderate-income individuals and families afford health insurance through the Marketplace. The amount of the credit varies depending on your income, family size, and the cost of the plan you choose.

Can I Get PTC if I Have MEC Through My Employer?

You cannot receive the PTC if you have an offer of affordable MEC from your employer. This means that the plan must meet certain affordability and value standards.

Affordability: The employer-provided plan must cost less than a certain percentage of your household income. For 2024, the affordability threshold is 9.61% of your household income.
Value: The employer-provided plan must cover a certain percentage of the costs of essential health benefits. For 2024, the value threshold is 60% of the actuarial value of the plan.

What if the Employer-Provided Plan Does Not Meet the Standards?

If the employer-provided plan does not meet the affordability or value standards, it does not count as an offer of MEC. In this case, you may be eligible for the PTC if you meet the other eligibility requirements.

What Should I Do If I’m Not Sure if My Employer-Provided Plan Meets the Standards?

If you’re not sure if your employer-provided plan meets the affordability or value standards, you can contact your employer’s human resources department or the insurance company that provides the plan. You can also get help from a licensed insurance agent who specializes in health insurance.

Seeking Help from a Licensed Agent

If you’re struggling to understand the PTC or MEC, it’s a good idea to seek help from a licensed agent. A licensed agent can help you determine if you qualify for the PTC and what plans are available to you. They can also help you enroll in a plan and answer any questions you have.

Don’t hesitate to reach out to a licensed agent if you need help with your health insurance. They can provide you with the guidance you need to make informed decisions about your health insurance coverage.