If Employer Insurance is Available, Can You Still Get Subsidies for Marketplace Insurance?
Employer Health Insurance and Marketplace Subsidies
The Affordable Care Act (ACA) provides subsidies to help individuals and families afford health insurance through the Health Insurance Marketplace. However, eligibility for these subsidies can be affected by employer-sponsored health insurance options.
In general, if you have access to affordable and minimum value employer-sponsored health insurance, you will not be eligible for Marketplace subsidies.
What is “Affordable” Employer Insurance?
For 2024, an employer-sponsored health insurance plan is considered affordable if your share of the monthly premium for the lowest-cost self-only coverage meets the following criteria:
It is less than 8.39% of your household income.
What is “Minimum Value” Employer Insurance?
To qualify as minimum value, an employer-sponsored health insurance plan must provide coverage that includes essential health benefits. These benefits include doctor visits, hospital stays, preventive care, and more.
Exceptions to Employer-Sponsored Coverage Rule
There are a few exceptions to the general rule that employer-sponsored health insurance makes you ineligible for Marketplace subsidies.
Family Glitch: If you are enrolled in an employer-sponsored family plan, but the cost of self-only coverage exceeds 8.39% of your household income, you may still qualify for subsidies.
Employer Contribution: If your employer makes a meaningful contribution to your health insurance premium, it may not affect your eligibility for subsidies.
Employer Exemptions: Certain employers, such as small businesses or religious organizations, may be exempt from providing health insurance.
Determining Eligibility
If you have employer-sponsored health insurance, it is important to carefully review your plan to determine if it is affordable and minimum value. You can also contact your employer’s human resources department for assistance.
If you are unsure whether or not you qualify for Marketplace subsidies, you should reach out to a licensed insurance agent. They can help you explore your options and make an informed decision.
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