If you have job-based insurance and want to check out options in the Health Insurance Marketplace, you can. But there are several important things to know first.
With most job-based health insurance plans, your employer pays part of your monthly premium. If you enroll in a Marketplace plan instead, the employer won’t contribute to your premiums. Keep this in mind if you compare your job-based insurance to Marketplace plans.
If you have an offer of job-based coverage and enroll in a Marketplace plan instead, you probably won’t qualify for a premium tax credit and other savings — even if your income would qualify you otherwise.
You’d have to pay full price for a Marketplace plan — even if you don’t enroll in the insurance your employer offers.
FYI If you have an offer of job-based insurance, the only way you’ll qualify for savings on a Marketplace plan is if your employer’s insurance offer doesn’t meet minimum standards for affordability and coverage. Most job-based plans meet these standards.
A job-based health plan is considered "affordable" if your share of the monthly premiums for the lowest-cost self-only coverage that meets the minimum value standard is less than 9.66% of your household income.
In other words, if your share of premiums for the lowest-cost plan that would covers only you (the employee) — not other members of your family — is less than 9.66% of your total household income, the plan is considered affordable.
You may pay more than 9.66% of your household income on monthly premiums if you’re enrolled in your employer’s spouse or family coverage. But affordability is determined only by the amount you’d pay for self-only coverage.
A health plan meets the minimum value standard if it pays at least 60% of the total cost of medical services for a standard population and offers substantial coverage of hospital and doctor services.
In other words, in most cases a plan that meets minimum value will cover 60% of covered medical costs. You’d pay 40%.
Most job-based plans meet the minimum value standard.
Ask your employer to fill out an Employer Coverage Tool (PDF).
Under the health care law, certain employers with 50 or more full-time employees (or equivalents) must offer qualifying health insurance coverage to their full-time employees (and their dependents) that is affordable and meets minimum value standards, or pay a fee called the Employer Shared Responsibility Payment.
Employers of any size (regardless of number of employees) may get a notice from the Marketplace if their employee:
The notice from the Marketplace states the employer may be subject to the fee and can file an appeal if they believe they offered coverage to an employee that both:
IMPORTANT: This appeal will NOT determine if an employer has to pay the fee. Only the Internal Revenue Service (IRS), not the Health Insurance Marketplace or the Marketplace Appeals Center, can determine which employers are subject to the fee. Learn more about the Employer Shared Responsibility Payment on IRS.gov.
When reviewing this appeal, the Marketplace might determine that an employee (and any household members) got help with costs through the Marketplace at the same time their employer offered them affordable health coverage that met the minimum value standard.
You aren’t eligible to receive financial assistance through the Marketplace for any month if you:
You may get a notice in the mail from the Marketplace if:
Your notice will tell you the official decision on the employer’s appeal and any actions you need to take next.
The notice might tell you to update your latest Marketplace application to report a change and note that the employer has offered you coverage or you’re enrolled in coverage. If you don’t report this change, you may need to pay back any financial assistance you used to lower your premiums, when you file your federal tax return for the year. Learn how to report changes.
If you want to cancel your Marketplace plan
- If you plan to end your Marketplace coverage and are not already enrolled in your employer’s health coverage: Check with your employer to see if you are eligible to enroll in your employer’s health coverage this time of year.
- If you end all health coverage (both your Marketplace plan and the health insurance through your employer) and don’t replace it: You may have to pay a fee for the months you don’t have coverage. The fee in 2017 is higher than it was in past years. There are also important health and financial risks if you don’t have health coverage. Learn more about the risks and costs of not having health coverage.
- If your financial assistance ends for your Marketplace plan: You may be eligible for a special enrollment period to change to another Marketplace plan without financial assistance.
Use our plans & prices tool and select "Skip" for the income question. You’ll see plans with the prices you pay if you don’t qualify for savings.
No. It’s against the law for your employer to fire or retaliate against you if you get a premium tax credit when you buy a health plan in the Marketplace.