People with coverage through a job
Steps to decide between job-based or Marketplace coverage
Review these steps to decide whether to pick job-based health insurance or enroll in a Marketplace plan:
1. Think about these before you decline or cancel job-based insurance:
- The employer won’t pay part of your plan’s monthly premium.
With most job-based health insurance plans, your employer pays part of your monthly
- You may not qualify for Marketplace
To qualify for savings, the offer of job-based health insurance can’t meet the minimum standards. This includes what’s considered
When you apply for Marketplace coverage, we’ll check if the job-based insurance premiums are considered affordable for you (the employee) and for others in your household.
Minimum value standard (a basic level of coverage)
In most cases, a job-based plan meets this standard if it’s designed to cover at least 60% of medical costs. It also must offer substantial coverage of hospital and doctor services.
Most job-based plans meet the minimum value standard.
Affordable monthly premiums
In 2023, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan is less than 9.12% of your household income.
- The lowest-cost plan must also meet the minimum value standard.
- If you’re the employee, affordability is based on only the premium you’d pay for self-only (individual) coverage.
- For coverage starting January 1, 2023, if you’re offered job-based coverage through a household member’s job, affordability is based on the premium amount to cover everyone in the household.
If the premiums aren’t considered affordable for the employee and the household, they may qualify for savings in a Marketplace plan. But, if the premium is considered affordable for the employee, but not for other members of the household, then only the other household members may qualify for savings.
2. Get information about job-based insurance
Get any documents about job-based health insurance that has information about premium costs and who in the household can get coverage. You may be able to find this information in an online employee portal or account, a letter, email, or other document from the employer that’s offering the health coverage.
You can also ask your employer to fill out an Employer Coverage Tool (PDF, 145 KB).
3. Fill out a Marketplace application to check for savings
Include the information that your employer filled out in the Employer Coverage Tool in your application. We’ll review your application and tell you if you and others in your household will qualify for savings. This year, households with offers of employer health coverage may have new opportunities for savings, even if they weren’t eligible before.
General rules about qualifying for savings through the Marketplace:
- You can’t get any savings for any month that you:
- Have an offer of job-based coverage that’s considered affordable (and meets the minimum standards)
- Are enrolled in job-based coverage
- If the job-based insurance isn’t affordable, you and others in your household may qualify for savings.
4. Compare Marketplace plans with your employer’s job-based plan
Think about which plan will meet your needs and budget. Log in and find plans in your area. When you’re logged in, you’ll get prices based on any savings you qualify for.
5. Make your decision
If you choose to get a Marketplace plan:
Generally, you can enroll in a plan during Open Enrollment (November 1-January 15). If your employer’s open season is at a different time of year or if you newly qualify for savings you may qualify for a Special Enrollment Period.
If you choose job-based coverage:
Accept the offer by the employer’s due date, or check when you can enroll in their health coverage.
If you have Marketplace coverage now, find out how to cancel it.