What if I have job-based insurance?



If you have coverage from a job (or a family member’s job), you're considered covered and won’t have to pay the fee that uninsured people must pay.

You may be able to change to Marketplace coverage, but you might not qualify for lower costs on your premiums based on your income. This will depend on the type and cost of insurance the employer provides.

Important. Marketplace Open Enrollment ended March 31. You can still buy a Marketplace health plan only if you qualify for a special enrollment period. You can apply for Medicaid and CHIP any time. Learn about special enrollment periods and other coverage options after Open Enrollment. Open Enrollment for 2015 coverage starts November 15, 2014.

If you have a job-based plan, you’re considered covered

Any job-based health plan you currently have qualifies as minimum essential coverage. You don't need to change to a Marketplace plan in order to avoid the penalty that uninsured people have to pay.

If you'd like to explore Marketplace coverage options you can, but there are several important things to consider.

Comparing job-based and Marketplace plans

With most job-based health insurance plans, an employer pays part of your premiums. If you pick a Marketplace plan instead, the employer doesn’t contribute to your premiums. You should consider this carefully before comparing Marketplace plans.

Learn more about the Marketplace.

Qualifying for Marketplace savings

If you decide to check out Marketplace plans, be aware that you may not qualify for lower costs on your monthly premiums and out-of-pocket costs, even if your income would qualify you otherwise.

Whether you qualify for lower costs based on your income will depend on the coverage the employer offers. You won't be able to get lower costs if your job-based coverage is considered affordable and meets minimum value.

The employer can tell you whether the insurance plan it offers meets minimum value. It can provide you with information to determine if the plan is considered affordable to you.

One way to gather this information is by asking your employer to fill out an Employer Coverage Tool.

“Affordable” plans and the 9.5% standard

A job-based health plan is considered “affordable” if the employee’s share of premiums for the lowest cost self-only coverage that meets the minimum value standard is less than 9.5% of their family’s income.

In other words, if your share of your premiums for a plan that covers only you (the employee)--not your family--is less than 9.5% of your family’s income, the plan is considered affordable.

You may pay more than 9.5% of your income on premiums for spouse or family coverage from your employer. But affordability is determined only by the amount you’d pay for self-only coverage from your employer.

Minimum value standards

A health plan meets the minimum value standard if it’s designed to pay at least 60% of the total cost of medical services for a standard population.

In other words, in most cases the plan will cover 60% of the covered medical costs and the person with coverage pays 40%.

You should ask your employer for help figuring out if the plan offered to you meets the minimum value standard. Your employer can also give you the information needed to determine if the plan is considered affordable to you.

One way to gather this information is by asking your employer to fill out an Employer Coverage Tool.

Consider your choices carefully

If it turns out that you don’t qualify for lower costs on insurance you’d buy through the Marketplace, be sure you take this into account before you consider choosing a plan other than your employer’s.

If you have COBRA or retiree coverage

Your rights, protections, and benefits

The health care law provides important new rights, strong consumer protections, and key benefits that apply to most job-based insurance plans.

Learn about your rights and protections.

Learn about free preventive benefits.

If you lose your job-based insurance

Learn about your options if you leave your job and therefore lose your coverage.