What if I already have job-based insurance?
If you are covered under your job-based plan, you might not qualify for lower costs on your premiums, even if your income would otherwise qualify you. The cost reductions that you are eligible for through the Marketplace will depend on the type and cost of the insurance coverage that your (or your family member’s) employer provides. If the coverage that your employer offers is considered to be affordable to you, and it meets the minimum value standard, then you will not be eligible for lower, income-based costs through the Marketplace.
The affordability of your job-based health plan is determined by the amount you’d pay for self-only coverage from your employer, which does not include premiums you pay to cover your spouse and other family members. If your share of the premium (for the employee only) is less than 9.5 percent of your W-2 income, then the health plan is considered affordable.
The other key factor of your health plan is whether or not it meets the minimum value standard. The minimum value standard designates that your health coverage should be designed to cover at least 60 percent of the total cost of medical services – leaving you to cover only the remaining 40 percent, or less, of the costs.
When you have job-based coverage, it’s typical for your employer to pay part of your premiums. If you elect a Marketplace plan instead, then your employer would no longer contribute to your premiums.
Your insurance agent can help you determine whether your job-based plan meets the minimum value standard, if it is considered affordable to you, and whether or not you should consider choosing a health plan other than the one provided by your employer.