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 outof-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.
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