What If I Already Have Health Coverage?
If you are enrolled in a plan or program that is considered minimum essential coverage, you do NOT need to take any action to be in compliance of the Affordable Care Act.
Can I Use the Marketplace If My Employer-Sponsored Plan Costs Too Much?
Yes, but you may need to pay full price for the cost of the Marketplace health insurance plan. If your employer-sponsored plan is “considered affordable” under the law, then you cannot qualify for any subsidies to help pay for your health insurance premiums, co-pays, or deductibles. If the employer-sponsored plan is “unaffordable” under the healthcare law, then you can possibly qualify for subsidies if you get insurance through the Marketplace at www.HealthCare.gov or your State Exchange based on your family size and household income.
What is Considered Affordable?
An employer-sponsored plan is “considered affordable” if your share of the premium for the “lowest cost self-only” coverage is less than 9.69% for year 2017 (9.66% for year 2016) of your household income. It is important to note that your premium cost for a plan that covers your “spouse or family” is NOT taken into consideration!
Year 2017 Employer Plan Example
Your household income is $40,000 and your employer offers a health insurance plan that covers “only you” and the lowest cost self-only plan available is $129 per month. Your annual cost for the plan is $1,548 ($129 x 12 months). Since this amount is less than $3,876 ($40,000 x 9.69%), your plan is “considered affordable” under the healthcare law and you CANNOT qualify for subsidies if you decide to get a Marketplace plan for you or your family.
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