Employer-Sponsored Health Coverage

My employer offers a health plan that covers preventive services and some other benefits, but it doesn’t cover inpatient hospital care (or only pays $100 per day for hospitalization). Because I’m offered this policy, does that mean I can’t qualify for subsidized coverage through the Marketplace?

The standard for “minimum value” has been clarified to also require plans to provide substantial coverage for hospitalization and for physician care.  The plan your employer offers would not meet this standard.  If that is the only plan your employer offers to you, then you would be eligible to apply for Marketplace coverage with premium tax credits.  However, if this so-called skinny plan is only one option offered to you, and if other plan choices offered to you by your employer do meet the “minimum value” standard and the affordability standard, then you would not be eligible for premium tax credits through the Marketplace.

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.