Employer-Sponsored Health Coverage

My employer offers a plan with very limited benefits. It only covers preventive services and a few doctor visits each year. However, this plan option is free. My employer also offers a more comprehensive plan option, but I can’t afford to sign up for that one. Can I apply for subsidies in the Marketplace instead?

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The limited benefit plan you described probably does not meet the standard for “minimum value.”  If that were the only plan your employer offered, you could qualify for premium tax credits to help pay for Marketplace coverage.  The premium tax credits could help you afford coverage that would be more comprehensive.

However, if your employer also offers a major medical plan option that meets the test of minimum value, and if your required contribution for self-only coverage under that plan is not more than 9.78% of your 2020 household income, you would not be eligible for Marketplace subsidies.

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.