Employer-Sponsored Health Coverage and the Marketplace

My employer’s workplace wellness program increases premiums for employees who don’t participate and/or can’t meet certain targets for healthy behavior. Can I leave my employer-sponsored plan and get Marketplace coverage?

Yes, you can leave your employer-sponsored plan and get Marketplace coverage, but your eligibility for premium tax credits depends on how much you must pay for premiums for your employer plan. If your premium contribution with the wellness penalty would be more than 9.02% of your income in 2025, or if your cost sharing increases are high enough to lower the value of your plan below the minimum value standard (60% of average costs of covered services), then you may be eligible for premium tax credits. This test applies whether you are actually penalized or not, and in advance of the penalty being applied (for example, if your employer gives you time to try to meet the health standard that triggers a penalty or reward).

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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The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California.