Help Paying Marketplace Premiums: When Other Coverage Is Available

My family and I are offered health benefits through my job, but we can’t afford to enroll. My employer pays 100% of the premium for workers, but contributes nothing toward the cost of adding my spouse and kids. Can we try to find a better deal in the Marketplace?

Yes they can.  People who are eligible for employer-sponsored coverage can still qualify for Marketplace premium tax credits if the employer-sponsored coverage is considered unaffordable.

The affordability test will look at the cost of self-only coverage for you, and at the cost of family coverage for your spouse and kids.  Because your employer pays 100% of the premium to cover you only, you will not be eligible for premium tax credits.  However, if the premium contribution you would have to pay to cover your spouse and kids under your employer plan is more than 9.12% of your household income in 2023, their coverage would be considered unaffordable and they could qualify for premium tax credits through the Marketplace.

Browse more questions in the Employer-Sponsored Health Coverage section.

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.

The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

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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.