Marketplace / ACA
My Job Offers Health Insurance: Can I Still Get ACA Marketplace Savings?
Your employer offers health insurance, but the premium feels expensive. Maybe adding your spouse or children makes it even more expensive.
Can you turn down the employer plan and get financial help through the Health Insurance Marketplace instead?
Sometimes — but simply declining coverage through work doesn't automatically make you eligible for Marketplace savings. The Marketplace looks at whether the job-based coverage offered to you meets specific affordability and coverage standards.
Can you buy Marketplace insurance if your job offers health coverage?
Yes. You can apply for and purchase Marketplace coverage even if health insurance is available through your job.
The important distinction is whether you qualify for financial assistance toward that Marketplace coverage.
HealthCare.gov says that if the employer coverage available to you is considered affordable and meets the minimum value standard, you generally won't qualify for Marketplace premium tax credits for the months that qualifying offer is available to you.
What does “affordable” employer coverage mean?
Affordable has a specific meaning under the Affordable Care Act. It isn't based simply on whether the premium feels expensive within your monthly budget.
For coverage beginning in 2027, HealthCare.gov says a job-based plan is considered affordable if your required contribution for the applicable lowest-cost employer coverage is less than 10.22% of household income.
That percentage can change from year to year, which is why an affordability determination should use the standard for the coverage year you're applying for.
Which employer plan is used for the affordability test?
If you're the employee, HealthCare.gov bases affordability on the premium you would pay for the lowest-cost employer plan that meets the minimum value standard and covers only you.
That means choosing a more expensive option at work doesn't necessarily make you eligible for Marketplace savings.
The Marketplace looks at the qualifying employer offer available to you, not simply the particular employer plan you would prefer to purchase.
What does minimum value mean?
Affordability is only one part of the test. The employer plan also needs to meet what's called the minimum value standard.
HealthCare.gov and the IRS explain that a job-based plan generally meets minimum value when it's designed to pay at least 60% of the total cost of medical services for a standard population and provides substantial coverage for physician and inpatient hospital services.
Most job-based health plans meet this standard, but you shouldn't guess. Your employer can provide information about whether the coverage meets minimum value.
What if employer coverage is affordable for you but too expensive for your family?
This is where the answer can be different for different people in the same household.
HealthCare.gov separately evaluates affordability for family members who are offered coverage through another household member's job.
It's possible for employer coverage to be considered affordable for the employee while coverage for a spouse or children is considered unaffordable. In that situation, the employee may not qualify for Marketplace savings while other eligible household members may.
You don't necessarily have to make one insurance decision for everyone in the household.
What if I simply decline my employer's insurance?
Declining the employer plan doesn't by itself remove the employer offer from the Marketplace eligibility calculation.
If you're offered job-based coverage that's considered affordable and meets minimum value, you generally can't receive Marketplace premium tax credits for the months that qualifying offer applies, even if you choose not to enroll in it.
You can still purchase a Marketplace plan, but you may have to pay the full Marketplace premium.
What if my employer's insurance really is unaffordable?
If the job-based coverage offered to you doesn't meet the applicable affordability standard, you may qualify for Marketplace savings if you meet the other eligibility requirements.
The same can be true if the employer coverage doesn't meet minimum value.
The Marketplace application determines eligibility using information about your household, expected income, and the employer coverage available to you.
What information should I get from my employer?
Before deciding that employer coverage is too expensive or assuming Marketplace savings aren't available, collect the actual numbers.
You'll want to know the premium for the lowest-cost qualifying self-only coverage, the cost to cover other household members, who is eligible for the employer plan, and whether the coverage meets minimum value.
HealthCare.gov provides an Employer Coverage Tool that an employer can complete if you need help gathering the information used on a Marketplace application.
What if I already have Marketplace coverage and then get offered insurance through a new job?
Don't ignore the new employer offer just because you're happy with your current Marketplace plan.
HealthCare.gov says a new offer of qualifying job-based coverage can affect your eligibility for Marketplace savings even if you don't accept the employer plan.
Update your Marketplace application with the new coverage offer and find out how it affects your household before deciding which coverage to keep.
Don't compare only the two monthly premiums
Employer coverage versus Marketplace coverage isn't always a simple comparison between two premium amounts.
First determine whether each person in the household is eligible for Marketplace savings. Then consider the coverage itself — including doctors, prescriptions, deductibles, other out-of-pocket costs, and your family's healthcare needs.
Golden Milestone Services is an independent insurance agency that helps individuals and families understand available ACA Marketplace coverage from the insurance companies we represent. Assistance is available in both English and Hmong.
If your job offers health insurance but you're wondering whether the Marketplace could be an option for you or your family, start with the employer offer and the household information. Those details determine whether Marketplace financial assistance may be available.
Common questions
Can I get ACA Marketplace insurance if my employer offers health insurance?
Yes, you can purchase Marketplace coverage. However, if the job-based coverage offered to you is considered affordable and meets the minimum value standard, you generally won't qualify for Marketplace premium tax credits for the months that qualifying offer is available.
What is the ACA employer coverage affordability percentage for 2027?
HealthCare.gov currently lists the 2027 affordability threshold as 10.22% of household income. The percentage can change by coverage year, so use the standard that applies to the year you're seeking coverage.
What if health insurance through my job is affordable for me but expensive for my family?
Marketplace affordability can be evaluated differently for the employee and other household members. It's possible for the employee to be ineligible for Marketplace savings while a spouse or other eligible family members qualify based on the cost of family coverage and other eligibility requirements.
Can I get Marketplace subsidies if I turn down my employer's health insurance?
Simply declining employer coverage doesn't make you eligible for Marketplace savings. If the employer offer is considered affordable and meets minimum value, the offer itself can prevent you from qualifying for premium tax credits even if you don't enroll in the employer plan.
What does minimum value mean for employer health insurance?
A job-based plan generally meets the minimum value standard when it's designed to pay at least 60% of total medical costs for a standard population and provides substantial coverage for physician and inpatient hospital services.
What should I do if I get employer insurance after I already have an ACA plan?
Update your Marketplace application with the new job-based coverage offer. A qualifying employer offer can change your eligibility for Marketplace financial assistance even if you don't accept the employer coverage.