If you have job-based insurance and want to check out options in the Health Insurance Marketplace, you can. But there are several important things to know first.
Things to think about before you decline or cancel job-based insurance
With Marketplace plans, you get no employer contribution
With most job-based health insurance plans, your employer pays part of your monthly premium. If you enroll in a Marketplace plan instead, the employer won’t contribute to your premiums. Keep this in mind if you compare your job-based insurance to Marketplace plans.
You probably won’t qualify for Marketplace savings
If you have an offer of job-based coverage and enroll in a Marketplace plan instead, you probably won’t qualify for a premium tax credit and other savings — even if your income would qualify you otherwise.
You’d have to pay full price for a Marketplace plan — even if you don’t enroll in the insurance your employer offers.
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If you have an offer of job-based insurance, the only way you’ll qualify for savings on a Marketplace plan is if your employer’s insurance offer doesn’t meet minimum standards for affordability and coverage. Most job-based plans meet these standards.
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"AFFORDABLE" PLANS AND THE 9.56% STANDARD
A job-based health plan is considered "affordable" if your share of the monthly premiums for the lowest-cost self-only coverage that meets the minimum value standard is less than 9.56% of your household income.
You may pay more than 9.56% of your household income on monthly premiums if you’re enrolled in your employer’s spouse or family coverage. But affordability is determined only by the amount you’d pay for self-only coverage.
THE MINIMUM VALUE STANDARD
A health plan meets the minimum value standard if it pays at least 60% of the total cost of medical services for a standard population and offers substantial coverage of hospital and doctor services.
In other words, in most cases a plan that meets minimum value will cover 60% of covered medical costs. You’d pay 40%.
Most job-based plans meet the minimum value standard.