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Can a consumer with access to employer-based coverage get a tax credit to buy a plan through the Health Insurance Marketplace?


A consumer who has access to employer-based coverage is free to buy a plan through the Health Insurance Marketplace. But tax credits to buy the coverage are only available if the employer's plan isn't affordable or doesn't provide minimum value. If a consumer has access to employer-sponsored coverage that is affordable and provides minimum value, the consumer will not be able to get tax credits and cost-sharing reductions.

Coverage isn't affordable if the cost of employee-only coverage under the employer plan costs the consumer more than 9.5% of the employee's annual household income. The plan doesn't provide minimum value if it pays for less than 60% of medical costs that the plan covers. HHS and IRS have developed a minimum value calculator.

An employer must provide a consumer with a minimum value written statement indicating whether the plan is above or below the 60% threshold. Consumers will receive this information together with the Statement of Benefits and Coverage when shopping for coverage through the Marketplace. An agent or navigator also should be able to help.

There's more information on the IRS website.

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