Can I enroll in Obamacare if my employer offers insurance?
If your employer offers insurance benefits, it can feel like a real employment win. When an employer pays for some or all of your monthly premiums, it can really help make health insurance affordable. It’s no surprise then that employer-based plans are the most common form of health coverage in the United States. In fact, more than half of the non-elderly population get their insurance through this kind of coverage.
But what if you don’t want the health insurance benefits through your job? Maybe because of the cost or the types of plans available, you want to look elsewhere. And what if you are interested in enrolling in an Obamacare plan through the online Marketplace. Is this even an option?
Short answer: Yes. But there are some important caveats to consider. Here, we break down what you need to know about enrolling in Obamacare if your employer offers insurance benefits too.
Can I enroll in Marketplace health insurance (Obamacare) if my employer offers insurance?
The Affordable Care Act ensures that almost all Americans can buy individual and family health insurance from the online Marketplace. To qualify to shop on the Marketplace, there are just a few general requirements. You need to live in the U.S., not be incarcerated, and be a U.S. citizen or hold a number of permitted immigration statuses that include being a refugee, a green card holder, a survivor of domestic violence, and more. If you meet these general criteria, you can shop for Obamacare plans during the annual Open Enrollment Period (OEP). You can also shop on the Marketplace during a Special Enrollment Period (SEP) if you have a qualifying life event like a marriage, birth, or move.
Many people like to shop on the health insurance Marketplace for its comprehensive, affordable health insurance plans. Want to compare prices to see if Marketplace coverage might be less expensive than opting into your employer-provided plan? You’ll need to consider a few things, especially when it comes to your bottom-line costs.
To see plans and prices in your area, enter your zip code below.
If I decide to enroll in a Marketplace plan, will I be eligible for subsidies/savings?
First, your employer may contribute to your health insurance costs when you enroll in an employer-sponsored plan. Sometimes they even contribute 100%. But if you opt-out of your employer-sponsored plan for an Obamacare plan, they won’t. Want to opt-out of an employer’s plan? You’ll be handling the costs of your monthly premiums on your own and paying full price.
Second, if you turn down an employer plan and enroll in an Obamacare plan, you probably won’t get any subsidies/savings. The only ways you can qualify for a subsidies are:
- The plan doesn’t meet the minimum value standard: the employer-sponsored plan is required to pay at least 60% of the total cost of medical services for a standard population and offer substantial coverage of hospital and doctor services. If the plan doesn’t meet this standard, then you’ll qualify for a Marketplace subsidy. You can find out if your employer-sponsored plan meets the minimum requirements by asking your employer to complete this Employer Coverage Tool.
- The plan doesn’t meet the affordability test: 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 9.78% of your household income. Affordability is determined only by the amount you’d pay for self-only coverage—if you’re paying more than 9.78% of your household income on monthly premiums and you’re enrolled in family coverage, as long as the amount you’d pay for just your premium is less than 9.78% of your household income, it passes the affordability test. This is know as the family glitch.
More on these minimum standards here.
To make this process a little easier, we’ve created a free guide you can save and refer back to later. Click here to grab this guide!
I was already enrolled in a Marketplace plan when I got a new job. Do I need to cancel it?
If you’re currently enrolled in a Marketplace-based health insurance plan and then get hired and your employer offers insurance, there are a few things to know. First is that now you’re probably no longer eligible for any savings or subsidies on your Marketplace plan. And this is true even if you don’t accept the employer-sponsored insurance and opt to continue on your Marketplace plan. If you’re offered job-based insurance that meets the federal minimum standards, then you lose your eligibility for cost savings on the Marketplace. So, some people may want to cancel their Marketplace plans to enroll in job-based insurance. For many, this will best allow you to stay covered and keep your costs down.
If you want to cancel your Marketplace plan, you can log into your Marketplace account to do so.
What happens if I decline my health insurance through my employer?
If you decline individual health insurance through your employer, you can enroll in an Obamacare plan through the Marketplace. Although you most likely will not qualify for any subsidies or other financial assistance. You will only be able to qualify for cost savings if the following applies:
1. Your employer-sponsored health plan doesn’t meet the “minimum value standard.”
If your employer-provided plan does not include substantial coverage (including physician and inpatient hospital services), it doesn’t meet the standards. And if it doesn’t pay for at least 60% of covered medical costs, it won’t either.
2. The cheapest plan through your employer costs more than a certain percentage of your household income.
And again, that plan must meet the “minimum value standard”. This number is 9.78% ; and each year the IRS issues an update on this percentage. This calculation is made using your portion of the monthly premium that covers you, the employee. This does not include premiums for others in your family.
Most job-based health insurance plans are deemed to be affordable and found to meet the “minimum value standard.” But if your employer-sponsored plan isn’t, you may qualify for a Marketplace subsidy depending on your income level.
You also have certain protections against retaliation related to your insurance. It’s against the law for your employer to fire or retaliate against you for reporting violations regarding their offered insurance. It’s also against the law for your employer to fire you or retaliate against you for getting a subsidy or tax credit for insurance off the Marketplace.
A reminder: You can only enroll in a Marketplace plan during the annual Open Enrollment period, unless you qualify for a Special Enrollment Period. Grab our free guide to enrolling in Marketplace insurance for more information.
If I stick with my employer-sponsored coverage, is that my cheapest option?
In most cases, sticking with your employer-sponsored coverage for your health insurance will be your cheapest option. Most employers contribute towards your monthly premium costs, meaning you might not be able to beat that price. Especially since some employers might even contribute up to 100% of your monthly costs for your health insurance premiums.
Unless your employer offers health insurance that does not meet the minimum standards outlined in the ACA, you won’t be able to qualify for any subsidies for your monthly premiums on the Marketplace. So while an Obamacare plan may seem cheaper on the surface, a quality employer-provided plan might be more affordable when you look at the big picture.
Can I use a Health Savings Account to pay for a Marketplace plan?
When you shop on the Marketplace for a plan, you may be able to pay your premiums with pre-tax dollars through a Health Savings Account (HSA). A Health Savings Account is a special type of savings account. It lets you set aside pre-tax dollars for certain kinds of qualified health expenses. Using an HSA can help you lower your healthcare costs overall through the use of pre-tax dollars. However, when it comes to the Marketplace, only certain plans let you use your HSA to pay for premiums. That means you would need to decide that enrolling through the Marketplace is the best option for you and then look specifically for an HSA plan.
And unless you get a High-Deductible Health Plan (HDHP), you won’t be able to use pre-tax dollars for your premiums. On average, plans with deductibles of at least $1,350 for an individual qualify as being HDHP. Likewise, plans with deductibles of $2,700 for a family generally qualify as being a HDHP. When you shop on the Marketplace, you can see which plans are HSA-eligible. Should you be able to use your HSA for your premiums, keep in mind that in 2018, the maximum amount you could contribute from an HSA for a HDHP was $3,450 for an individual and $6,900 for a family.
What percentage of health insurance do employers typically pay?
Most employees who are covered through employer-sponsored plan make some kind of contribution to the cost of their monthly premiums. Employees contributed an average of $104 per month to their employer-sponsored insurance in 2019, according to the Kaiser Family Foundation.
Employees at small businesses typically contribute a higher percentage of the premium for family coverage than employees at larger companies. And on average, employees who work for companies with a larger amount of lower-wage workers (where at least 35% of workers earn $25,000 or less a year) contribute more towards their monthly premiums for both single coverage and family coverage than employees do at companies with fewer low-wage workers.
What if the health insurance through my employer is too expensive?
Many people run up against the problem of their employer-provided health insurance seeming way too expensive. Especially when it includes covering their entire family. Unfortunately, if the costs are still underneath approximately 9.5% of your annual household income, it is still “affordable” by legal standards, and you still aren’t eligible for subsidies through the Marketplace.
If you find it cost-prohibitive to ensure your children through your job-based health plan, you may have other options. Depending on your income level, you might be able to get them coverage separate from yours through the Children’s Health Insurance Program (CHIP). CHIP is the federal program that matches federal dollars with state dollars to provide healthcare for low-income families who earn too much to qualify for Medicaid. Children who live in a household where the household income meets the qualifications can enroll in CHIP. And this is true even when parents get or accept an insurance benefits offer from their employer.
You can see if you or your family qualifies for Medicaid or CHIP by entering your zip code and income information here.
The coverage offered by my employer doesn’t cover my spouse. What can I do?
If you spouse still needs health insurance coverage, they can shop on the Marketplace for an Obamacare plan. And if they don’t have insurance through their job or your job, they might be able to qualify for a subsidy. If your spouse has a subsidized Marketplace plan and you have insurance through your employer, that might be the most cost effective.
Even if your spouse is eligible for coverage through your employer, they still can elect to shop on the Marketplace. And even if they don’t qualify for subsidies, they still might be able to find more affordable coverage for just themselves when compared to coverage through your employer-provided plan.
Do I have any other health insurance options?
You have several coverage options.
- Marketplace/Obamacare plan. You can enroll in a Marketplace health insurance plan, also known as Obamacare or Affordable Care Act insurance. See plans and prices here. You can also give us a call at (872) 228-2549 if you need help enrolling.
- Medicaid. You also may be eligible for Medicaid, depending on your income. You can see if you’re eligible and apply here.
- COBRA. If you’ve been laid off recently, you usually have the option of COBRA, where you pay the full premium of the same insurance your employer purchased for you. COBRA is typically much more expensive than Marketplace insurance, but it allows you to continue the coverage you already had. Learn more about comparing COBRA with Obamacare health insurance.
- Medicare. Once you turn 65, you’re eligible for Medicare. Call us to enroll at (855) 677-3060.
Lost coverage
Released from incarceration
Got married
My new employer offers health insurance after you have been on the job for one year. in the meantime can I get health insurance through obamacare.
Yes, you can! Go to healthsherpa.com to see plans and prices.
New job with employer offering single coverage for $185/month for me and $818/mo family. I have wife and 1 child. My annual income is $31200. Wife full time student. Current premium through marketplace is $444/month. Must I change to employer plan? If I must choose employer coverage can my wife and child stay with marketplace. I have money in 401k which I can w/d but do net want to do that.
Unfortunately, what you’re experiencing is known as the family glitch (we have an article on it here: https://www.healthsherpa.com/blog/family-glitch/). Basically, if a job-based plan available to an individual is deemed affordable by ACA standards and also meets the law’s “minimum value” standard, then that person and their family are not eligible for a premium tax credit if they choose to buy Marketplace coverage instead–even if the premiums for an entire family don’t meet that same affordability threshold.
If the single coverage of $185/month meets the affordability threshold (meaning it’s less than 9.78 percent of your household income), you can either 1) get employer coverage for all 3 of you for $818/month through your employer or 2) get Marketplace insurance for all three of you, but with no subsidy.
Give us a call to talk through your options at 855.772.2663.
That is what I thought but was hoping I had misinterpreted what I read. Thanks so much!
Hello
My employer offers ‘affordable plan’. But by income level I do qualify for Essential Community Plan on NY marketplace.
Can I choose Essential Plan instead of ‘affordable’.
Thank you
We’d have to know more about your situation to determine that. Call us at 855.772.2663 to talk through your options.
My employer is self insured and made me PT after my return to work after my amputation, therefore they don’t have to offer me benefits, so I have the Obamacare benefits and works fine for me. I want to go back to FT, can I keep my Obamacare benefits since they are self insured?
It depends on whether the coverage they are offering you counts as “affordable” according to the Affordable Care Act’s definition, which means the premiums have to be less than 9.78 percent of your household income. If you are offered employer insurance and it’s affordable for you, you’ll lose your Obamacare subsidies and you’ll have to pay full price for the plan. You can call us at 855.772.2663 to talk through your options.
Can my spouse buy insurance for herself and the children through Marketplace with subsidies assuming the household income is low enough, while I enroll in the employer-provide insurance plan? Thanks.
Unfortunately, your family may be ineligible for subsidies through the Marketplace if the insurance offered to you through your employer is considered “affordable.” This is known as the “family glitch.” The plan used to define affordability when it comes to the ACA is based on the lowest priced “self-only” plan the employer offers-—meaning a plan covering only the employee and not any dependents. The mathematical standard for calculating affordability is only used for the employee, not the whole family—it’s not applied to that plan for all the dependents that same plan may need to cover.
We have a full description here: https://www.healthsherpa.com/blog/family-glitch/
Hello
I started a new job on Dec 2019. I was already enrolled in Obamacare to have coverage from Jan, 01/20, but new employer offers a 100% paid insurance plan after 90 days. I filled in the form for the insurance in advance, but the trial period ended and I have not received any notice of coverage, nor ID. Meanwhile, I’ve been covered by the Obamacare plan. Since I’m no longer eligible for a tax credit towards monthly premium, I’m concerned over the possibility of any sanction, because I’m still receiving that credit to keep my premium affordable. I’m single w/no dependents, 25K annual income, and I can afford the $37 monthly premium (after tax credit) in my Obamacare plan, which is a plan that quite fits what I need. What happens if I keep this plan instead of having the employer’s one? THANK YOU
If you’re eligible for a fully covered employer plan, then you will no longer be eligible for the subsidy that makes your Obamacare plan only $37 a month. So if you keep the Obamacare plan instead of your employer plan, you’ll have to pay full price for the Obamacare plan. I’d recommend you check with your employer and see why their plan hasn’t kicked in yet. It’s possible that the employer plan kicks in the first of the month after your 90-day trial period, so you’d have coverage starting June 1.
Thank you very much!
Hi! I have been self-employed with Obamacare this year. I just got a good-paying full-time job offer with health care benefits that starts in July. I will take the job and terminate Obamacare at the end of June. Will the health care subsidies for Obamacare be based on my self-employed income thru June or, alternatively, will it be based on my income for the entire year (which is going to be much higher)?
Thanks for the insight! Bill
It will be based on your annual income for the year. You won’t have to pay the difference immediately—it will be reconciled on your 2020 tax return. But we’d recommend you set aside some money to pay extra on your taxes this year so that you’re not surprised with the bill.
Thanks for the advice. I was afraid of that. Somehow it doesn’t seem fair to me that I should be “penalized” for finding a better-paying job and removing myself from the Obamacare rolls by moving to private insurance – does it? I guess that, by paying the additional subsidy, I am helping to supplement the health care of others who remain on Obamacare. A contribution to the “greater good” in a sense.
Thanks, Bill
I have a marketplace plan now without a tax credit because I declined my employer’s insurance at the time. Now I am unemployed. Would I be eligible for a tax credit now?
Yes, you would be eligible for a tax credit on a Marketplace plan, or you could be eligible for Medicaid depending on your income and state. You can see how much of a tax credit you’re eligible for by putting in your information here: https://www.healthsherpa.com/
You can also call us at (872) 228-2549.
Hello,
I just started a new part time job that offers a limited Healthcare plan for part time employees. It does not cover hospitalizations or surgical procedures. Can I keep my ACA plan with the tax subsidies, instead of the employee plan?
Check with your employer and see if this plan meets with “minimum value standard” (more info on what that means here: https://www.healthcare.gov/glossary/minimum-value/)
If the plan does not meet the minimum value standard, then you can keep your ACA plan with the tax subsidies! If it does meet the minimum value standard, then you will no longer qualify for subsidies on the ACA plan.
It sounds like this plan does not meet the minimum value standard, but we’d need to know more about it to know for sure. Check with your employer and see.
My employer offers insurance which has to be renewed every July 1st. Employees were just provided with 2 options. I have been told the company will not contribute to insurance anymore (previously they have). If I got an equivalent plan to what I have currently, it would cost me 4.5x more. That is a significant pay cut for me! I read somewhere that if the amount of your employers offered insurance is more than 9.5% of your income, then you can sign up for Affordable Health Care. Is this true? Is this considered a “life event”? Would I be able to sign up July 1st? Thank you.
This is true! And according to the ACA, a job-based health plan covering only the employee is affordable if it costs 9.78% or less of the employee’s household income. Since your workplace insurance does not pass this affordability test, you can see if you qualify for subsidies on Affordable Care Act insurance. Give us a call at 872.228.2549 to talk about your options.
Hello,
I retired early, and don’t yet qualify for Medicare. In Fall of 2019, I signed up for health insurance for 2020 through ACA, and am getting a significant discount on our premium based on our income. (I think it is an advance on a tax credit, but I’m not sure) We’ve already met our $13K deductible and Out-Of-Pocket maximum for this year with our ACA coverage. .
I’m taking a job as a temporary contractor through a consulting firm that offers health insurance. The contract will only last 9 months. The benefits document provided by my new employer includes multiple health insurance plans, which indicate their level of ACA compliance, as follows.
* Plan 1: “This plan is not considered compliant coverage in accordance with the Affordable Care Act”
* Plan 2: “This plan is compliant under the Affordable Care act for the individual mandate but does not meet the minimum value requirement.”
* Plan 3: “This coverage is compliant under the Affordable Care Act.”
Since we’ve already met our OOP on our ACA insurance, I’m reluctant to switch to my new employer’s health insurance, because I assume we’d be starting over with deductible & OOP through the new employer’s plan.
What will happen if I keep my insurance through ACA, instead of taking one of the plans offered by my new employer?
Thanks!
Scott
Is the insurance premium covered by your employer? If your cost for plan 3 is less than 9.78% of your household income, then the coverage is affordable under the ACA, which means you won’t qualify for any more ACA subsidies. But if plan 3 costs more than 9.78% of your household income for your individual coverage, then you can still get ACA insurance with a subsidy.
You can also give us a call at (872) 228-2549 to talk through it.
Our family lost our medical coverage abruptly a few days ago due to employer canceling coverage. My husband has been unemployed since Covid started and they’ve been covering the cost thus far and then decided not to any longer. We’re trying to find a plan that works for us but the costs are INSANE. I’m still employed but denied coverage through my employer previously because I was covered under my husband. We have 3 kids that we claim but 1 is a 19 y/o college student with a job. Should she get coverage under her job now? Am I able to get coverage for my whole family through my employer after previously denying it? What if they only offer Kaiser and we prefer being able to choose our doctors outside of Kaiser? Thanks in advance.
Hello! We’ll need some information on your income and location to give you answers to these questions. Give us a call at 872-228-2549 and we can help you over the phone.
I have been offered a job at a company that offers health insurance to people who regularly work 31 or more hours per week. I am scheduled to work 27 hours a week, and sometimes more, but most of the time under the 31 hours. Will I still qualify for the ACA subsidy? How does the government know if a individual is eligible for insurance or not?
Yes, you’ll be eligible for subsidies. See plans and prices at healthsherpa.com.
Yes, you’ll be eligible for subsidies. See plans and prices at healthsherpa.com
Wife and I on marketplace ins since beginning of year. We sre semi retired. Wifes is doing a contract job for a duration of 10 weeks starting 8/3, it will offer insurance. Lowest plan cost for her will be 155.00 per wk. Weekly taxable wage of 640.00.
Income for household to date is 28000.00.
How is it calculated for the 9.86 threshold to keep the marketplace insurance.
A job-based health plan covering only the employee that costs 9.78% or less of the employee’s household income is deemed affordable. We’d need to know your total household income per month. If the cost of the insurance is 9.78% of your total household income, then it’s deemed affordable and you’ll be ineligible for subsidies. If the cost of insurance is more than 9.78% of your household income, then you’ll still be eligible for ACA subsidies.
Is it legal in NJ, for a job to request your private medicall insurance info for their records, when you refuse the coverage they offer? Thanks.
Not sure about the state law in New Jersey, you’d have to look into that with someone local.
my wife is retired and her health plan through her retirement system allows me to get coverage. Would this disqualify me from seeking my own plans via obamacare/healthcare.gov?
That would not disqualify you, but you will be subject to the affordability rule, which means you may not qualify for subsidies depending on the cost of your wife’s individual insurance for just herself. According to the ACA’s affordability rule, a job-based health plan covering only the employee is affordable if it costs 9.78% or less of the employee’s household income. If a job-based plan available to an individual is deemed affordable by ACA standards and also meets the law’s “minimum value” standard, then that person and their family are not eligible for a premium tax credit if they choose to buy Marketplace coverage instead, even if the premiums for an entire family don’t meet that same affordability threshold.
More info here: https://www.healthsherpa.com/blog/family-glitch/
You can give us a call at (872) 228-2549 if you have questions.