Affordability tool
- Ebony A. Brady
- Dec 9, 2023
- 7 min read
Updated: Dec 22, 2023
People with coverage through a job
If you have an estimated result that your employer coverage may be un-affordable, contact me by email and I can go over alternative coverage options with you
Text me your results
Email me your results
This is an estimate. A guideline for next steps in health coverage options.
In 2024, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by the employer
is less than
8.39% of your household income
Refer to glossary for more details.
For an estimate of Affordability the questions are below
Does your employer offer a health plan that meets 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. Most job-based plans Meet the Minimum Value Standard?
if YES go to the next question
if NO stop and return this form to employee
How much does the Employee have to pay for the Lowest Cost plan offered to the Employee only that meets the minimum value standard? Do not include family plans. NOTE: If the employer offers wellness programs, enter the premium that the employee would pay if the employee got the maximum discount for any tobacco cessation programs and didn’t get any other discounts based on wellness programs
a. NOTE: Enter the lowest amount the employee could pay for health coverage. Employee would pay this premium example $400.00
b. Employee would pay this amount Select one below:
Weekly
Every 2 weeks
Twice a month
Once a month
Quarterly
Yearly
What changes will the Employer make for the New Plan Year. Select one below
A. Employer won’t offer health coverage as of this date: (mm/dd/yyyy)
B. The premium amount will change for the lowest-cost plan that meets the minimum value standard* and is available to the employee only (Premium should only reflect discounts for tobacco cessation programs. See question 15.)
a. Employee would pay this premium: $
b. How often? Weekly, Every 2 weeks, Twice a month, Once a month, Quarterly, Yearly
c. Date of change: (mm/dd/yyyy)
C. I don’t know if the employer will make changes
D. Employer won’t make any of these changes
If you have job-based insurance
Notice:
You or others in your household may qualify for premium tax credits, even if you weren't eligible before, if you:
Have an offer of job-based health coverage (for the employee or household), but haven’t accepted it yet. Get tips before accepting the offer.
Lose job-based health coverage. Find options.
Steps to decide between job-based or Marketplace coverage
Review these steps to decide whether to pick job-based health insurance or enroll in a Marketplace plan:
1. Think about these before you decline or cancel job-based insurance:
The employer won’t pay part of your plan’s monthly premium.
You may not qualify for Marketplace
What are the minimum standards?
2. Get information about job-based insurance
Get any documents about job-based health insurance that has information about premium costs and who in the household can get coverage. You may be able to find this information in an online employee portal or account, a letter, email, or other document from the employer that’s offering the health coverage.
You can also ask your employer to fill out an Employer Coverage Tool (PDF, 145 KB).
3. Fill out a Marketplace application to check for savings
Include the information that your employer filled out in the Employer Coverage Tool in your application. We’ll review your application and tell you if you and others in your household will qualify for savings. Households with offers of employer health coverage may have new opportunities for savings, even if they weren’t eligible before.
General rules about qualifying for savings through the Marketplace:
You can’t get any savings for any month that you:
Have an offer of job-based coverage that’s considered affordable (and meets the minimum standards)
Are enrolled in job-based coverage
If the job-based insurance isn’t affordable, you and others in your household may qualify for savings.
Notice:
There’s no risk in applying
If you fill out an application, you can still choose to get job-based coverage. You won’t automatically get coverage by applying
4. Compare Marketplace plans with your employer’s job-based plan
Think about which plan will meet your needs and budget. Log in and find plans in your area. When you’re logged in, you’ll get prices based on any savings you qualify for
5. Make your decision
If you choose to get a Marketplace plan:
Generally, you can enroll in a plan during Open Enrollment (November 1-January 15). If your employer’s open season is at a different time of year or if you newly qualify for savings you may qualify for a Special Enrollment Period.
Get details on Special Enrollment Periods
If you choose job-based coverage:
Accept the offer by the employer’s due date, or check when you can enroll in their health coverage.
If you have Marketplace coverage now, find out how to cancel it.
Notice:
It’s against the law for your employer to fire or retaliate against you if you:
Get a premium tax credit when you enroll in a health plan in the Marketplace.
Report certain violations of the Affordable Care Act to your employer or the government.
Get more details on these protections
If you lose job-based health insurance
If you lose job-based health insurance, you have 2 main options:
Enroll in aplan through the Health Insurance Marketplace®
Sign up for COBRA coverage
Option 1: Enroll in a Marketplace plan
If you leave your job for any reason (even if you quit or get fired) and lose your job-based health insurance, you can enroll in a Marketplace plan. You’ll qualify for a Special Enrollment Period to enroll to get coverage for the rest of the year.
For this Special Enrollment Period, you need to apply for Marketplace coverage within 60 days of losing your job-based coverage. Your coverage can start the first day of the month after you lose your job-based coverage.
When you apply for coverage in the Marketplace, you’ll find out if you qualify for:
Savings on your monthly premiums (called "
Free or low-cost coverage from Medicaid or the Children’s Health Insurance Program (CHIP).
Create an account to apply any time.
Preview plans and estimated prices for a Marketplace plan based on your income
Option 2: Sign up for COBRA coverage
You may be able to keep your job-based health plan through COBRA continuation coverage.
COBRA coverage lets you pay to stay on your job-based health insurance for a limited time after your job ends (usually 18 months). You usually pay the full premium yourself, plus a small administrative fee
Contact your employer to learn about your COBRA options.
If you've already signed up for COBRA coverage, find out if you can switch from COBRA to a Marketplace health plan.
Get more details about COBRA coverage from the Department of Labor
More answers: If you lose job-based coverage
Can a Marketplace plan start the same day I lose my job-based insurance?
No. Marketplace plans take effect the first day of the month after your job-based insurance ends. So if you lose your insurance plan on March 7 and select a Marketplace plan by March 31, coverage can start April 1
Do I need to provide proof that I lost insurance through my job?
You may need proof that you lost health insurance through your job. When you apply for Marketplace coverage, you’ll get an eligibility notice. It will tell you if you need to submit documents to confirm your loss of coverage. The Marketplace may also contact you directly
When I apply for a Marketplace plan after losing job-based insurance, does the income I made this year before I left my job count?
Yes. Savings on a Marketplace plan are based on your estimated income for everyone in your tax household for the full calendar year. Learn how to estimate your yearly income
What if I lost my job-based insurance and I’m now eligible to enroll in a spouse’s plan? Can I buy a Marketplace plan instead?
Yes. But if you’re offered coverage through your spouse’s job and it’s considered
affordable, you won’t qualify for premium tax credits or other savings on a Marketplace plan – even if you don’t accept the offer
What if I leave my job with insurance and start another job that has a waiting period before I can enroll in it?
You can buy a Marketplace plan to provide coverage until your new job-based insurance starts. Until then, you can qualify for savings on a Marketplace plan based on your income.
Once you enroll in the new job-based insurance you can keep the Marketplace plan, but you’d have to pay full price. You can end your Marketplace plan any time without penalty
What if I leave my job that
had health insurance and take a new job that doesn’t offer health insurance?
As long as you don’t have another offer ofqualifying health coverage, you can enroll in a Marketplace plan and may be eligible for premium tax credits and other savings based on your income
Using a Flexible Spending Account (FSA)
If you have a health plan through a job, you can use a Flexible Spending Account (FSA) to pay for health care costs, like deductibles, copayments, coinsurance, and some drugs. They can lower your taxes
How Flexible Spending Accounts work
A Flexible Spending Account (FSA, also called a “flexible spending arrangement”) is a special account you put money into that you use to pay for certain out-of-pocket health care costs.
You don’t pay taxes on this money. This means you’ll save an amount equal to the taxes you would have paid on the money you set aside.
Employers may make contributions to your FSA, but they aren’t required to.
With an FSA, you submit a claim to the FSA (through your employer) with proof of the medical expense and a statement that it hasn't been covered by your plan. Then, you’ll get reimbursed for your costs. Ask your employer about how to use your specific FSA.
To learn more about FSAs:
Contact your employer for details about your company’s FSA, including how to sign up.
Get details from the IRS in this publication (PDF, 1.22 MB)
Facts about Flexible Spending Accounts (FSA)
They are limited to $3,050 per year per employer. If you’re married, your spouse can put up to $3,050 in an FSA with their employer too.
You can use funds in your FSA to pay for certain medical and dental expenses for you, your spouse if you’re married, and your dependents.
You can spend FSA funds to pay deductibles and copayments, but not for insurance premiums.
You can spend FSA funds on prescription medications, as well as over-the-counter medicines with a doctor's prescription. Reimbursements for insulin are allowed without a prescription.
FSAs may also be used to cover costs of medical equipment like crutches, supplies like bandages, and diagnostic devices like blood sugar test kits.
Get a list of generally permitted medical and dental expenses from the IRS.
You can’t use a Flexible Spending Account with a Marketplace plan.
Instead, a similar product, called a
FSA limits, grace periods, and carry-overs
You generally must use the money in an FSA within the plan year. But your employer may offer one of 2 options:
It can provide a "grace period" of up to 2 ½ extra months to use the money in your FSA.
It can allow you to carry over up to $610 per year to use in the following year.
Your employer doesn’t have to offer these options. If it does, it can be either one of these options, but not both.
Warning:
Plan ahead
At the end of the year or grace period, you lose any money left over in your FSA. Don’t put more money in your FSA than you think you'll spend within a year on things like copayments, coinsurance, drugs, and other allowed health care costs
Which Health Matching Account Level is Affordable to you ?
