ACA If Group Insurance if Offered to Employee or Spouse

If you’d like to change to a Marketplace plan

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.Begin highlighted textFYI

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.End highlighted text


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.


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.

How to find out if your insurance offer meets affordability and coverage standards

Ask your employer to fill out an Employer Coverage Tool (PDF).

If your employer appeals

You aren’t eligible to receive financial assistance through the Marketplace for any month if you:

  • Have an offer of employer health coverage that meets the standards for minimum value and affordability
  • Are enrolled in employer health coverage that meets these standards

You may get a notice in the mail from the Marketplace if:

  • You’re enrolled in a Marketplace plan with premium tax credits or other cost savings, and
  • The Marketplace reviews your employer’s appeal and decides that they offered you coverage that’s both affordable and meets minimum value standards, or you enrolled in employer health coverage for at least one month this year

Your notice will tell you the official decision on the employer’s appeal and any actions you need to take next.

The notice might tell you to update your latest Marketplace application to report a change and note that the employer has offered you coverage or you’re enrolled in coverage. If you don’t report this change, you may need to pay back any financial assistance you used to lower your premiums, when you file your federal tax return for the year. Learn how to report changes.

If you want to cancel your Marketplace plan

  • If you plan to end your Marketplace coverage and are not already enrolled in your employer’s health coverage: Check with your employer to see if you are eligible to enroll in your employer’s health coverage this time of year.
  • If you end all health coverage (both your Marketplace plan and the health insurance through your employer) and don’t replace it: You may have to pay a feefor 2018 plans and earlier. There are also important health and financial risks if you don’t have health coverage. Learn more about the risks and costs of not having health coverage.
  • If your financial assistance ends for your Marketplace plan: You may be eligible for a special enrollment period to change to another Marketplace plan without financial assistance.

More answers: If you want to consider Marketplace insurance

 How can I find out how much a full-priced plan would cost? Can my employer punish me if I get a tax credit when I buy a health plan through the Marketplace?

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