Q. It is my understanding that people who are employed and have insurance through their jobs that offer individual coverage for less than 9.5 percent of their income are not eligible to enroll through the state exchange. Am I confused?
A. Yes, you are, but yours is a common misperception. Almost anyone can buy a health plan on the health insurance marketplaces. As long as you live in the United States, you’re a U.S. citizen or someone who’s lawfully present here, and you're not in jail, you can probably buy a marketplace plan.
Having access to employer coverage doesn’t change that fact. It may, however, affect your eligibility for subsidies that can make marketplace coverage more affordable. Premium tax credits are available to people with incomes up to 400 percent of the federal poverty level (currently $45,960 for an individual), and cost-sharing subsidies are available to those with incomes up to 250 percent of poverty ($28,725).
If your employer offers coverage that meets the health law’s standards for affordability and adequacy, you won’t be eligible for subsidies on the exchange. A plan is considered affordable if the cost for self-only coverage doesn’t exceed 9.5 percent of your household income, and it’s adequate if it pays for at least 60 percent of covered medical expenses, on average.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.