If you have coverage from a job (or a family member’s job):
- You will not owe a fee because you have met the Shared Responsibility Provision. With job-based insurance, you are considered covered and won’t have to pay the fee that uninsured people must pay.
- You may also purchase your own healthcare insurance. You have the option of opting out of the employer’s plan and may purchase your own policies for yourself or your family members. In many cases, foregoing your employer’s plan may be more expensive for you the employee, because your employer is no longer paying a portion of your premium. You will want to compare the plan provisions and provider networks, of course, and you can also investigate whether you will be eligible for assistance with premiums.
- Under certain conditions you may still be eligible for reduced premium payments. If the employer’s coverage does not meet the Minimum Value Standard, or is not “deemed affordable” to you, (and only you, the employee) then you may also have the option of purchasing a plan through the Marketplace and perhaps receive Advanced Tax Credits to pay for part of your premium.
How do you know if your job-based plan is “Deemed Affordable” and meets Minimum Value Standards?
- A job-based health plan is “deemed affordable” if the employee’s share of premiums for the lowest cost self-only coverage that meets the minimum value standard is less than 9.5% of their family’s income. In other words, if your share of your premiums for a plan that covers only you (the employee)–not your family–is less than 9.5% of your family’s income, the plan is considered affordable. You may pay more than 9.5% of your income on premiums for spouse or family coverage from your employer. But affordability is determined only by the amount you’d pay for self-only coverage from your employer.
- A health plan meets the minimum value standard if it’s designed to pay at least 60% of the total cost of medical services for a standard population.In other words, in most cases the plan will cover 60% of the covered medical costs and the person with coverage pays 40%.
You can ask your employer for help figuring out if the plan offered to you meets the minimum value standard. Your employer can also give you the information needed to determine if the plan is considered affordable to you.
The government provides an information gathering tool that helps employees report their employer’s coverage called an Employer Coverage Tool the information provided on this form allows the government to determine the employee’s eligibility for participation on the exchange based on the employee’s income and the employers’ participation in providing insurance coverage to their employees.
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Patient Protection & Affordable Care Act (PPACA) information discussed in communications is most accurate as of this date. The Department of Health & Human Services may amend or change federal regulations at any time.
More on this subject to come!