When Your Job-Based Insurance is Too Expensive: What the ACA Says You Can Do
You’ve got health insurance at work — but the premiums feel like another mortgage payment. Many people believe that if their employer offers coverage, they’re stuck with it. The truth? The Affordable Care Act (ACA) says otherwise in certain situations.
The 9.02% Rule — Plain and Simple
The ACA has an “affordability” test:
If the lowest-price self-only plan your employer offers costs more than 9.02% of your household income, it’s considered unaffordable.
If family coverage (for your spouse or kids) costs more than 9.02% of your household income, it’s also considered unaffordable — for them.
This means:
You may qualify for a Marketplace plan with subsidies if your self-only premium fails the test.
Your spouse or dependents may qualify for subsidies even if your self-only premium passes the test but their family coverage costs too much.
Why This Matters
An “unaffordable” job-based plan can mean paying hundreds more each month than necessary.
By qualifying for the affordability exemption, you could:
Switch to a Marketplace plan that meets your needs and budget.
Receive premium tax credits (subsidies) to lower your monthly costs.
Access more provider choices depending on the plan you select.
Common Scenarios We See
The Family Glitch Fix
Your self-only coverage at work is cheap, but adding your spouse and kids costs over $1,000 a month. Now, they can apply for Marketplace subsidies without you losing your employer plan.High Premium for Self-Only Coverage
Your individual coverage costs over 9.02% of your income. You can shop Marketplace options instead — with potential subsidy help.Wellness Incentives Don’t Count
Even if your employer offers wellness discounts, they’re not factored into the ACA affordability calculation.
How to Check If You Qualify
Calculate 9.02% of your total household income.
Compare it to the annual premium for your lowest-cost plan (self-only or family, depending on who’s applying).
If the premium is higher — you may qualify for Marketplace help.
How We Help
Our team can:
Review your employer coverage and premiums against ACA rules.
Confirm if you or your dependents qualify for Marketplace subsidies.
Guide you through the application and plan selection process.
📞 Call us at 904-654-5450
💻 Visit MereBenefits.com
Don’t overpay for coverage just because it’s offered at work — let’s see if you can get a better deal.
#simplyforyourbenefit
