QUESTION

I have an offer of coverage from my employer, but the premiums are too expensive and I have to pay a lot out-of-pocket. Can I get financial help in the health insurance marketplace?

Individuals with coverage | Coverage for Employees of a Small Employer
ANSWER

If the lowest cost, self-only coverage in your employer’s plan is 9.61 percent or more of your household income in 2022 and meets a "minimum value" threshold, you may be eligible for a premium tax credit for coverage in your state’s health insurance marketplace. Minimum value means that the plan covers at least 60 percent of the average costs of covered services, including hospitalization and physician services. The application for coverage in a health insurance marketplace includes questions you or your employer can answer to help determine whether your health benefits qualify you for a premium tax credit. Subsidies are calculated based on the price of available plans and household income; lower income individuals are eligible for greater subsidy amounts, and some higher income individuals may not receive. (26 C.F.R. 1.36B-6; 26 U.S.C. §36B; IRS Revenue Procedure 2020-36).

Individuals with no coverage
Individuals with coverage
Coverage for small employers
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