QUESTION

I have an offer of employer-sponsored coverage, but the premiums are too expensive and I have to pay a lot out-of-pocket. Can I get premium tax credits in the health insurance market place?

Individuals with coverage | Coverage for Employees of a Large 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, you may be eligible for a premium tax credit for coverage in your state’s health insurance marketplace. 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 subsidies. The coverage must also provide minimum value, meaning it 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 your employer can answer to help determine whether your health benefits qualify you for a premium tax credit. (26 C.F.R. 1.36B-6; 26 U.S.C. §36B; IRS Revenue Procedure 2020-36).

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