QUESTION

I’m offered health benefits at work, but they’re not very good. I understand I may be eligible for marketplace subsidies if my job-based plan doesn't meet a "minimum value" standard. What does that mean?

Individuals with no coverage | Eligibility for Premium Tax Credits and Cost-Sharing Reductions
ANSWER

The term “minimum value” means that your job-based plan would cover at least 60 percent of the costs of covered health services for an average group of people. A minimum value plan must also cover at least inpatient hospitalization and physician services. Most employer plans will meet this test, but some may not. The marketplace application includes a form with questions about job-based coverage. You can take this form to your employer and ask them to fill it out. With that information the marketplace will determine whether the plan meets minimum value. Alternatively, your employer plan is required to provide you a Summary of Benefits and Coverage. This document should tell you whether or not your employer plan meets the minimum value standard. If it doesn’t, you may be able to qualify for premium tax credits to help pay for marketplace coverage. (45 C.F.R. § 156.145; 26 C.F.R. § 1.36B-6).

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