QUESTION

My employer offers a “mini-med” plan. It only covers preventive services and a few doctor visits each year. I want better coverage. Can I apply for coverage and premium tax credits in the marketplace?

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

You can apply for coverage in the marketplace and if your employer plan doesn’t meet the Affordable Care Act’s standard for minimum value, you may qualify for premium tax credits. To meet the minimum value standard, the plan must cover at least 60 percent of covered services for an average population, including hospitalization and physician services. If your employer plan only covers preventive services and a few doctor visits, it is likely it doesn’t meet the minimum value standard (which means it would be considered inadequate and you could be eligible for premium tax credits to help buy a marketplace plan). However, if your employer offers another plan or plans, in addition to the mini-med plan, that is found to be adequate and the premiums for self-only coverage in that plan would be considered affordable for you, you will not qualify for premium tax credits in the marketplace. (26 C.F.R. § 1.36B-2).

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