QUESTION

My employer’s health plan doesn’t cover brand-name drugs, only generics. Does that mean it doesn’t have minimum value? Can I shop for better coverage and subsidies on the marketplace?

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

Whether your employer’s health plan meets minimum value will depend on a number of factors. The marketplace application includes a form with questions about job-based coverage. You should take this form to your employer and ask them to fill it out. Your Summary of Benefits and Coverage for the plan will also tell you if the plan meets minimum value. With that information the marketplace will determine whether the plan meets minimum value. 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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