QUESTION

My employer’s plan is grandfathered so it doesn’t cover preventive services. Can I shop for better coverage in the marketplace if my job-based plan is grandfathered?

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

Most people are eligible to shop for coverage in the marketplace. However, you can only qualify for premium tax credits if your job-based plan — whether it is a grandfathered plan or not — is unaffordable or if it doesn’t meet minimum value. 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; 80 Fed. Reg. 72192, Nov. 18, 2015).

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