People with coverage through a job

Steps to decide between job-based or Marketplace coverage

Review these steps to decide whether to pick job-based health insurance or enroll in a Marketplace plan:

1. Think about these before you decline or cancel job-based insurance:

• The employer won’t pay part of your plan’s monthly premium.
  With most job-based health insurance plans, your employer pays part of your monthly

The amount you pay for your health insurance every month. In addition to your premium, you usually have to pay other costs for your health care, including a deductible, copayments, and coinsurance. If you have a Marketplace health plan, you may be able to lower your costs with a premium tax credit. Refer to glossary for more details.

A tax credit you can use to lower your monthly insurance payment (called your “premium”) when you enroll in a plan through the Health Insurance Marketplace®. Your tax credit is based on the income estimate and household information you put on your Marketplace application. Refer to glossary for more details.

or extra savings, even if your income would qualify otherwise.
To qualify for savings, the offer of job-based health insurance can’t meet the minimum standards. This includes what’s considered

In 2024, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by the employer is less than 8.39% of your household income. Refer to glossary for more details.

monthly premiums and the basic level of coverage. Most job-based plans meet these standards.

What are the minimum standards?

In most cases, a job-based plan meets this standard if it’s designed to cover at least 60% of medical costs. It also must offer substantial coverage of hospital and doctor services.

If the premiums aren’t considered affordable for the employee and the household, they may qualify for savings in a Marketplace plan. But, if the premium is considered affordable for the employee, but not for other members of the household, then only the other household members may qualify for savings.

• Find out if your individual coverage HRA meets requirements for “affordability.”
• Learn more about how individual HRA offers work (PDF, 629 KB).
• Use this worksheet (PDF, 147 KB ) to find out if your QSEHRA meets requirements for “affordability.”

2. Get information about job-based insurance

Get any documents about job-based health insurance that has information about premium costs and who in the household can get coverage. You may be able to find this information in an online employee portal or account, a letter, email, or other document from the employer that’s offering the health coverage.

3. Fill out a Marketplace application to check for savings

Include the information that your employer filled out in the Employer Coverage Tool in your application. We’ll review your application and tell you if you and others in your household will qualify for savings. Households with offers of employer health coverage may have new opportunities for savings, even if they weren’t eligible before.

• You can’t get any savings for any month that you:
  • Have an offer of job-based coverage that’s considered affordable (and meets the minimum standards)
  • Are enrolled in job-based coverage

  There’s no risk in applying
  If you fill out an application, you can still choose to get job-based coverage. You won’t automatically get coverage by applying.

  4. Compare Marketplace plans with your employer’s job-based plan

  Think about which plan will meet your needs and budget. Log in and find plans in your area. When you’re logged in, you’ll get prices based on any savings you qualify for.

  5. Make your decision

  If you choose to get a Marketplace plan:

  Generally, you can enroll in a plan during Open Enrollment (November 1-January 15). If your employer’s open season is at a different time of year or if you newly qualify for savings you may qualify for a Special Enrollment Period.

  If you choose job-based coverage:

  Accept the offer by the employer’s due date, or check when you can enroll in their health coverage. If you have Marketplace coverage now, find out how to cancel it. It’s against the law for your employer to fire or retaliate against you if you:
  • Get a premium tax credit when you enroll in a health plan in the Marketplace.
  • Report certain violations of the Affordable Care Act to your employer or the government.