Can You Get ACA If Your Employer Offers Insurance?

Navigating healthcare options in the United States can be complex. Many receive health insurance through their employers. However, the Affordable Care Act (ACA) Marketplace also offers coverage and financial assistance. Understanding how employer-sponsored insurance and the ACA Marketplace interact is a common concern, especially when considering Marketplace enrollment despite an employer offer.

Understanding Employer-Sponsored Coverage and the ACA Marketplace

Employer-sponsored health insurance is a benefit provided by many companies, allowing employees and their dependents to enroll in a group health plan. These plans typically involve shared costs for premiums and include benefits determined by the employer. The ACA Marketplace operates as a public exchange where individuals and families can purchase health insurance plans, often with government financial assistance.

Individuals can purchase a health plan through the ACA Marketplace, even if their employer offers insurance. The primary distinction is eligibility for financial assistance, such as premium tax credits or cost-sharing reductions. These subsidies make coverage more affordable for eligible individuals and depend on specific criteria related to the employer’s offer.

Determining if Your Employer’s Offer is “Affordable”

A factor in determining eligibility for ACA Marketplace subsidies is whether your employer’s health insurance offer is considered “affordable.” Affordability is defined by an annual threshold set by the Internal Revenue Service (IRS). For 2025, employer health coverage is affordable if the employee’s required contribution for the lowest-cost, self-only coverage does not exceed 9.02% of their household income.

To assess this, compare the annual premium for your employer’s lowest-priced, self-only plan to your estimated Modified Adjusted Gross Income (MAGI). Your MAGI typically includes your adjusted gross income from your tax return, plus any untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. If your employer’s plan meets this affordability standard, you will not qualify for premium tax credits or cost-sharing reductions through the ACA Marketplace.

Determining if Your Employer’s Plan Provides “Minimum Value”

Beyond affordability, another test for ACA Marketplace subsidy eligibility is whether your employer’s health plan provides “minimum value.” A health plan meets the minimum value standard if it covers at least 60% of the total allowed costs of benefits. This means the plan is expected to pay for a substantial portion of medical expenses, including physician and inpatient hospital services.

Employers are typically responsible for determining if their plans meet this standard and provide this information to employees. You can find out if your employer’s plan satisfies the minimum value requirement by requesting a “Summary of Benefits and Coverage” (SBC) document from your employer. The SBC is a standardized document that outlines the plan’s benefits, coverage, and cost-sharing, and it will indicate if the plan provides minimum value. If your employer’s plan offers minimum value, even if it is deemed unaffordable, you may still not qualify for ACA Marketplace subsidies.

Applying for Marketplace Coverage and Financial Assistance

If, after evaluating your employer’s offer, you determine that it is either unaffordable or does not provide minimum value, you can then proceed with applying for coverage and potential financial assistance through the ACA Marketplace. The application process typically involves visiting the official Marketplace website, such as HealthCare.gov, or your state’s specific health insurance exchange. You will need to provide detailed information about your household, including income data and specifics about any employer-sponsored health coverage available to you.

The Marketplace application uses the information you provide, including your Modified Adjusted Gross Income (MAGI), to assess your eligibility for premium tax credits and cost-sharing reductions. These financial assistance programs are designed to lower the cost of monthly premiums and out-of-pocket expenses for eligible individuals and families. If the Marketplace determines that your employer’s coverage is either not affordable or does not meet minimum value, and your income falls within the qualifying range, you may be eligible for these subsidies. Conversely, if your employer’s plan is deemed affordable and provides minimum value, you can still purchase a plan through the Marketplace, but you would likely pay the full, unsubsidized premium, making the employer’s plan often the more advantageous option.