If your employer offers health insurance coverage, it can feel like a big win. Employer-based insurance plans are the most common form of health coverage in the United States, but what if you don’t want to use the health insurance benefits through your job?
Perhaps the cost or the types of plans available don’t align with your health goals, so you want to look elsewhere. Can you enroll in an Affordable Care Act plan instead?
Yes, of course. But there are some important factors to consider. Our insurance agents at McKnight & McKnight Insurance Solutions break down what you need to know if you want to enroll in an ACA plan, even if your employer offers health insurance benefits.
Enrolling in an Affordable Care Act Plan
The Affordable Care Act (ACA) was designed to ensure that almost all Americans can easily buy health insurance for themselves and their families. To qualify, there are just a few general requirements including:
- You must live in the U.S.
- You cannot be incarcerated
- You must be a United States citizen or hold a green card
If you meet these criteria you can shop for an ACA-compliant health plan during the annual Open Enrollment Period each year.
You may also qualify for a Special Enrollment Period (SEP) if you have a qualifying life event such as a marriage, move, birth, or death.
One important consideration when deciding between an ACA plan or an employer-based health plan is the bottom-line costs.
Learn More > What is the Affordable Care Act?
Will I Be Eligible for any Subsidies or Savings?
If you are enrolled in an employer-sponsored plan, your employer may contribute to your health insurance costs. Sometimes they may even pay 100% of the cost. But if you decide to opt out of your employer-sponsored plan, they will not contribute in any way.
Also, if you turn down an employer plan and enroll in an ACA plan, you might not get any subsidies or savings. You may qualify for subsidies if:
- The employer-based plan does not meet the minimum value standard. This refers to the rule that employer-sponsored plans are required to pay at least 60% of the total cost of medical services for a standard population and offer substantial coverage for doctor and hospital services. If your employer-based plan doesn’t meet these standards, you will qualify for an ACA subsidy.
- The plan does not meet the affordability test. A job-based health care plan is considered to be affordable if your share of the self-only coverage monthly costs less than 9.61% of your household income.
If you aren’t sure if you should choose an ACA plan or employer-based health coverage, call our agents at McKnight & McKnight Insurance Solutions. We will help you decide which plan is best for you and your family. Schedule a phone call with us today!
“My group health insurance plan was canceled by the insurance provider and my renewal option was nearly double what I had been paying for my family. I went to McKnight & McKnight and they were able to find me a plan that was only 37% of what my renewal was going to be. Even cheaper than I had been paying!! Thanks, Bob! Highly recommended.”
Is Employer-Based Coverage Cheaper?
In most cases, staying with your employer-based health insurance coverage is likely your cheapest option. Since most employers contribute to your monthly premiums, you might not be able to beat the price with an ACA plan. Before changing plans, it is important to note that you may not qualify for subsidies and savings unless you meet specific requirements. Our licensed agents can help you determine if your household qualifies for any ACA subsidies.
What if My Employer-Based Plan is Too Expensive?
Many people run into problems with their employer-provided health insurance based on how expensive it is, especially if it covers their entire family.
Unfortunately, if the costs are under the 9.5% threshold of your annual household income, the plan is still considered “affordable” by legal standards, so you still won’t be eligible for subsidies through an ACA plan.
Those seeking to reduce premiums might also wish to consider a high deductible/catastrophic health insurance plan. For those in good health, this is a less expensive alternative to costly ACA plans. Unsure of which option is right for you? Expert, licensed agents at McKnight & McKnight Insurance Solutions can help you compare the premiums and benefits of both ACA and lower-priced Catastrophic plans.
What Happens if My Spouse Isn’t Covered Under My Employer-Based Plan?
If your spouse needs health coverage they, can shop for an ACA plan. They may qualify for a subsidy if they don’t have the option to enroll in a health care plan at their job or through yours.
Even if your spouse is eligible for coverage through your employer, they can still shop for an ACA plan, even if they don’t qualify for subsidies. They might find that it is more affordable to choose coverage for themselves when compared to the costs through your employer-provided plan.
Keep Reading > Employer Group Insurance Vs. Individual Insurance
Call Our Independent Insurance Agents
If you or your spouse need help finding a healthcare plan (ACA/Marketplace or otherwise), our independent insurance agents at McKnight & McKnight Insurance are here to help you get the coverage you need at a cost that best fits your budget.
Our team is licensed in many states and is ready to make the process of enrolling in health insurance fast, simple, and most of all, friendly.
Get started today! Fill out an online quote or call us!