An employer-sponsored plan is considered “affordable” based upon the percentage the employee is required to contribute to the premiums for self-only coverage (by salary reduction or otherwise). The self-only coverage premium standard applies, even if the employer offers the coverage to other family members. In order to be considered affordable, the employee should not have to contribute more than a certain “contribution percentage” of their total household Modified Adjusted Gross Income.
For 2019, the contribution percentage is 9.86% (this percentage will increase annually).
Furthermore, your employer-sponsored plan must also provide “minimum value.” A health plan meets the minimum value standard if it pays at least 60% of the total cost of medical services and its benefits include substantial coverage of physician and inpatient hospital services. To find out if your job-based plan meets the minimum value standard, ask your employer.
If the coverage your employer offers is not affordable or does not meet the standard of minimum value, you may be eligible to purchase a Qualified Health Plan through the Marketplace and see if you are eligible for Premium Tax Credits and Cost-Sharing Reductions.
To see if your employer-sponsored plan is affordable and adequate, download our Employer Coverage Tool.
Note: Whether or not your employer-sponsored plan is affordable does not affect your eligibility for Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus.