Employer-sponsored coverage (also called job-based coverage or group health insurance) is health insurance offered through your employer as part of your benefits package. Your employer typically pays a portion of the monthly premium and you pay the rest through payroll deductions.
Employer-sponsored coverage affects your ACA Marketplace eligibility in an important way: if your employer offers a plan that meets minimum value standards (covers at least 60% of costs) and is considered affordable (your share of the premium for self-only coverage doesn’t exceed a set percentage of household income), you generally do not qualify for Marketplace subsidies — even if family coverage under that plan is unaffordable.
This is called the family glitch — and it was partially addressed by an IRS rule change that took effect in 2023. Under the fix, family members can now qualify for Marketplace subsidies if the cost of family coverage under the employer plan is unaffordable, even if the employee’s self-only premium is affordable.
If you lose employer-sponsored coverage involuntarily, that’s a qualifying life event that opens a 60-day Special Enrollment Period.
Possibly, but only if the employer plan fails the affordability or minimum value tests. If the plan is considered affordable and meets minimum value, you’re generally not eligible for Marketplace subsidies — even if a Marketplace plan would cost less overall. A broker can run the comparison for your situation to determine whether you have a viable subsidy pathway.
Yes — losing employer-sponsored coverage involuntarily (job loss, reduction in hours, or leaving a job) is a qualifying life event. You have 60 days to enroll in a Marketplace plan or elect COBRA continuation coverage. In most cases, a Marketplace plan will cost less than COBRA, especially if you qualify for subsidies.
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