The plan at work costs too much. Now what?
You were told that a job offer of insurance means no help with a marketplace plan. That is the short version, and the short version is wrong often enough to be worth fifteen minutes of your time.
There are two tests, not one, and your family is measured separately from you. A plan can be affordable for you and far out of reach for your spouse and children — and when that happens they can get a marketplace plan with a tax credit while you stay on the plan at work. That rule changed in 2023 and most people have still never heard of it. Here is the whole thing in plain words.
Ten questions, answered straight
Tap the one that sounds like you.
My job offers insurance and I cannot afford it. Can I get help with my own plan instead?
Maybe — and the test is narrower than almost anyone tells you.
The rule most people have heard is “if your job offers coverage, you get no subsidy.” That is only true if the plan at work passes two separate tests: it has to be affordable by the government’s definition, and it has to meet something called minimum value. If it fails either one, the door to help is open.
And one more thing changed in 2023 that still has not reached most people: your family is now tested separately from you. The plan can be affordable for you and unaffordable for them, and then they can get help even though you cannot.
This is the question we get wrong answers on more than any other. It takes two numbers from your HR department and about fifteen minutes. Nothing to pay.
How does the marketplace decide my work plan is affordable?
With one calculation, and it is not the one you would guess.
They take your share of the premium for the cheapest plan at work that covers just you — not family, not the plan you actually picked — and compare it to your household income for the year.
For the 2027 plan year, that plan is affordable if your share is 10.22% of household income or less. For 2026 the figure was 9.96%. Above the line and the plan is unaffordable, and you can look at the marketplace with help.
Two things people trip over. The number is your cost, not the employer’s — what they pay does not enter it. And it is based on the income you expect this coming year, so if your hours were cut or a second income stopped, the answer can flip.
The plan is affordable for me but not for my family. Is that still a no?
No. This is the one worth reading twice.
Until 2023, if the plan at work was affordable for the employee alone, the whole household was shut out of help — even when adding a spouse and children cost a fortune. People called it the family glitch. It was fixed.
Now there are two tests. You are measured on the cost to cover just you. Your spouse and children are measured on the cost to add them.
Here is what that looks like with real numbers. A household earning $60,000 a year. Covering the worker alone costs $245 a month, which is 4.9% of income — affordable, so the worker gets no help. Adding the family costs $845 a month, which is 16.9% of income — far over the line. The spouse and children can get a marketplace plan with a premium tax credit.
A split household is allowed. The worker stays on the plan at work, the family goes to the marketplace with help. It is not a loophole and nobody is doing anything clever — it is how the rule reads.
If your employer pays well for you and nothing for dependents, there is a good chance this is you. Bring the two premiums and we will run it.
What is minimum value, and why would a work plan fail it?
Minimum value means the plan pays at least 60% of the cost of covered care for a typical group of people, and gives real coverage for hospital stays and doctor visits.
Most normal group plans pass. The ones that fail tend to be the thin products sold to employers with a lot of hourly or seasonal staff — sometimes called minimum essential coverage plans, skinny plans, or a fixed-payout plan dressed up as insurance. They can look like a benefit on a hiring sheet and still fail the test.
If the plan at work fails minimum value, you can go to the marketplace with help no matter how cheap it was. Cheap does not mean it counts.
If you cannot tell what you have been offered, show it to us. Reading these is routine for us and it costs you nothing.
Can I turn down the plan at work and buy my own?
You can always buy your own. The only question is whether help comes with it.
You are never required to take the plan at work, and the marketplace will sell you a plan either way. But if the plan at work is affordable and meets minimum value, you get no premium tax credit — even if you turn the plan down. Declining it does not unlock help. That is the part that surprises people.
One more trap worth naming. If you buy a plan straight from an insurance company instead of through the marketplace, there is no tax credit at all, whatever your income. Same plan, same insurer, no help — because the credit only exists on the exchange. We see this one several times every year.
My work plan went up and open enrollment is over. Am I stuck for a year?
Often not. There is a special enrollment period built for exactly this.
When the plan at work becomes unaffordable — the premium went up, or your income went down and your share did not — or it stops meeting minimum value, that opens a 60-day window to move to a marketplace plan with help.
Two warnings. The clock is short, and it starts at the change, not when you notice. And you generally cannot walk away from the plan at work in the middle of its year without a qualifying event, so for most people this lines up with the employer’s renewal.
If your renewal letter just landed and the number went up, call before you sign anything. After the window closes the answer is usually January.
My employer gives me money to buy my own plan. Does that count?
Yes, and it has its own rules, and one of them has a deadline you can miss by accident.
What you have is probably an individual coverage HRA — an ICHRA, recently also called a CHOICE arrangement. Your employer puts in an allowance and you buy your own plan with it. More and more small employers around here are doing this.
The test works like the one above, with the allowance subtracted. If what is left for you to pay is small enough, the offer counts as affordable and you get no tax credit. If it is too big, the offer is unaffordable and you may take the credit instead.
Here is the deadline. You can only choose the tax credit instead of the allowance if you opt out before the arrangement’s start date, and the choice covers your whole family for that year. You cannot opt out in the middle of the year and claim the credit, and you cannot use both at once.
So the comparison has to be done before the start date, not after. Send us the notice your employer gave you and we will do the math while there is still a choice to make.
I filed my taxes separately from my spouse. Is that why I got nothing?
Very likely, yes. It is one of the quietest reasons people get no help.
If you are married and file married filing separately, you are not eligible for the premium tax credit at all — whatever you earn. Filing jointly is a condition of the help, and almost nothing warns you about it until the credit is gone.
There is an exception, and it matters. If you are living apart from a spouse because of domestic abuse or because you were abandoned, you can claim the credit without filing jointly. You do not have to prove it to us and we are not going to ask you for details.
If a tax decision is costing you the help, there may still be time to look at it. That is a conversation worth having with whoever prepares your return — and we are glad to show you what the help would be worth, so you know what is at stake.
My parents claim me on their taxes. Can I still get help?
Not on your own return, no — but the household may still get help, and that is a different question.
If someone else claims you as a dependent, you cannot take the premium tax credit yourself. The credit follows the tax return you appear on. So the right question is not “do I qualify” but “does the household qualify, with me counted in it.”
Often that works out better, because household size is part of the calculation and adding a person raises the income limit. Sometimes the cleaner answer is to come off the return. It is worth doing the arithmetic both ways before anyone files.
What do you need from me to check this?
Less than you would think, and it costs nothing.
Three numbers settle most of it. Your share of the cheapest plan at work that covers just you, per month. Your share of the plan that covers your family, per month. And the household income you expect for the year. Your HR department has the first two — there is a standard form for it and they will know the one you mean.
If you also have the summary of benefits for the plan, bring it. That is where minimum value is hiding.
We are paid by the insurance company when someone enrolls, and a plan costs you exactly the same whether you use us or not. There is no fee at any point. And if the answer turns out to be that the plan at work is your best option, we will tell you that too.
If a renewal letter just landed, the clock has started
For coverage starting January 1 you need to be enrolled by December 15 in Connecticut and Pennsylvania, and by December 31 in New Jersey. Open enrollment runs to January 15 in Connecticut and Pennsylvania and to January 31 in New Jersey. A plan at work that became unaffordable opens its own 60-day window, and that one starts at the change, not when you notice it.
Call or text (860) 200-2272, or send a message. Bring the two premiums from HR. English or Spanish, and asking costs nothing.