I’m eligible for job based coverage, can I still shop around for another health plan through Stride?

Technically, yes, but you are likely ineligible for a subsidized health plan if you are enrolled in or eligible for health coverage through your employer or through a spouse’s employer.

This is because most employer plans meet the minimum value and affordability standards set by the government. If your job-based plan meets this affordability standard, then you will have to pay full price for a Marketplace plan, which is likely even more expensive!

According to the marketplace: "In 2023, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by the employer is less than 9.12% of your household income."

We'll break that down a bit more below!

New rules for families offered employer coverage: 

In past years affordability was based on the cost to cover just the employee only, however this year affordability is calculated based on the cost to the whole family!

Key point to know: 

• If the cost to cover just the employee (not including the family) is affordable, then they will not qualify for marketplace savings. But if the cost to cover all the employees' family members is unaffordable, then the family members will qualify for savings!
• Essentially there can be a world in which the employee receives affordable coverage from their employer while their family can qualify for financial help through the marketplace!

How to calculate affordability:

First you need to find the affordability for just the employee!

• Let's say we have a family:
  • They earn $60,000 per year (this includes everyone's income in the household). 
  • Their monthly income is $5,000
• 9.12% of their monthly income of $5,000 = $456

We know that this person pays $350 per month for just their self coverage through the employer.

• Because the amount they have to pay ($350) is less than 9.12% of their monthly income ($456), their plan is considered affordable!
• They are not eligible for financial assistance through the marketplace.

Next we have to consider the family! Let's say the employee pays $800 per month for his spouse and child with the employer plan (in addition to the $350 he pays to cover himself).

• The family's plan through the employee is not affordable! 
• Because the cost to cover the family ($800 per month) is above 9.12% of their monthly household income ($456), their plan is considered unaffordable.
• The family members (spouse and child only) are eligible for savings through the marketplace and can purchase a plan with financial help! 

Remember, affordability is determined separately by the cost of self-only coverage and the cost of additional coverage for your spouse or family.