If the employer sponsored plan I am enrolled in renews in the middle of the calendar year and the new cost to me is more than 9.5% of my AGI does that qualify me for a special enrollment opportunity through the Marketplace including any subsidies I might be eligible for?


Answer

If an employer plan would cost more than 9.5% of household MAGI for self only coverage, after employer contribution, then it qualifies you for ACA coverage. If it is during open enrollment you can simply get a Marketplace plan, if it is outside of open enrollment or need a plan to start sooner you can special enrollment. You can only use special enrollment if you are losing coverage, such as in a case where you are being offered an unaffordable employer plan mid-year. To enroll in the Marketplace and get cost assistance, despite being offer employer coverage, you'll need to have your employer fill out an employer coverage tool.

You can learn more here.

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