FAQs

Do I qualify for a subsidy on the exchange?

 

Whether you qualify for a subsidy depends on your income and whether you are offered coverage from your employer. You may be eligible for subsidy on the exchange if:

 

• You were not offered coverage by your employer, or

 

• The coverage offered was not affordable and your household income is no more than 400% of the federal poverty and the cost of coverage on the exchange would exceed a sliding scale of 2% to 9.5% of your household income

 

Coverage from an employer is considered not affordable if the employee’s share of that plan is more than 9.5% of the employee’s household income.

 

What is the difference between group and individual health insurance?

 

Individual health insurance is a type of plan that employees can purchase for themselves and their families­ in a manner similar to car insurance. Employees own their own policies and can take their policies with them even if they decide to leave the company. The employee pays for the policy, and the employer reimburses them for the premium or a portion of the premium.

Group health insurance coverage is a type of health plan that is purchased by an employer and is offered to eligible employees and eligible dependents. The employer selects a health plan for employees, purchases the plan, and requires that employees pay a share of the premium. Under group health insurance, there is a minimum percentage rate that the employer must contribute. The employer owns the policy, and employees will have only limited coverage when they end up leaving the company.