KBenefits Insurance Services
Employer Plan Affordability

Is your Employer's Plan Affordable or Unaffordable

If an employer's health insurance is deemed unaffordable, it typically refers to a situation where the cost of the employer-sponsored health insurance exceeds a certain percentage of an employee's income, as defined by the Affordable Care Act (ACA). Under the ACA, large employers with 50 or more employees are required to offer affordable health insurance coverage to their employees or face potential penalties.

According to the ACA, employer-sponsored health insurance is considered affordable if the employee's share of the premium for the lowest-cost self-only coverage option does not exceed a certain percentage of their household income. This percentage is adjusted annually by the IRS and is generally set at 9.83% of household income for 2023.


If an employee's share of the premium for the lowest-cost self-only coverage exceeds the affordability threshold, they may be eligible for financial assistance through the Health Insurance Marketplace (also known as the Exchange) to help them obtain more affordable health insurance coverage. This could include premium tax credits, which reduce the monthly cost of premiums, or cost-sharing reductions, which reduce out-of-pocket costs such as deductibles, copayments, and coinsurance.




Contact us for advice, navigation, plan options & free enrollment assistance.

Christopher S. Kudryk

KBenefits Insurance Services
Employee Benefits

Individual Health Insurance
Medicare Plan Options


Christopher S. Kudryk
Insurance Specialist

KBenefits specializes in health, dental, vision, life and medicare insurance for employers and individuals in NJ & NY.

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