Can I enroll in a private health insurance if my employer offers insurance?

Written by Access Health CT | Published May 3rd, 2021 | Updated May 3rd, 2021

If you are being offered coverage through an employer, or through a family member’s employer, it may affect your ability to enroll through Access Health or get help with paying for healthcare coverage.  

 

Can I enroll through Access Health CT if my employer offers health insurance? 


Yes, you can still enroll in a private health insurance plan (Qualified Health Plan) through Access Health CT, 
however if the employer's coverage is considered Affordable and meets the Minimum Value Standard, you will not be eligible to receive financial help (a Premium Tax Credit (PTC) or Cost-Sharing Reduction (CSR)), regardless of your household income.    

  • Affordable:  A  health insurance plan is deemed "affordable" if the employee's premium contribution toward the least-expensive plan for employee-only coverage (not including spouse or eligible dependents) is equal to or less than 9.78% of the household's Modified Adjusted Gross Income. 
  • Minimum Value Standards:  A health plan meets minimum value standards if it pays at least 60% of the total cost of medical services including substantial coverage of physician and inpatient hospital services.  



How is Affordability calculated? 


Access Health CT will use the information you provide in your application for health coverage to determine if your employer’s coverage is “affordable”. 
 


Make sure to contact the Human Resources department at your employer to gather all information required in our application.  Not entering enough information regarding your employer’s coverage offered will disqualify you for Premium Tax Credit (PTC) until all necessary information is provided and we can determine that you do indeed qualify.
 


My employer doesn’t offer coverage, but my spouse’s employer does. Am I still eligible for individual medical coverage through Access Health CT?
 


Yes, you can enroll in a plan through Access Health CT. 
However, if the plan offered by your spouse’s employer is offered to you – and the plan is considered affordable and meets the Minimum Value Standard – you may not be eligible for some financial help through AHCT. 


A  health insurance plan is considered to be affordable for the whole family, e.g. employee, 
spouse and dependents, if the premium cost to the employee alone is considered affordable.  The employer plan may cost more for the family if employee's spouse and/or dependents are added but that is not what is used as the measure of affordability. 

You should fill out the employer-sponsored coverage section of the Access Health CT application and answer all the questions. The enrollment and eligibility system will produce an accurate determination. If you do not know the details of your employer's (or your spouse's employer) health insurance, you should check with the employer and update your Access Health CT application with this information. 



A recent job or job-based coverage loss could mean you were offered COBRA, click here to learn more.