You may be asked the questions below. Read the information below each question for more information and/or how to answer.
Are you currently eligible for health coverage through a job (even if it’s from another person’s job, like a parent or spouse)?
You’re eligible for health coverage if you could get health coverage through a job, even if you’re not currently enrolled.
You should select “Yes” even if you don’t think you can afford the coverage that’s being offered. You’ll be asked questions to see if the coverage meets the minimum standards for affordability. Most job-based plans meet these standards. However, if it doesn’t, you may qualify for savings on a Marketplace plan.
Select “No” if:
- You’re not able to get health coverage because you (or a family member) don’t work enough hours.
- You could get health coverage if you (or a family member) worked more hours.
If you're using the Employer Coverage Tool (PDF, 125 KB) this is item 13.
Will you be eligible for health coverage from a job during 2023 (even if it’s from another person’s job, like a spouse or parent/guardian)?
You’re eligible for health coverage if you could get health coverage through a job, even if you’re not currently enrolled.
Select “Yes” if:
- You could get health coverage in the next 3 months through your job or another person’s job.
- You’re currently in a waiting period for coverage to start.
Select “No” if you won’t have health coverage in the next 3 months through your job or another person’s job.
Select “I don’t know” if you’re not sure. If you select this, the Marketplace won’t be able to determine your eligibility for a premium tax credit, but may be able to enroll you in a Marketplace health plan or other programs.
If you’re using the Employer Coverage Tool (PDF, 125 KB), this is item 13.
Tell us which employer(s) offer(s) health coverage to you
Check each box that applies to you. Include:
- Employers that offer coverage to you, even if that coverage is through a spouse, parent, or other family member.
- All employers that offer health coverage if you’re eligible for health coverage through more than one employer.
Count each offer of health coverage whether or not you’re enrolled in coverage through this job. For example, if you’re part of a couple and could get coverage through multiple employers, but are only enrolled in coverage through one employer, you should list both employers.
Enter your employer’s address
We may contact your employer to get information about any health coverage that may be available to you. Be sure to enter the information, like the address, of the person or department at your job that manages employee benefits. If you need help with this item, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), these are items 7-10.
Enter your employer’s phone number
If this information is pre-populated, we got this information from our data sources. If it’s not correct, enter the correct contact information for the person or department at your job that manages employee benefits.
If you need help with this item, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), this is item 11.
Enter the Employer Identification Number (EIN)
You can find the Employer Identification Number (EIN) on a pay stub or W-2 from this employer. If you don’t know this number, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), this is item 4.
Tell us about your employer
We may ask you to tell us your employer’s name, address, phone number, or EIN. If you need help with these items, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), these are items 3-6.
Who can we contact about an employer’s health coverage?
If you’re not sure, ask your employer. If this employer gave you the contact information for the person at the job or a third party administrator that helps with providing health benefits, include the person’s contact information. If your employer didn’t give you this information, leave this blank.
If you’re using the Employer Coverage Tool (PDF, 125 KB) these are items 6-12.
Are you currently enrolled in an employer’s health coverage?
You’re “enrolled” if you can use your health benefits.
Select “Yes” if you’re a retiree and are accepting money from a Health Reimbursement Arrangement (HRA).
What’s your current work status at an employer?
If you’re retired, select “Retired” — don’t select “No longer working at this employer.”
Is the coverage from your employer COBRA coverage?
COBRA gives employees the right to continue to pay to keep themselves and their family on employee health coverage for a limited time (usually 18 months) after their employment ends or they otherwise lose coverage.
If you’re currently enrolled in COBRA and plan to keep COBRA coverage during the coverage year, you won’t qualify for premium tax discounts through the Marketplace, but may be eligible to enroll in a Marketplace health plan or other programs.
Learn more about COBRA coverage.
Is the coverage from your employer a retiree health plan?
A retiree health plan is an employer-provided health care plan that carries over to retirement.
If you’re currently enrolled in a retiree health plan and plan to keep the retiree health plan during the coverage year, you won’t qualify for premium tax discounts through the Marketplace, but may be eligible to enroll in a Marketplace health plan or other programs.
Does your employer offer a health plan that meets the minimum value standard?
Most job-based plans meet the minimum value standard. A health plan meets the minimum value standard if it's designed to pay at least 60% of the total cost of medical services for a standard population, and if its benefits include substantial coverage of inpatient hospital and physician services.
If you select “I don’t know,” the Marketplace won’t be able to determine your eligibility for a premium tax credit, but you may be eligible to enroll in a Marketplace health plan or other programs.
If you select "Yes," you won't be eligible for a premium tax credit. Individuals offered job-based coverage that provides minimum value and is considered affordable aren't eligible for help paying costs.
If you need help with this item, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), this is item 14.
For the lowest-cost plan available only to the employee that meets the minimum value standard: (Only tell us about self-only plans offered to the employee.)
These items are asking about the lowest-cost plan offered by the employer that would cover the employee only. Don’t include information for family coverage. Only include plans that meet the minimum value standard. The employee may or may not be enrolled in this particular plan.
These questions help the Marketplace determine if the employee is offered an affordable health plan by the employer.
If you need help with this item, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), this is item 15.
How much is the premium for this plan?
This item is asking about the premium amount of the lowest-cost plan offered by the employer that would cover the employee only. Don’t include information for family coverage. Only include plans that meet the minimum value standard.
Enter the regular amount the employee would have to pay for coverage (the premium). The employee may or may not be enrolled in this particular plan.
If the employer has wellness programs, provide the premium that the employee would pay if the employee received the maximum discount for any tobacco cessation programs and didn’t receive any other discounts based on wellness programs.
If this employee is offered an amount through a Health Reimbursement Arrangement (HRA) that the employee may use to help with premiums, make sure the employer counts this amount towards the amount the employee must pay for coverage when responding to this question.
These items help the Marketplace determine if the employee is offered an affordable health plan by the employer.
If you select “I don’t know,” the Marketplace won’t be able to determine your eligibility for a premium tax credit, but you may be eligible to enroll in a Marketplace health plan or other programs.
If you need help with this item, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), this is item 15(a).
How often would you pay this amount?
If you need help with this item, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), this is item 15(b).
Do you expect the employer to make any of these changes to the coverage offered to you in 2023?
Select “I don’t know” if you don’t know if your employer will make any changes. This won’t affect your eligibility results.
If you need help with this item, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), this is item 16.
Will the employer no longer offer health coverage?
If you’re losing your health coverage, you can buy health coverage through the Marketplace. You may also qualify for a premium tax credit.
If the employer will no longer offer a plan that meets the minimum value standard, check the box.
If you need help with this item, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), this is item 16.
What will be the last day the employer offers coverage?
Enter the last day that you could get health benefits under the employer plan.
“The employer will change the cost of premiums for the lowest-cost plan available to the employee that meets minimum value”: This item is asking about the premium amount of the lowest-cost plan offered by the employer that would cover the employee only. Don’t include information for family coverage. Only include plans that meet the minimum value standard. Enter the regular amount the employee would have to pay for coverage (the premium). The employee may or may not be enrolled in this particular plan.
If this employee is offered an amount through a Health Reimbursement Arrangement (HRA) that he or she may use to help with premiums, make sure the employer counts this amount towards the amount the employee must pay for coverage when responding to this question.
If you need help with this item, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), this is item 16.
How much will the employee have to pay in premiums for this plan? (This will be asked if you selected “The employer will change the cost of premiums for the lowest-cost plan available to the employee that meets minimum value” for the question above.)
This item is asking about the premium amount of the lowest-cost plan offered by the employer that would cover the employee only. Don’t include information for family coverage. Only include plans that meet the minimum value standard.
Enter the regular amount the employee would have to pay for coverage (the premium). The employee may or may not be enrolled in this particular plan.
If this employee is offered an amount through a Health Reimbursement Arrangement (HRA) that the employee may use to help with premiums, make sure the employer counts this amount towards the amount the employee must pay for coverage when responding to this question.
If you need help with this item, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), this is item 16(a).
How often would you have to pay this amount? (This will be asked if you entered an amount for the question above.)
If you need help with this item, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), this is item 16(b).
When will the employer make this change? (This will be asked if you selected “The employer will change the cost of premiums for the lowest-cost plan available to the employee that meets minimum value.”)
If you need help with this item, ask your employer.
If you’re using the Employer Coverage Tool (PDF, 125 KB), this is item 16(c).
Do you expect to drop the employer’s health coverage in 2023?
Select “Yes” if you’re going to cancel your health coverage.
What’s your last day of coverage through this employer? (This will be asked if you selected “Yes” to the question above.)
Enter the last day you could get health benefits through your employer’s plan.
What’s the first day you’ll be covered by the employer’s health plan?
Enter the first day that you’ll be able to use health services under your employer’s plan.