Unaffordable Employer Sponsored Coverage

As of January 2023, how affordability is determined for employer- sponsored health insurance changed. Affordability is now calculated for the employee and their families separately.

For 2024, the coverage is considered unaffordable if the annual premium is more than 8.39%* of your total household income. If the employee’s coverage is affordable for themselves but not their family, their family may still qualify for a Special Enrollment Period and be eligible for a tax credit. While this may mean that your family has a policy through a different carrier, everyone will be covered by affordable health insurance.

For additional information, visit our Special Enrollment Period page.

What does this mean for employers?

Employers meeting all the guidelines on providing health insurance coverage to their employees don’t need to do anything. If the coverage that is offered to their employees and/or families is considered unaffordable, Your Health Idaho will confirm the premium(s) exceed 8.39% and calculate the amount of tax credit they are eligible for. Providing information to employees about Your Health Idaho as an option for their family’s coverage is a win for everyone. Employers benefit from not contributing to dependent coverage, and employees benefit by having affordable coverage for their families, putting money back in their pockets.

There are two times a year to enroll – Your Health Idaho’s Open Enrollment, October 15 to December 15, or during the employer’s open enrollment. We highly recommend employees confirm with Your Health Idaho that their current or offered coverage is considered unaffordable before making any decisions. Additional information is available here.

Low-Cost Options to COBRA

If you are going through an employment transition or recently lost employer health insurance, you might be eligible for a Special Enrollment Period. Health coverage at Your Health Idaho can be a low-cost option when compared to COBRA.

Why choose coverage through Your Health Idaho instead of COBRA?

• • COBRA may be expensive if your previous employer doesn’t help with premium payments or provides assistance only for a limited time.
  • Your Health Idaho is the only place you can receive a tax credit to pay for some or all of your monthly health insurance premiums.
  • You may also qualify for additional savings through Cost-Sharing Reductions, available on Silver Tier plans.

Review your options carefully. If you decide to enroll in COBRA, you will not be eligible for a Special Enrollment Period until your COBRA coverage ends or until Open Enrollment in the fall. If you would like more information on enrolling with a Special Enrollment Period for the loss of employer-sponsored coverage, please visit the Special Enrollment page.

If you have questions or would like additional help, contact Your Health Idaho at 855-944-3246 or visit the Find Help page to find a local certified agent whose assistance is at no cost.

*This percentage is determined each year by the IRS.

Health Reimbursement Arrangements (HRAs)

A Health Reimbursement Arrangement (HRA) is an employer health benefit that provides employees with tax-free reimbursement for qualified medical expenses when enrolled in an individual health insurance plan, such as those purchased through Your Health Idaho.

Your employer may offer a Qualified Small Employer HRA (QSEHRA) or an Individual Coverage HRA (ICHRA) as an alternative to traditional group health insurance coverage. Your employer will provide you with a written notice at least 90 days before your HRA plan year starts. Make sure to keep this letter, as it contains the information required to enroll, including the type of HRA, coverage terms, the start date, and details to determine your HRA plan’s affordability.

Qualified Small Employer HRA (QSEHRA)
Small employers with less than 50 employees can offer a QSEHRA. QSEHRAs reimburse you for medical expenses, including monthly premiums, co-pays, deductibles, and other out-of-pocket costs. To qualify, you must be enrolled in minimum essential individual health insurance coverage, a requirement met by all plans offered by Your Health Idaho. QSEHRAs have a capped benefit amount set yearly by the IRS.

Individual Coverage HRA (ICHRA)
An ICHRA reimburses employees for some or all of the cost of health insurance monthly premiums for coverage they purchase on their own. There are no limits to the benefit amount, allowing your employer the flexibility to determine their contribution and the option to give a higher contribution to employees with dependents. To use ICHRA funds, you must be enrolled in minimum essential individual health insurance coverage.

When to Enroll
If your employer offers an HRA that starts on January 1, you must enroll in a plan during Your Health Idahoan’s Open Enrollment, October 15 – December 15, to ensure your coverage will begin at the same time.

If your employer offers an HRA start date other than January 1, it may be considered a Qualifying Life Event (QLE), and you would qualify for a Special Enrollment Period to enroll in coverage. The date coverage begins under the HRA plan is considered the date of your QLE.

HRA’s and the Advanced Premium Tax Credit (APTC)
If your employer offers an HRA and you want to check if you are eligible for an APTC, here are a few important things to know.

Help is Here
The process can be confusing, but you don’t have to do it alone. Your Health Idaho-certified agents and brokers across the state are ready to help at no cost to you. To find free, expert help in your area, click here.