Most of the time, Vermonters who can get health coverage through work aren’t eligible for financial help through Vermont Health Connect (VHC). However, if your employer offers health insurance that is not considered adequate or affordable by the federal government, you may be able to get financial help. Here's how to find out if your employer's health coverage is adequate and affordable:
The first step is to get information from your employer. You need two pieces of information about your employer's health plan:
- Is the plan adequate? In other words, does it meet the federal minimum value standard? Your human resources department or employer can give you this information.
- Is the plan affordable? Look at what you would pay for the lowest cost single plan (a plan for only you) through your work insurance. You have to look at the cost of a single plan even if you are enrolled in a family or couple plan. Don’t count what your employer pays. If you pay more of your household income than the federal affordability standard, the plan is not affordable.
An easy way to get this information is to ask your employer to fill out the Employer Coverage Tool for the plan year you’re looking for.
Once your employer has given you a completed Employer Coverage Tool, you can use the worksheet below to find out if your employer's coverage is affordable under the federal standards. If you prefer, you can also send the completed Employer Coverage Tool with your application for health coverage and we can figure out your plan's affordability for you. If the plan is not affordable, you can apply for financial help paying for a Vermont Health Connect plan during your next enrollment period.
(Please note that if your employer is offering coverage through Vermont Health Connect, you must use the cost of the lowest cost bronze plan available to a single person.)
Employer-Sponsored Insurance Affordability Worksheet
- The percent of household income that the federal government considers affordable:______________________ (line 1) Review the list of affordability rates by year, and find the affordability rate for the plan year you’re looking for. Put the rate on line 1.
- The amount you would have to spend every month to get the lowest cost single (self-only) plan for the plan year you’re looking for: ______________________ (line 2)
- Multiply line 2 by 12 to get the amount you would spend every year: __________________________ (line 3)
- Enter your estimated household income for the plan year you’re looking for (include wages and tips, salary, self-employment income, interest and dividends received, alimony received, Social Security paid to your household, other income): _____________________ (line 4)
- Divide line 3 by line 4 to find your cost as a percent of your household income: _____________________ (line 5)
- Take the number from line 5.
- Move the period two places to the right. For example, .0932 becomes 9.32
- Add a percent symbol after it. For example: 9.32 becomes 9.32%.
- Write that number here: _____________________ (line 6)
If line 6 is a larger percentage than the federal percentage in line 1, your plan is considered unaffordable. Based on this information, you may qualify for financial help if you apply for coverage through Vermont Health Connect.
If line 6 is not a larger percentage than the percentage in line 1, your plan meets the federal definition of affordability. Based on this information, you will not qualify for financial help through Vermont Health Connect.
- VHC uses Modified Adjusted Gross Income (MAGI) to determine your income. A health plan is 'affordable' if the cost of a single plan is less than, or equal to, the federal affordability standard for the plan year as a percentage of your tax household's MAGI.
- You must use the lowest cost single plan for your calculation, even if you’re going to buy a plan that covers other family members.
- 'Your required contribution' (line 2 of the worksheet) is the amount you pay each month after the money your employer pays toward your health insurance (if any).