For plan year 2025 a job-based health plan that costs 9.02% or less of the employee's household income is considered affordable coverage. If a job-based plan is "affordable," and meets the minimum value standard, you're not eligible for a premium tax credit if you buy coverage through Georgia Access instead.
The plan used to define affordability is the lowest priced "self-only" plan the employer offers - meaning a plan covering only the employee, not dependents. This is true even if you're enrolled in a plan that costs more or covers dependents.
The cost is the amount the employee would pay for the insurance, not the plan's total premium.
The employee's total household income is used. Total household income includes income from everybody in the household who's required to file a tax return.
Example:
- Household’s monthly income = $4,083 (about $49,000 per year).
- 9.02% of the household’s monthly household income = $369
For the employee:
- Monthly premium the employee would have to pay for the lowest-priced plan that covers just the employee = $300
- Is the plan affordable for the employee? YES. The premium the employee would have to pay to cover just themselves ($300) is less than 9.02% of the household’s income ($369). Because the job-based coverage is affordable for the employee, the employee won’t qualify for savings in Georgia Access.
For other household members:
- Monthly premium the employee would have to pay for the lowest-priced plan that covers other members of their household = $450
- Is the plan affordable for other household members? NO. The premium the employee would have to pay to cover others in the household ($450) is more than 9.02% of the household’s income ($369). Because the job-based coverage isn't affordable for the employee’s household members, the employee’s household members may qualify for savings in Georgia Access.
To find out if your employer’s plan meets the affordability standard, ask your employer.