Jeffrey Wade
If you're wondering whether you can get medical insurance from your employer at any time, it's important to understand that while you can get insurance through your job, there are specific factors and limitations to consider. Firstly, your employer is mandated by law to offer health insurance that is affordable and provides minimum essential coverage to a certain percentage of their full-time employees and their children. This means that not all employers are required to provide insurance, and the specifics of the plans offered can vary. It's also worth noting that you have the option to decline your employer's insurance and seek alternative coverage, but individual plans are often more expensive.
| Characteristics | Values |
|---|---|
| Can you get medical insurance from your employer at any time? | No, there are specific enrollment periods. |
| Can you decline employer-provided health insurance? | Yes, you can decline and purchase an individual plan. |
| Can you get individual insurance if you have employer-provided insurance? | Yes, but you may not be eligible for government subsidies. |
| Can you get employer-provided insurance if you have individual insurance? | Yes, but you may lose savings on your individual plan. |
| Is employer-provided insurance always cheaper? | No, but it usually is as employers subsidize a large portion of the premium. |
| Is individual insurance always more expensive? | No, it may be cheaper if you qualify for subsidies. |
| What is considered "affordable" insurance? | In 2024, if employee contributions are less than 8.39% of the household income. In 2025, this increases to 9.02%. |
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What You'll Learn
- If your employer doesn't offer insurance, you can wait for open enrollment to sign up for your own coverage
- You can decline your employer's insurance and get your own, but individual plans are often pricier
- If your employer's insurance is unaffordable, you may qualify for savings on a Marketplace plan
- If you have a Marketplace plan and get offered job-based insurance, you may no longer qualify for savings on your Marketplace plan
- Employers with 50+ full-time employees must offer affordable insurance to 95% of full-time employees and their children or pay a penalty
If your employer doesn't offer insurance, you can wait for open enrollment to sign up for your own coverage
If your employer does not offer health insurance, you can wait for the next open enrollment period to sign up for your own coverage. This period typically runs from November 1 to January 15 in most states, and it is when employees can enroll, disenroll, or make changes to their health benefits. During this time, insurance rates are reassessed, and health plan prices are often altered for the coming benefit year.
If you are unable to wait for the next open enrollment period, there are a few other options available to you. Firstly, you can explore the possibility of creating your own 'benefits package'. This may involve purchasing supplemental benefits such as dental, vision, or disability insurance to add to your existing coverage. Additionally, if your employer does not offer group coverage, they may be able to assist with your individual health insurance premiums through a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) or an Individual Coverage Health Reimbursement Arrangement (ICHRA).
Another option is to look into state-specific programs. For example, Basic Health Programs are available in New York, Minnesota, and Oregon, while The ConnectorCare program in Massachusetts is open to new enrollees. Additionally, American Indians and Alaskan Natives can enroll in coverage year-round through the marketplace/exchange, and Medicaid/CHIP enrollment is also available nationwide for eligible applicants.
If you have recently experienced certain qualifying life events, such as losing your previous coverage, moving, getting married, having a baby, or adopting a child, you may be eligible for a Special Enrollment Period. This allows you to enroll in a health insurance plan outside of the regular open enrollment period.
Finally, it is important to consider your provider network when comparing plans. Pay close attention to the specific doctors included in the plan's network and the medications covered by the plan, as these can vary significantly between different options.
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You can decline your employer's insurance and get your own, but individual plans are often pricier
You can decline your employer's health insurance and get your own, but it's important to carefully evaluate your budget and alternative options before making a decision. Individual plans are often more expensive than employer-sponsored plans because the latter are usually subsidised by the employer. Employers that offer health insurance typically pay about 83% of the cost of employees' coverage and 73% of premiums for family coverage, with employees contributing the remaining 17% or 27% respectively.
If you're covering your entire family on your employer's plan, it's worth finding out how much it would cost to insure just yourself under that plan. In some cases, the cost to cover your family may be lower if you split them onto two plans, using an individual market plan for your family members and your employer-sponsored plan for yourself. This is especially true if your employer subsidises the cost of premiums for employees but not for dependents and spouses.
If you decline your employer's health insurance, you can enrol in a different plan during your employer's open enrolment period, unless you qualify for special enrolment due to a qualifying event, such as getting married or having a child. You can find an individual plan through the Healthcare.gov marketplace, directly from a private health insurance company, or through another source, such as Medicare or Medicaid.
It's important to consider the provider network, drug formularies, and out-of-pocket costs of both options before making a decision. Additionally, if you have a Marketplace plan and get an offer of health insurance through your job, you may no longer qualify for savings on your Marketplace plan, even if you don't accept the job-based coverage.
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If your employer's insurance is unaffordable, you may qualify for savings on a Marketplace plan
If you have job-based health insurance or are offered health insurance by your employer, you will not qualify for savings on a Marketplace plan if the job-based plan is considered affordable. In 2025, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by your employer is less than 9.02% of your household income. If your employer's insurance is deemed unaffordable, you and other members of your household may qualify for savings on a Marketplace plan.
When you apply for Marketplace coverage, the affordability of the job-based insurance premiums will be checked for you (the employee) and other members of your household. A job-based plan usually meets the minimum value standard if it is designed to cover at least 60% of medical costs and offers substantial coverage of hospital and doctor services. Most job-based plans meet this standard. If the job-based insurance is considered affordable for you but not for other members of your household, then only the other household members may qualify for savings.
If you have a Marketplace plan and are offered health insurance by your employer, you may no longer qualify for savings on your Marketplace plan even if you do not accept the job-based coverage offer. If you have already accepted the offer of job-based insurance, you may want to cancel your Marketplace plan for yourself and anyone else in your household eligible for the new job-based coverage. You won't qualify for savings if you're enrolled in a job-based plan.
If your employer does not offer health insurance and you do not have a recent or imminent qualifying life event, you will likely need to wait until open enrollment to sign up for your own health coverage. Open enrollment typically runs from November 1 to January 15. However, American Indians and Alaska Natives can enroll in coverage year-round through the marketplace/exchange, and Medicaid/CHIP enrollment is also available year-round for eligible applicants.
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If you have a Marketplace plan and get offered job-based insurance, you may no longer qualify for savings on your Marketplace plan
In the United States, the Affordable Care Act (Obamacare) allows individuals to purchase health insurance through the Health Insurance Marketplace (HealthCare.gov). This is particularly useful for those who do not have access to employer-sponsored health insurance.
If you have a Marketplace plan and receive an offer for job-based insurance, you may no longer be eligible for savings on your Marketplace plan, even if you don't accept the job-based coverage. This is because, when you apply for Marketplace coverage, the affordability of the job-based insurance premiums for you and your household is assessed. If the job-based insurance is deemed affordable, you won't qualify for a premium tax credit if you opt for a Marketplace plan. In 2025, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by the employer is less than 9.02% of your household income.
If you have an offer but haven't accepted it yet, it is advisable to update your Marketplace application to understand how this offer impacts your Marketplace savings. If you qualify for savings, you may want to retain your Marketplace coverage. However, if you have already accepted the offer of job-based insurance, you may want to cancel your Marketplace plan for yourself and your household members who are eligible for the new job-based coverage.
It is important to note that you can cancel a Marketplace plan at any time during the year, although it is recommended that you request the cancellation in advance, aligning it with the start of your new employer-sponsored coverage.
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Employers with 50+ full-time employees must offer affordable insurance to 95% of full-time employees and their children or pay a penalty
In the United States, employers with 50 or more full-time employees are mandated to offer affordable health insurance coverage to their full-time employees and their children until the age of 26. This mandate, known as the "employer mandate", came into effect in 2016, and failure to comply may result in penalties for the employer.
The definition of a full-time employee varies, but generally, it refers to employees who work 30 or more hours per week or 130 hours per calendar month, including vacation and paid leaves of absence. It is important to note that this mandate does not require employers to provide coverage for spouses, and they are only required to offer affordable coverage for the employee and their children.
The affordability of health insurance is determined by the employee's household income. In 2024, coverage is considered affordable if the employee's contribution for employee-only coverage does not exceed 8.39% of their household income. This percentage will increase to 9.02% in 2025.
If an employer does not offer health insurance coverage or provides coverage to less than 95% of its full-time employees and their dependents, they may be subject to a penalty known as the "employer shared responsibility payment". This penalty is calculated based on the number of full-time employees and is triggered if at least one of the employees receives a premium tax credit for purchasing individual coverage on a Health Insurance Marketplace.
It is worth noting that the penalty amount depends on whether the employer does not offer any coverage or offers coverage that is unaffordable or does not provide minimum value. The minimum value of a health insurance plan is generally considered to be covering at least 60% of medical costs and providing substantial coverage for inpatient and physician services.
Employees who do not have employer-provided health insurance or are unsatisfied with their current coverage can explore alternative options during the open enrollment period, which typically runs from November 1 to January 15. During this period, individuals can sign up for their own health coverage, potentially finding more affordable options or plans that better meet their needs.
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Frequently asked questions
No, you can only get medical insurance from your employer during open enrollment, which runs from November 1 to January 15 in most states. If your employer’s open season is at a different time of year, you may qualify for a Special Enrollment Period.
If your employer doesn't offer medical insurance, you can purchase your own individual policy. You can find an individual plan through the Healthcare.gov marketplace, directly from a private health insurance company, or through another source, such as Medicare or Medicaid.
Yes, you can decline your employer's health insurance. However, individual health plans can be significantly more expensive than employer-sponsored coverage, especially if your employer contributes to premiums.
