Marketplace coverage & HRAs
The
helps individuals and families shop for and enroll in health coverage. Before you accept the
offer from your employer, figure out if you’re eligible for savings on Marketplace coverage — you may save more with Marketplace savings than the HRA.
Do I qualify for Marketplace savings?
When you apply for Marketplace coverage, you’ll find out if you qualify for:
- Savings on a Marketplace plan, called the “” that lowers the monthly premium you pay to your Marketplace plan
- Free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP)
When your employer offers or provides you an HRA, your eligibility for Marketplace savings is determined by:
- The type of HRA — check the letter you got from your employer
- The dollar amount your employer will contribute to the HRA
- Your household income
- If other household members can use the HRA
Warning: An individual coverage HRA offer may impact your eligibility for savings on Marketplace coverage. The only way you’ll qualify for savings to help pay for Marketplace coverage is if you don’t accept the individual coverage HRA and the individual coverage HRA isn’t considered affordable. Learn more about affordability.
HRAs & the affordability standard
The only way you’ll qualify for Marketplace savings and any eligible household members is if your employer’s HRA isn’t considered affordable.
- Find out if your individual coverage HRA meets requirements for “affordability.”
- Learn more about how individual HRA offers work (PDF, 629 KB)
- Use this worksheet (PDF, 143 KB) to find out if your QSEHRA meets requirements for “affordability"
What if my employer offers me an HRA and other coverage?
- Use the Employer Coverage Tool (PDF, 154 KB) to figure out if you can get Marketplace coverage with savings instead.
- Confirm you qualify for savings when you apply for Marketplace coverage and tell us what coverage you’re offered from your employer.
Select whether you qualify for savings for more details and next steps:
If you qualify for the premium tax credit, the HRA isn’t considered affordable. Your next steps depend on your HRA type:
- If you have an individual coverage HRA and want to get the savings, you must:
- Enroll in Marketplace coverage to apply the savings. You can’t use both a premium tax credit and the HRA. If you accept your HRA and use the tax credit, you may owe money when you file your federal taxes.
- Tell your employer you decline (or opt out of) the HRA so you can use the premium tax credit for your Marketplace coverage.
- If you have a QSEHRA, you can:
- Use a combination of the premium tax credit and HRA amount, if the QSEHRA is considered unaffordable.
- You should lower the amount of the premium tax credit you use towards your monthly premiums. When the Marketplace asks how much of the premium tax credit you want to take in advance, subtract your monthly QSEHRA amount from the total premium tax credit amount you qualify for. Complete this worksheet for help to decide how much of the tax credit you should take (PDF, 143 KB).
If you qualify for free or low-cost coverage through Medicaid or CHIP, it doesn’t matter if the HRA is considered affordable.
- If eligible, we’ll send your information to your state Medicaid agency.
- If you enroll in Medicaid or CHIP instead of other coverage, tell your employer you’re declining (or opting out of) the HRA.
- If you don’t enroll in Medicaid or CHIP, you can still apply your HRA to a full-price Marketplace plan.
If you don’t qualify for a Marketplace plan with the premium tax credit, or for Medicaid or CHIP, you can use your HRA to help pay for coverage instead.
For certain types of HRAs, you and any eligible household members must enroll in a health plan that you bought through the Marketplace or another source, like directly through an insurance company, to use the HRA money.