We're here to help you figure out your role in the NY State of Health Exchange and how it will affect your agency.
Q. Under the Affordable Care Act, can an employee buy individual health coverage through the state exchange if his employer offers him coverage? Does it matter how many employees the employer has?
A. Almost anyone may purchase coverage through the individual exchange, whether or not they can get coverage through work. The only people who cannot are those who are: 1) Residing in the U.S. in violation of its laws; or 2) incarcerated. Anyone else is free to buy (or not buy) through the exchange. However, if the employer’s plan covers at least 60 percent of the insurer’s allowed charges, and if the employee contribution for self-only coverage is less than 9.5 percent of that employee’s gross household income, the employee will not qualify for a premium tax credit. That’s a pretty strong incentive for employees to go with the employer’s plan.
Employer size does not affect an employee’s ability to buy coverage through the exchange. However,employers with more than 50 full-time equivalent employees face a tax penalty if one or more full-time employees get premium tax credits by purchasing coverage through the exchange. Employers with fewer than 50 full-time equivalents do not have to worry about that.