Determining whether an employer-sponsored health plan meets the affordability requirements under the Affordable Care Act (ACA) for the 2024 plan year involves comparing the employee’s required contribution for the lowest-cost, self-only coverage offered by the employer to a specific percentage of the employee’s household income. For 2024, the applicable percentage is 9.12%. As an example, if an employee’s annual household income is $50,000, the maximum amount they can be required to contribute for that minimum essential coverage is $4,560 annually, or $380 per month ($50,000 x 0.0912 = $4,560). If the employee’s required contribution exceeds this amount, the coverage is considered unaffordable.
Assessing whether health coverage is affordable is essential because it determines whether employees are eligible for premium tax credits to purchase coverage on the Health Insurance Marketplace. If an employer offers coverage that is deemed unaffordable, or that does not meet minimum value requirements, employees may be eligible for these subsidies, shifting some of the coverage responsibility from the employer to the federal government. This calculation also plays a vital role in employer compliance with the ACA’s employer mandate, which requires applicable large employers (ALEs) to offer affordable, minimum value coverage to their full-time employees or potentially face penalties. The historical context reveals that the affordability percentage is adjusted annually, reflecting changes in the cost of healthcare and inflation rates, making annual assessment crucial.