What the Government Considers “Affordable”
For employees receiving their benefits from an employer.
If the employee portion of the health insurance the employer provides costs more than 9.5% of the employee’s income, and it doesn’t cover at least 60% (Minimum Value) of the employees medical expenses, this is considered to be “unaffordable”. If your insurance is “unaffordable” you are then permitted to see if you qualify for a Subsidy (Advanced Premium Tax Credit). If the employee’s insurance from their employer is affordable, then the employee is NOT eligible for a tax subsidy.
If you DO NOT receive health insurance from your employer.
As individuals or families, if your portion of the health insurance premium costs more than 8% of your household income, it is considered “unaffordable”, which means you don’t have to buy a medical plan “excludable.”
For individuals and families that go to the exchange to buy health insurance, IF the insurance is greater than 8% of your Modified Adjusted Gross Income (MAGI) it is considered “unaffordable” and you are not required to buy insurance. MOST Americans will find they will qualify for either Medicaid or a Subsidized plan that makes insurance “affordable.”
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Health Insurance with a Preexisting Condition
You may assume that since you have a preexisting condition, you’ll pay a higher premium than someone who is in perfect health. However, an insurer cannot reject you, refuse to pay for health benefits pertaining to your illness or injury, or charge you a higher premium because of your condition.