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Employer-Sponsored Coverage
If you are offered unaffordable health insurance, COBRA, or an HRA (QSEHRA or ICHRA) through your employer, you may qualify for a tax credit and be eligible to enroll in coverage through Your Health Idaho.
- Affordability
- Eligibility
- COBRA Alternatives
- HRAs
Unaffordable Employer-Sponsored Coverage
How to Determine Affordability
For 2026, health insurance is considered unaffordable if the cost of the lowest-cost health plan* offered by your employer is more than 9.96%** of your total household income. It is calculated separately for the employee and their family.
Offered employer-sponsored coverage? See if it’s considered affordable with our calculator — no account required.
Affordability is based on an employer’s lowest-price plan, even if it is not the plan the employee and their family are enrolled in. This percentage is determined each year by the IRS. For 2026 plans, the percentage is 9.96%.
YOUR ELIGIBILITY
If Your Employer-Sponsored Coverage Is…
Three common scenarios and what each one means for you.
SCENARIO 1
Unaffordable for your family
Your family may qualify for a tax credit and be eligible to enroll in coverage through Your Health Idaho. You would stay on your employer-sponsored coverage.
SCENARIO 2
Unaffordable for your dependents
Your dependents may qualify for a tax credit and be eligible to enroll in coverage through Your Health Idaho. You and your spouse would stay on your employer-sponsored coverage
SCENARIO 3
Unaffordable for you and your family
You and your family may qualify for a tax credit and be eligible to enroll in coverage through Your Health Idaho.
WHEN CAN YOU ENROLL
There are two time a year when you can enroll:
Enroll during your employer's Open Enrollment period
October 15 – December 15
Enroll during Your Health Idaho's Open Enrollment
We highly recommend confirming your employer-sponsored coverage is unaffordable before canceling your policy or opting out of enrollment. You can do this by completing the application; this does not commit you to enrollment through Your Health Idaho.
Ready to enroll?
LOSING JOB-BASED COVERAGE?
Low-Cost Alternatives to COBRA
If you are going through an employment transition or recently lost employer health insurance, you might be eligible for a Special Enrollment Period. Health coverage at Your Health Idaho can be a low-cost option when compared to COBRA. Review your options carefully. If you decide to enroll in COBRA, you will not be eligible for a Special Enrollment Period until your COBRA coverage ends or until Open Enrollment in the fall.
COBRA is Expensive
COBRA may be expensive if your previous employer doesn’t help with premium payments or provides assistance only for a limited time.
Tax Credits
Your Health Idaho is the only place you can receive a tax credit to pay for some or all of your monthly health insurance premiums.
Additional Savings
Services range from preventive screenings and counseling to behavioral therapy.
If you would like more information on enrolling with a Special Enrollment Period for the loss of employer-sponsored coverage, please visit the Special Enrollment page. If you have questions or would like additional help, contact Your Health Idaho at 855-944-3246 or visit the Find Help page to find a local certified agent whose assistance is at no cost.
HEALTH REIMBURSEMENT ARRANGEMENTS
Does Your Employer Offer an HRA?
A Health Reimbursement Arrangement (HRA) is an employer health benefit that provides employees with tax-free reimbursement for qualified medical expenses when enrolled in an individual health insurance plan, such as those purchased through Your Health Idaho.
Your employer may offer a Qualified Small Employer HRA (QSEHRA) or an Individual Coverage HRA (ICHRA) as an alternative to traditional group health insurance coverage. Your employer will provide you with a written notice at least 90 days before your HRA plan year starts. Make sure to keep this letter, as it contains the information required to enroll, including the type of HRA, coverage terms, the start date, and details to determine your HRA plan’s affordability.
FOR SMALL EMPLOYERS
QSEHRA
Qualified Small Employer HRA
Small employers with less than 50 employees can offer a QSEHRA. QSEHRAs reimburse you for medical expenses, including monthly premiums, co-pays, deductibles, and other out-of-pocket costs. To qualify, you must be enrolled in minimum essential individual health insurance coverage, a requirement met by all plans offered through Your Health Idaho. QSEHRAs have a capped benefit amount set yearly by the IRS.
FOR ANY SIZE EMPLOYER
ICHRA
Individual Coverage HRA
An ICHRA reimburses employees for some or all of the cost of health insurance monthly premiums for coverage they purchase on their own. There are no limits to the benefit amount, allowing your employer the flexibility to determine their contribution and the option to give a higher contribution to employees with dependents. To use ICHRA funds, you must be enrolled in minimum essential individual health insurance coverage.
ICHRA vs QSEHRA
How HRAs Affect Your Tax Credit Eligibility
If your employer offers an HRA and you want to check if you are eligible for an Advance Premium Tax Credit (APTC), here are a few important things to know.
| ICHRA | QSEHRA | |
|---|---|---|
| Can I still get an APTC if I'm offered an HRA? | If your employer offers an HRA that makes coverage through Your Health Idaho affordable to buy, then you will not be eligible for the APTC. | If your employer offers an HRA that makes coverage through Your Health Idaho affordable to buy, then you will not be eligible for the APTC. |
| What does it mean for an HRA to be considered affordable? | Your ICHRA is considered affordable if the cost to buy the lowest-cost silver plan after applying the HRA is less than 9.96% of your income. | Your QSEHRA is considered affordable if the cost to buy the second-lowest-cost silver plan after applying the QSEHRA is less than 9.96% of your income. |
| What if my employer offers an HRA that is unaffordable? | You will need to decline the ICHRA to be eligible for a tax credit and would need to meet the other requirements for tax credit eligibility. | If you qualify for a tax credit, you will need to deduct your monthly QSEHRA amount from your monthly tax credit amount. |
GET HELP AT NO COST
Not Sure Where to Start?
Speak with a certified agent or broker at no cost. They’ll help you determine affordability, compare plans, and enroll — on your schedule, at your pace.
855-944-3246
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Affordability Threshold