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Employer coverage

Minimum value: the employer-plan test behind PTC eligibility

Understand the 60% actuarial standard and substantial inpatient and physician coverage requirement without relying on a plan label.

Ruling
An employer plan generally provides minimum value when it covers at least 60% of allowed benefit costs and provides substantial inpatient hospital and physician coverage. The employer should supply minimum-value information.

Use employer documentation

Review the Summary of Benefits and Coverage and Marketplace employer coverage tool or notice. Deductible size alone does not decide minimum value, and an employee should not try to reconstruct actuarial value from a short benefit summary.

Combine minimum value with affordability

An offer generally blocks PTC only when it both provides minimum value and is affordable under the applicable test. Actual enrollment in employer coverage has a separate effect even when the offer would have failed one of those tests.

Decision example and mistake

An employer calls a plan comprehensive, but its notice states that it does not meet minimum value. The employee may have a Marketplace path if other rules are met. The mistake is treating minimum essential coverage and minimum value as interchangeable terms.

Use employer plan evidence

Retain the Summary of Benefits and Coverage and the employer's minimum-value representation. Minimum essential coverage, minimum value, and affordability are separate concepts. A plan generally needs at least 60% actuarial value plus substantial inpatient hospital and physician benefits for this test; deductible size or an employer's marketing name is not enough.

If documentation is incomplete, ask for a written employer determination; a Marketplace estimate made from a deductible alone is weak support at reconciliation.

Filing and enrollment checks

  • Locate the minimum-value statement in employer materials.
  • Ask the employer to resolve conflicting documents before enrollment.
  • Test affordability only after identifying a plan that provides minimum value.

Continue with

Employer coverage affordability and the 2026 premium tax creditEmployer affordability for a spouse and dependentsReporting a new job offer, Medicare, Medicaid, or other coverage

Authorities used for this guide