Employers and Health Coverage: Navigating Your Options

Apr 24, 2024

Understanding health coverage options at work is essential, whether you’re facing a job change or are simply seeking clarification on your employer’s requirements. The necessity of your employer providing health care coverage depends on the size of the company and if you are self-employed. Taking the time to navigate this is important and critical to the protection of your health and wellness.

Is My Employer Required to Provide Coverage?

Smaller companies with less than 50 full-time employees may offer benefits on a voluntary basis, without legal requirement. Larger employers, however, are required to provide health insurance to 95% of their full-time employees in order to avoid penalties under the Affordable Care Act. The insurance provided must meet minimum requirements for coverage and affordability, including extending coverage to dependents, such as biological or adopted children under the age of 26. 

Both part-time and full-time employees who are not offered insurance by their employer can apply through Nevada Health Link to find out what they are qualified for. But if you’re offered health coverage by your employer, you can still opt for insurance through Nevada Health Link instead, if the health insurance option from your employer is deemed “unaffordable”  (more than 8.39% of your household income).

Even if health insurance is deemed affordable for yourself, it may not be for your family. If a family has to pay more than a certain percentage of household income (8.39%) for the employer-sponsored plan, they will potentially be eligible for premium tax credits in the marketplace.

There is a separate affordability determination for the employee (based on self-only coverage), and for family members (based on the total cost of family coverage). So, depending on how an employer subsidizes the cost of family coverage, it’s possible that coverage could be considered affordable for the employee but not for family members. In that case, the family members would potentially be eligible for a premium tax credit in the marketplace, but the employee would not.

Health insurance for the self-employed or freelance workers can also be found using NevadaHealthLink.com, which prioritizes insurance plans that are tailored to fit the lifestyle and budget of people with changing needs.

Your Options After Losing Health Insurance from Employers

The Consolidated Omnibus Budget Reconciliation Act or COBRA allows you to continue health coverage provided by your group health plan under specific circumstances such as a job loss or reduced working hours.

Residents of Nevada who lose Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage for any reason, should consider utilizing Loss of Minimum Essential Coverage (Loss of MEC) as their Qualifying Life Event selection when applying for coverage through Nevada Health Link during a Special Enrollment Period. 

It is important to report any life or income changes even after enrolling in health coverage through NevadaHealthLink.com, to ensure the most advantageous eligibility determination for each consumer. Examples of life changes include the loss of health coverage, a new addition to the family, relocation to a new service area, change in income, getting married or divorced, and turning 26.

Empowering Nevadans Regardless of Employer Coverage