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Navigating health insurance options can feel overwhelming, especially with all the terms and guidelines around coverage and affordability. At Simco, we want to help you and your employees make sense of it all, from understanding what qualifies as credible coverage to how affordable coverage is determined, and what the income limits mean for Marketplace tax credits in 2025. What Is Credible Coverage? Credible coverage refers to health insurance plans that meet or exceed the minimum standards set by government regulations. This is important because if you have credible coverage, you generally don’t qualify for premium tax credits through the health insurance Marketplace. Examples of credible coverage include: Employer-sponsored group health plans Medicare and Medicaid Certain veterans’ health plans Individual health insurance plans that meet minimum essential coverage standards Most employer-sponsored health plans, whether from small businesses or large corporations, are considered credible coverage. This means if you or your employees have health insurance through your job, it likely meets these standards, protecting you from paying unnecessary penalties and possibly disqualifying you from claiming Marketplace subsidies. Why does credible coverage matter? Because if you already have credible coverage, you generally won’t qualify for premium tax credits on Marketplace plans. The government uses this benchmark to ensure people aren’t “double-dipping” by receiving subsidies when they already have adequate insurance. What Does Affordable Coverage Mean? Affordable coverage refers to the cost threshold for employer-provided health insurance that determines if it’s affordable relative to your household income. The IRS sets this threshold annually, and for 2025, the maximum employee-only premium cost to be considered affordable is 9.02% of your household income . Here’s how it works: If the monthly premium you pay for employee-only coverage is less than 9.02% of your household income, your coverage is deemed affordable. If it costs more, you or your employees may be eligible for Marketplace subsidies or tax credits if you choose to enroll there instead. This affordability standard helps employees understand if they have access to reasonably priced insurance through their employer or if Marketplace options might be a better fit financially. Income Guidelines for 2025 Marketplace Tax Credits To qualify for premium tax credits that help lower the cost of Marketplace health insurance, your household income must fall within certain federal poverty level (FPL) ranges. For 2025, individuals and families with household incomes between 100% and 400% of the federal poverty level may be eligible for these credits. The exact dollar amounts vary depending on your household size and location, but generally, the lower your income within this range, the greater your potential tax credit. These credits are designed to make health insurance more accessible and affordable for people who do not have credible or affordable coverage through an employer. Why This Matters as the 2025 Annual Enrollment Period Approaches With the 2025 Annual Enrollment Period (AEP) approaching soon (October 15 to December 7), it’s the perfect time to review your Medicare coverage and evaluate your options. Many people discover that their current plans may no longer be the best fit, or that marketplace options and tax credits could help bridge coverage gaps. Simco is here to guide you and/or your employees through the complexities of health insurance during AEP and beyond. We’ll assess your situation, explain your options, and guide you through enrollment with confidence. Have questions? Contact us today! We’ve got you covered.