A health plan from your job is considered “affordable” if your share of the monthly premiums for the lowest-cost coverage that meets the minimum value standard is less than a certain percentage of your household income. This percentage may change each year.

If you’re not sure if your health insurance from your job is considered affordable under the Affordable Care Act (ACA), use our tool below to find out. You may need your employer to complete an Employer-sponsored Health Insurance Affordability Worksheet.

Calculate Affordability for Year 2024

Under the Affordable Care Act (ACA), your employer’s plan is considered affordable in 2024 if the lowest-cost plan costs less than 8.39% of your household’s income. The family member who works for the employer offering coverage should use the lowest cost premium for coverage to cover just the employee. If other family members could enroll in the employer’s plan, they should use the lowest cost premium for the plan that covers them all. The following steps will help you determine if the plan is affordable:

A. Determine your household’s Modified Adjusted Gross Income for 2024

Earlier in the online application, you estimated your household’s annual income.  Write that number down here: $ _____________

If you are not sure what your projected household Modified Adjusted Gross Income will be, here is how you can estimate it:

If you believe your household’s income will be similar to what it was on your last tax return, you can use that return as a tool.

1. If you filed IRS Form 1040, write down Adjusted Gross Income from Line 8b. $ _____________
2. Write down tax-exempt interest from Line 2a. $ _____________
3. Write down your total Social Security benefits in Line 5a $ _____________
4. Write down your taxable Social Security in Line 5b. $ _____________
5. Subtract the taxable Social Security in Number 4 (above) from the total Social Security in Number 3 (above) and write down the difference $ _____________
6. Write down any foreign earned income from IRS Form 2555 Line 43, 46, or 47, whichever applies to you (Note: most people will not have this income.) $ _____________
7. Add up the amounts you wrote down in Number 1, Number 2, Number 5, and Number 6 $ _____________
This is your estimated Modified Adjusted Gross Income for the year.

B. Find out what 8.39% of your monthly household income is

1. Take the Modified Adjusted Gross Income you estimated and multiply it by 0.0839 $ _____________
2. Divide the amount in Number 1 by 12 $ _____________
This is 8.39% of your estimated monthly income for next year

C. Write down the lowest-cost monthly premium for employee-only coverage   $___________

Note: If you do not know this information, One way to get this information is by asking your employer to fill out the Employer-sponsored Health Insurance Affordability Worksheet.

Is this amount more than 8.39% of your income in Section B?

  • If YES, insurance IS NOT affordable to the employee.
  • If NO, insurance IS affordable to the employee.

Write down the lowest-cost monthly premium for the plan that offers coverage to the rest of the family  $___________

Note: If you do not know this information, One way to get this information is by asking your employer to fill out the Employer-sponsored Health Insurance Affordability Worksheet.

Is this amount more than 8.39% of your income in Section B?

  • If YES, insurance IS NOT affordable to the rest of the household.
  • If NO, insurance IS affordable to the rest of the household.

Read across the row closest to your household’s estimated income to see how much an affordable premium is

If your annual household income is: $5,000 Insurance is affordable if the lowest cost plan costs less than this amount per month: $35
$10,000 $70
$15,000 $105
$20,000 $140
$25,000 $175
$30,000 $210
$35,000 $245
$40,000 $280
$45,000 $315
$50,000 $350
$55,000 $385
$60,000 $420
$65,000 $454
$70,000 $489
$75,000 $524
$80,000 $559
$85,000 $594
$90,000 $629
$95,000 $664
$100,000 $699

Calculate Affordability for Year 2023

Under the Affordable Care Act (ACA), your employer’s plan is considered affordable in 2023 if the lowest-cost plan costs less than 9.12% of your household’s income. The family member who works for the employer offering coverage should use the lowest cost premium for coverage to cover just the employee. If other family members could enroll in the employer’s plan, they should use the lowest cost premium for the plan that covers them all. The following steps will help you determine if the plan is affordable:

A. Determine your household’s Modified Adjusted Gross Income for 2023

Earlier in the online application, you estimated your household’s annual income.  Write that number down here: $ _____________

If you are not sure what your projected household Modified Adjusted Gross Income will be, here is how you can estimate it:

If you believe your household’s income will be similar to what it was on your last tax return, you can use that return as a tool.

1. If you filed IRS Form 1040, write down Adjusted Gross Income from Line 8b. $ _____________
2. Write down tax-exempt interest from Line 2a. $ _____________
3. Write down your total Social Security benefits in Line 5a $ _____________
4. Write down your taxable Social Security in Line 5b. $ _____________
5. Subtract the taxable Social Security in Number 4 (above) from the total Social Security in Number 3 (above) and write down the difference $ _____________
6. Write down any foreign earned income from IRS Form 2555 Line 43, 46, or 47, whichever applies to you (Note: most people will not have this income.) $ _____________
7. Add up the amounts you wrote down in Number 1, Number 2, Number 5, and Number 6 $ _____________
This is your estimated Modified Adjusted Gross Income for the year.

B. Find out what 9.12% of your monthly household income is

1. Take the Modified Adjusted Gross Income you estimated and multiply it by 0.0912 $ _____________
2. Divide the amount in Number 1 by 12 $ _____________
This is 9.12% of your estimated monthly income for next year

C. Write down the lowest-cost monthly premium for employee-only coverage   $___________

Note: If you do not know this information, One way to get this information is by asking your employer to fill out the Employer-sponsored Health Insurance Affordability Worksheet.

Is this amount more than 9.12% of your income in Section B?

  • If YES, insurance IS NOT affordable to the employee.
  • If NO, insurance IS affordable to the employee.

Write down the lowest-cost monthly premium for the plan that offers coverage to the rest of the family  $___________

Note: If you do not know this information, One way to get this information is by asking your employer to fill out the Employer-sponsored Health Insurance Affordability Worksheet.

Is this amount more than 9.12% of your income in Section B?

  • If YES, insurance IS NOT affordable to the rest of the household.
  • If NO, insurance IS affordable to the rest of the household.

Read across the row closest to your household’s estimated income to see how much an affordable premium is

If your annual household income is: $5,000 Insurance is affordable if the lowest cost plan costs less than this amount per month: $38
$10,000 $76
$15,000 $114
$20,000 $152
$25,000 $190
$30,000 $228
$35,000 $266
$40,000 $304
$45,000 $342
$50,000 $380
$55,000 $418
$60,000 $456
$65,000 $494
$70,000 $532
$75,000 $570
$80,000 $608
$85,000 $646
$90,000 $684
$95,000 $722
$100,000 $760

Calculate Affordability for Year 2022

Under the Affordable Care Act (ACA), your employer’s plan is considered affordable in 2022 if the lowest-cost plan that covers only the employee (self-only) costs less than 9.61% of your household’s income. Don’t use the cost of a family plan, even if you need coverage for your whole family. The following steps will help you determine if the plan is affordable:

A. Determine your household’s Modified Adjusted Gross Income for 2022

Earlier in the application, you estimated your household’s annual income.  Write that number down here: $ _____________

If you are not sure what your projected household Modified Adjusted Gross Income will be, here is how you can estimate it:

If you believe your household’s income will be similar to what it was on your last tax return, you can use that return as a tool.

1. If you filed IRS Form 1040, write down Adjusted Gross Income from Line 8b. $ _____________
2. Write down tax-exempt interest from Line 2a. $ _____________
3. Write down your total Social Security benefits in Line 5a $ _____________
4. Write down your taxable Social Security in Line 5b. $ _____________
5. Subtract the taxable Social Security in Number 4 (above) from the total Social Security in Number 3 (above) and write down the difference $ _____________
6. Write down any foreign earned income from IRS Form 2555 Line 43, 46, or 47, whichever applies to you (Note: most people will not have this income.) $ _____________
7. Add up the amounts you wrote down in Number 1, Number 2, Number 5, and Number 6 $ _____________
This is your estimated Modified Adjusted Gross Income for the year.

B. Find out what 9.61% of your monthly household income is

1. Take the Modified Adjusted Gross Income you estimated and multiply it by 0.0961 $ _____________
2. Divide the amount in Number 1 by 12 $ _____________
This is 9.61% of your estimated monthly income for next year

C. Write down the lowest-cost monthly premium for employee-only coverage   $___________

Note: If you do not know this information, One way to get this information is by asking your employer to fill out the Employer-sponsored Health Insurance Affordability Worksheet.

Is this amount more than 9.61% of your income in Section B?

  • If YES, insurance IS NOT affordable to you.
  • If NO, insurance IS affordable to you.

Read across the row closest to your household’s estimated income to see how much an affordable premium is

If your household income is: $5,000 Insurance is affordable if the lowest cost plan to cover the employee only (not a family plan) costs less than: $40
$10,000 $80
$15,000 $120
$20,000 $160
$25,000 $200
$30,000 $240
$35,000 $280
$40,000 $320
$45,000 $360
$50,000 $400
$55,000 $440
$60,000 $481
$65,000 $521
$70,000 $561
$75,000 $601
$80,000 $641
$85,000 $681
$90,000 $721
$95,000 $761
$100,000 $801

Calculate Affordability for Year 2021

Under the Affordable Care Act (ACA), your employer’s plan is considered affordable in 2020 if the lowest-cost plan that covers only the employee costs less than 9.83% of your household’s income. Don’t use the cost of a family plan, even if you need coverage for your whole family. The following steps will help you determine if the plan is affordable:

A. Determine your household’s Modified Adjusted Gross Income for 2021

Earlier in the application, you estimated your household’s annual income.  Write that number down here: $ _____________

If you are not sure what your projected household Modified Adjusted Gross Income will be, here is how you can estimate it:

If you believe your household’s income will be similar to what it was on your last tax return, you can use that return as a tool.

1. If you filed IRS Form 1040, write down Adjusted Gross Income from Line 8b. $ _____________
2. Write down tax-exempt interest from Line 2a. $ _____________
3. Write down your total Social Security benefits in Line 5a $ _____________
4. Write down your taxable Social Security in Line 5b. $ _____________
5. Subtract the taxable Social Security in Number 4 (above) from the total Social Security in Number 3 (above) and write down the difference $ _____________
6. Write down any foreign earned income from IRS Form 2555 Line 43, 46, or 47, whichever applies to you (Note: most people will not have this income.) $ _____________
7. Add up the amounts you wrote down in Number 1, Number 2, Number 5, and Number 6 $ _____________
This is your estimated Modified Adjusted Gross Income for the year.

B. Find out what 9.83% of your monthly household income is

1. Take the Modified Adjusted Gross Income you estimated and multiply it by 0.0983 $ _____________
2. Divide the amount in Number 1 by 12 $ _____________
This is 9.83% of your estimated monthly income for next year

C. Write down the lowest-cost monthly premium for employee-only coverage   $___________

Note: If you do not know this information, One way to get this information is by asking your employer to fill out the Employer-sponsored Health Insurance Affordability Worksheet.

Is this amount more than 9.83% of your income in Section B?

  • If YES, insurance IS NOT affordable to you.
  • If NO, insurance IS affordable to you.

Read across the row closest to your household’s estimated income to see how much an affordable premium is

If your household income is: $5,000 Insurance is affordable if the lowest cost plan to cover the employee only (not a family plan) costs less than: $41
$10,000 $82
$15,000 $123
$20,000 $164
$25,000 $205
$30,000 $246
$35,000 $287
$40,000 $328
$45,000 $369
$50.000 $410
$55,000 $451
$60,000 $492
$65,000 $532
$70,000 $573
$75,000 $614
$80,000 $655
$85,000 $696
$90,000 $737
$95,000 $778
$100,000 $819

Calculate Affordability for Year 2020

Under the Affordable Care Act (ACA), your employer’s plan is considered affordable in 2020 if the lowest-cost plan that covers only the employee costs less than 9.78% of your household’s income. Don’t use the cost of a family plan, even if you need coverage for your whole family. The following steps will help you determine if the plan is affordable:

A. Determine your household’s Modified Adjusted Gross Income for 2020

Earlier in the application, you estimated your household’s annual income.  Write that number down here: $ _____________

If you are not sure what your projected household Modified Adjusted Gross Income will be, here is how you can estimate it:

If you believe your household’s income will be similar to what it was on your last tax return, you can use that return as a tool.

1. If you filed IRS Form 1040, write down Adjusted Gross Income from Line 8b. $ _____________
2. Write down tax-exempt interest from Line 2a. $ _____________
3. Write down your total Social Security benefits in Line 5a $ _____________
4. Write down your taxable Social Security in Line 5b. $ _____________
5. Subtract the taxable Social Security in Number 4 (above) from the total Social Security in Number 3 (above) and write down the difference $ _____________
6. Write down any foreign earned income from IRS Form 2555 Line 43, 46, or 47, whichever applies to you (Note: most people will not have this income.) $ _____________
7. Add up the amounts you wrote down in Number 1, Number 2, Number 5, and Number 6 $ _____________
This is your estimated Modified Adjusted Gross Income for the year.

B. Find out what 9.78% of your monthly household income is

1. Take the Modified Adjusted Gross Income you estimated and multiply it by 0.0978 $ _____________
2. Divide the amount in Number 1 by 12 $ _____________
This is 9.78% of your estimated monthly income for next year

C. Write down the lowest-cost monthly premium for employee-only coverage   $___________

Note: If you do not know this information, One way to get this information is by asking your employer to fill out the Employer-sponsored Health Insurance Affordability Worksheet.

Is this amount more than 9.78% of your income in Section B?

  • If YES, insurance IS NOT affordable to you.
  • If NO, insurance IS affordable to you.

Read across the row closest to your household’s estimated income to see how much an affordable premium is

If your household income is: $5,000 Insurance is affordable if the lowest cost plan to cover the employee only (not a family plan) costs less than: $41
$10,000 $82
$15,000 $122
$20,000 $163
$25,000 $204
$30,000 $245
$35,000 $285
$40,000 $326
$45,000 $367
$50.000 $408
$55,000 $448
$60,000 $489
$65,000 $530
$70,000 $571
$75,000 $611
$80,000 $652
$85,000 $693
$90,000 $734
$95,000 $774
$100,000 $815

Calculate Affordability for Year 2019

Under the Affordable Care Act (ACA), your employer’s plan is considered affordable in 2019 if the lowest-cost plan that covers only the employee costs less than 9.86% of your household’s income. Don’t use the cost of a family plan, even if you need coverage for your whole family. The following steps will help you determine if the plan is affordable:

A. Determine your household’s Modified Adjusted Gross Income for 2019

Earlier in the application, you estimated your household’s annual income.  Write that number down here: $ _____________

If you are not sure what your projected household Modified Adjusted Gross Income will be, here is how you can estimate it:

If you believe your household’s income will be similar to what it was on your last tax return, you can use that return as a tool.

1. If you filed IRS Form 1040, write down Adjusted Gross Income from Line 8b. $ _____________
2. Write down tax-exempt interest from Line 2a. $ _____________
3. Write down your total Social Security in Line 5a $ _____________
4. Write down your taxable Social Security in Line 5b. $ _____________
5. Subtract the taxable Social Security in Number 4 from the total Social Security in Number 3 and write down the difference $ _____________
6. Write down any foreign earned income from IRS Form 2555 Line 43, 46, or 47, whichever applies to you (Note: most people will not have this income.) $ _____________
7. Add up the amounts you wrote down in Number 1, Number 2, Number 5, and Number 6 $ _____________
This is your estimated Modified Adjusted Gross Income for the year.

B. Find out what 9.86% of your monthly household income is

1. Take the Modified Adjusted Gross Income you estimated and multiply it by 0.0986 $ _____________
2. Divide the amount in Number 1 by 12 $ _____________
This is 9.86% of your estimated monthly income for next year

C. Write down the lowest-cost monthly premium for employee-only coverage   $___________

Note: If you do not know this information, One way to get this information is by asking your employer to fill out the Employer-sponsored Health Insurance Affordability Worksheet.

Is this amount more than 9.86% of your income in Section B?

  • If YES, insurance IS NOT affordable to you.
  • If NO, insurance IS affordable to you.

Read across the row closest to your household’s estimated income to see how much an affordable premium is

If your household income is: $5,000 Insurance is affordable if the lowest cost plan to cover the employee only (not a family plan) costs less than: $41
$10,000 $82
$15,000 $123
$20,000 $164
$25,000 $205
$30,000 $247
$35,000 $288
$40,000 $329
$45,000 $370
$50.000 $411
$55,000 $452
$60,000 $493
$65,000 $534
$70,000 $575
$75,000 $616
$80,000 $657
$85,000 $698
$90,000 $740
$95,000 $781
$100,000 $822

Calculate Affordability for Year 2018

Under the Affordable Care Act (ACA), your employer’s plan is considered affordable in 2018 if the lowest-cost plan that covers only the employee costs less than 9.56% of your household’s income. Don’t use the cost of a family plan, even if you need coverage for your whole family. The following steps will help you determine if the plan is affordable:

A. Determine your household’s Modified Adjusted Gross Income for 2018

Earlier in the application, you estimated your household’s annual income.  Write that number down here: $ _____________

If you are not sure what your projected household Modified Adjusted Gross Income will be, here is how you can estimate it:

If you believe your household’s income will be similar to what it was on your last tax return, you can use that return as a tool.

1. If you filed IRS Form 1040, write down Adjusted Gross Income from Line 37. $ _____________
2. Write down tax-exempt interest from Line 8b. $ _____________
3. Write down your total Social Security in Line 20a $ _____________
4. Write down your taxable Social Security in Line 20b. $ _____________
5. Subtract the taxable Social Security in Number 4 from the total Social Security in Number 3 and write down the difference $ _____________
6. Write down any foreign earned income from IRS Form 2555 Line 43, 46, or 47, whichever applies to you (Note: most people will not have this income.) $ _____________
7. Add up the amounts you wrote down in Number 1, Number 2, Number 5, and Number 6 $ _____________
This is your estimated Modified Adjusted Gross Income for the year.

B. Find out what 9.56% of your monthly household income is

1. Take the Modified Adjusted Gross Income you estimated and multiply it by 0.0956 $ _____________
2. Divide the amount in Number 1 by 12 $ _____________
This is 9.56% of your estimated monthly income for next year

C. Write down the lowest-cost monthly premium for employee-only coverage   $___________

Note: If you do not know this information, One way to get this information is by asking your employer to fill out the Employer-sponsored Health Insurance Affordability Worksheet.

Is this amount more than 9.56% of your income in Section B?

  • If YES, insurance IS NOT affordable to you.
  • If NO, insurance IS affordable to you.

Read across the row closest to your household’s estimated income to see how much an affordable premium is

If your household income is: $5,000 Insurance is affordable if the lowest cost plan to cover the employee only (not a family plan) costs less than: $39
$10,000 $79
$15,000 $119
$20,000 $159
$25,000 $199
$30,000 $239
$35,000 $278
$40,000 $318
$45,000 $358
$50.000 $398
$55,000 $438
$60,000 $478
$65,000 $517
$70,000 $557
$75,000 $597
$80,000 $637
$85,000 $677
$90,000 $717
$95,000 $756
$100,000 $796

Calculate Affordability for Year 2017

Under the Affordable Care Act (ACA), your employer’s plan is considered affordable in 2017 if the lowest-cost plan that covers only the employee costs less than 9.69% of your household’s income. Don’t use the cost of a family plan, even if you need coverage for your whole family. The following steps will help you determine if the plan is affordable:

A. Determine your household’s Modified Adjusted Gross Income for 2017

Earlier in the application, you estimated your household’s annual income.  Write that number down here: $ _____________

If you are not sure what your projected household Modified Adjusted Gross Income will be, here is how you can estimate it:

If you believe your household’s income will be similar to what it was on your last tax return, you can use that return as a tool.

1. If you filed IRS Form 1040, write down Adjusted Gross Income from Line 37. $ _____________
2. Write down tax-exempt interest from Line 8b. $ _____________
3. Write down your total Social Security in Line 20a $ _____________
4. Write down your taxable Social Security in Line 20b. $ _____________
5. Subtract the taxable Social Security in Number 4 from the total Social Security in Number 3 and write down the difference $ _____________
6. Write down any foreign earned income from IRS Form 2555 Line 43, 46, or 47, whichever applies to you (Note: most people will not have this income.) $ _____________
7. Add up the amounts you wrote down in Number 1, Number 2, Number 5, and Number 6 $ _____________
This is your estimated Modified Adjusted Gross Income for the year.

B. Find out what 9.69% of your monthly household income is

1. Take the Modified Adjusted Gross Income you estimated and multiply it by 0.0969 $ _____________
2. Divide the amount in Number 1 by 12 $ _____________
This is 9.69% of your estimated monthly income for next year

C. Write down the lowest-cost monthly premium for employee-only coverage   $___________

Note: If you do not know this information, One way to get this information is by asking your employer to fill out the Employer-sponsored Health Insurance Affordability Worksheet.

Is this amount more than 9.69% of your income in Section B?

  • If YES, insurance IS NOT affordable to you.
  • If NO, insurance IS affordable to you.

Read across the row closest to your household’s estimated income to see how much an affordable premium is

If your annual household income is: $5,000 Insurance is affordable if the lowest cost plan to cover the employee only (not a family plan) costs less than this amount per month: $40
$10,000 $80
$15,000 $121
$20,000 $161
$25,000 $201
$30,000 $242
$35,000 $282
$40,000 $323
$45,000 $363
$50,000 $403
$55,000 $444
$60,000 $484
$65,000 $524
$70,000 $565
$75,000 $605
$80,000 $646
$85,000 $686
$90,000 $726
$95,000 $767
$100,000 $807

Calculate Affordability for Year 2016

Under the Affordable Care Act (ACA), your employer’s plan is considered affordable in 2016 if the lowest-cost plan that covers only the employee costs less than 9.66% of your household’s income. Don’t use the cost of a family plan, even if you need coverage for your whole family. The following steps will help you determine if the plan is affordable:

A. Determine your household’s Modified Adjusted Gross Income for 2016

Earlier in the application, you estimated your household’s annual income.  Write that number down here: $ _____________

If you are not sure what your projected household Modified Adjusted Gross Income will be, here is how you can estimate it:

If you believe your household’s income will be similar to what it was on your last tax return, you can use that return as a tool.

1. If you filed IRS Form 1040, write down Adjusted Gross Income from Line 37. $ _____________
2. Write down tax-exempt interest from Line 8b. $ _____________
3. Write down your total Social Security in Line 20a $ _____________
4. Write down your taxable Social Security in Line 20b. $ _____________
5. Subtract the taxable Social Security in Number 4 from the total Social Security in Number 3 and write down the difference $ _____________
6. Write down any foreign earned income from IRS Form 2555 Line 43, 46, or 47, whichever applies to you (Note: most people will not have this income.) $ _____________
7. Add up the amounts you wrote down in Number 1, Number 2, Number 5, and Number 6 $ _____________
This is your estimated Modified Adjusted Gross Income for the year.

B. Find out what 9.66% of your monthly household income is

1. Take the Modified Adjusted Gross Income you estimated and multiply it by 0.0966 $ _____________
2. Divide the amount in Number 1 by 12 $ _____________
This is 9.66% of your estimated monthly income for next year

C. Write down the lowest-cost monthly premium for employee-only coverage   $___________

Note: If you do not know this information, One way to get this information is by asking your employer to fill out the Employer-sponsored Health Insurance Affordability Worksheet.

Is this amount more than 9.66% of your income in Section B?

  • If YES, insurance IS NOT affordable to you.
  • If NO, insurance IS affordable to you.

Read across the row closest to your household’s estimated income to see how much an affordable premium is

If your annual household income is: $5,000 Insurance is affordable if the lowest cost plan to cover the employee only (not a family plan) costs less than this amount per month: $40
$10,000 $80
$15,000 $120
$20,000 $161
$25,000 $201
$30,000 $241
$35,000 $281
$40,000 $322
$45,000 $362
$50,000 $402
$55,000 $442
$60,000 $483
$65,000 $523
$70,000 $563
$75,000 $603
$80,000 $644
$85,000 $684
$90,000 $724
$95,000 $764
$100,000 $805

Calculate Affordability for Year 2015

Under the Affordable Care Act (ACA), your employer’s plan is considered affordable in 2015 if the lowest-cost plan that covers only the employee costs less than 9.56% of your household’s income.  Don’t use the cost of a family plan, even if you need coverage for your whole family.  The following steps will help you determine if the plan is affordable:

A. Determine your household’s Modified Adjusted Gross Income for 2015

Earlier in the application, you estimated your household’s annual income.  Write that number down here: $ _____________

If you are not sure what your projected household Modified Adjusted Gross Income will be, here is how you can estimate it:

If you believe your household’s income will be similar to what it was on your last tax return, you can use that return as a tool.

1. If you filed IRS Form 1040, write down Adjusted Gross Income from Line 37. $ _____________
2. Write down tax-exempt interest from Line 8b. $ _____________
3. Write down your total Social Security in Line 20a $ _____________
4. Write down your taxable Social Security in Line 20b. $ _____________
5. Subtract the taxable Social Security in Number 4 from the total Social Security in Number 3 and write down the difference $ _____________
6. Write down any foreign earned income from IRS Form 2555 Line 43, 46, or 47, whichever applies to you (Note: most people will not have this income.) $ _____________
7. Add up the amounts you wrote down in Number 1, Number 2, Number 5, and Number 6 $ _____________
This is your estimated Modified Adjusted Gross Income for the year.

B. Find out what 9.56% of your monthly household income is 

1. Take the Modified Adjusted Gross Income you estimated and multiply it by 0.0956 $ _____________
2. Divide the amount in Number 1 by 12 $ _____________
This is 9.56% of your estimated monthly income for next year

C. Write down the lowest-cost monthly premium for employee-only coverage   $___________

Note: If you do not know this information, One way to get this information is by asking your employer to fill out the Employer-sponsored Health Insurance Affordability Worksheet.

Is this amount more than 9.56% of your income in Section B?

  • If YES, insurance IS NOT affordable to you.
  • If NO, insurance IS affordable to you.

Read across the row closest to your household’s estimated income to see how much an affordable premium is

If your household income is: $5,000 Insurance is affordable if the lowest cost plan to cover the employee only (not a family plan) costs less than: $39
$10,000 $79
$15,000 $119
$20,000 $159
$25,000 $199
$30,000 $239
$35,000 $278
$40,000 $318
$45,000 $358
$50.000 $398
$55,000 $438
$60,000 $478
$65,000 $517
$70,000 $557
$75,000 $597
$80,000 $637
$85,000 $677
$90,000 $717
$95,000 $756
$100,000 $796