ESI

When someone enrolls in health coverage through their employer, they are generally making that selection for the full plan year under federal rules. They may only make changes during their employer’s annual open enrollment period. However, federal rules provide specific scenarios when an employee can make mid-year plan changes. To make any mid-year changes, the employee must experience a qualifying mid-year election change event recognized by federal rules and allowed by their employer. Some examples of these qualifying events include: Marriage, divorce, or legal separation Change in number of dependents (for example, childbirth or adoption) Involuntary loss of coverage under another plan Change in employment status For any questions regarding mid-year plan changes, including dropping coverage through your employer, it’s important to speak to your employer.[1] If you have questions and would like to speak with someone from the Health Connector, please email connector.policy@mass.gov For more information, please see: What to Know If You Get Help Paying for Health Insurance from Both the Health Connector and Your Employer – Massachusetts Health Connector Job-based Insurance Affordability Calculator - Premium Tax Credit Department of Labor information on Continuation of Health Coverage – COBRA Massachusetts Division of Insurance MiniCobra Continuation of Coverage Benefits Guide Tax Treatment of Cafeteria Plans – Final Regulation __________ [1] See Tax Treatment of Cafeteria Plans on IRS.gov: https://www.irs.gov/pub/irs-regs/td8921.pdf 

You can switch out of your employer’s plan to a Health Connector plan during your employer’s annual open enrollment period. Even if you could continue on your employer’s plan, the ending of that plan would trigger a special enrollment opportunity for you to sign up for Health Connector coverage. An employee is not eligible to receive subsidies through the Health Connector if their employer-sponsored coverage is considered affordable (according to a federal definition) and provides minimum value coverage. However, as noted below, an employee is not eligible to receive subsidies through the Health Connector if their employer-sponsored coverage is considered affordable (according to a federal definition) and provides “minimum value” coverage. If you are not in your employer’s annual open enrollment period, you would need to experience a qualifying mid-year election change event to leave the employer’s plan. If you leave your employer’s plan, you may apply for and enroll in Health Connector coverage. If you do not have a qualifying mid-year election change event to leave your employer’s plan, and you still want to apply for and enroll in Health Connector coverage, please know that you will need to experience a qualifying event to enroll with the Health Connector and you would be covered by both your employer plan and Health Connector plan. That means that you would be paying for double coverage.

An employee is not eligible to receive subsidies through the Health Connector if their employer-sponsored coverage is considered affordable (according to a federal definition) and provides “minimum value” coverage. Employer-sponsored coverage is considered affordable if the portion of the annual premium you must pay for self-only coverage does not exceed the annually adjusted percentage of household income set by the IRS, which is 9.02% in 2025. Employer-sponsored coverage is considered to meet “minimum value” standards if the plan covers at least 60 percent of the total allowed cost of benefits expected to be incurred under the plan. The plan also must provide substantial coverage of in-patient hospitalization and physician services. Most employer plans meet this standard. The Health Connector has a tool located here to help you calculate the affordability of your job-based coverage.