The comparison usually ends before it starts, because of one rule: if your employer offers coverage that counts as affordable and meets minimum value, you cannot take a premium tax credit on the marketplace. You may still buy a marketplace plan — you just pay full price for it.
The affordability test for 2026
Coverage is “affordable” if the premium for employee-only coverage on the cheapest plan that meets minimum value costs no more than 10.22% of household income in 2026. Note what is measured: your own coverage, not the family's. That is the whole test, and it is done on the lowest-cost qualifying plan even if you enrolled in a richer one.
The family rule, since 2023
For years the test was applied to the employee's premium and then used to disqualify the whole family — the “family glitch”. The IRS fixed it in 2023: a family's eligibility is now judged on what family coverage costs at the employer. So a household can legitimately split — the employee on the work plan, the spouse and children on subsidized marketplace coverage — when the dependent premium is the expensive part. That is often the case: employers subsidise the employee heavily and pass most of the dependent cost through. See paying $1,000+/month for family coverage.
When the marketplace wins outright
- Your employer offers nothing, or nothing that meets minimum value.
- Employee-only coverage costs more than 10.22% of household income.
- You are self-employed, part-time, contract or between jobs.
- Family coverage at work fails the test even though your own does not.
Comparing them honestly
Compare the employee share of the premium, not the total. Add the deductible and the out-of-pocket maximum on each side. Check that your doctors and drugs are covered on both, and remember that employer premiums come out pre-tax, which is worth more than it looks at higher incomes.
If you want the split-coverage math run properly, enter your ZIP code below with what your employer charges for family coverage, or call (713) 575-9904.