Offered Health Insurance at Work in Texas But Can't Afford It? When You Can Still Get a Marketplace Subsidy

The general rule (and its big exception)

One of the most common frustrations we hear sounds like this: "My employer's plan is unaffordable, the marketplace is unaffordable, so what am I actually supposed to do?"

Here's the rule most people half-remember: if your job offers you health coverage, you usually can't get a premium tax credit on the marketplace. That's true — but only if the employer's offer is considered both affordable and minimum value. If the offer fails either test, the door to a subsidy reopens.

The 9.96% affordability test for 2026

For 2026, an employer's offer of coverage is 'affordable' only if the cost of the lowest-priced self-only plan is no more than 9.96% of your household income. That percentage is set by the IRS and changes yearly — it rose from 9.02% in 2025 to 9.96% for 2026.

If your share of that self-only premium is more than 9.96% of your income, the offer is legally unaffordable, and you can shop the marketplace with subsidies instead.

Example: your household income is $50,000. 9.96% of that is about $4,980 a year, or roughly $415/month. If the cheapest self-only plan at work costs you more than ~$415/month, it's unaffordable — and you may qualify for a subsidized marketplace plan.

The other door: 'minimum value'

Even if the price passes, the plan also has to provide minimum value — meaning it covers at least 60% of expected costs and includes substantial coverage for physician and inpatient hospital services. Some bare-bones or 'skinny' plans don't meet that bar.

If your employer's plan fails the minimum-value test, you can also qualify for marketplace subsidies, regardless of the price. It's worth asking your HR department directly whether the plan meets minimum value — they're required to be able to tell you.

How to check your number

Three steps:

1. Find the self-only premium — your share of the cheapest employee-only plan your employer offers (not the family price for this test).
2. Multiply your household income by 0.0996. That's your 2026 affordability ceiling.
3. Compare. If your annual self-only cost is higher than that ceiling, the offer is unaffordable and you can pursue subsidized marketplace coverage.

A Texas caveat worth knowing

Because Texas hasn't expanded Medicaid, subsidy eligibility generally requires projecting income at 100% of the federal poverty level or above. Below that, many adults fall into the coverage gap. So the affordability exception helps most when your income is in the subsidy-eligible range and your work plan is simply too pricey for what you earn.

What to do next

If your employer's offer is unaffordable or not minimum value, run a marketplace quote with an accurate income estimate before your enrollment deadline. If it's borderline, a licensed advisor can check the exact numbers with you — getting the self-only premium and household income right is what determines whether the subsidy door is open.