Last week I broached the subject of income-based premiums and Out of Pocket (OOP) limits for health insurance plans. (Review HERE, if you’d like.)

The Affordable Care Act (ACA/’Obamacare’) already opened that ‘door’: “employer sponsored health insurance is considered affordable if the employee’s required contribution for the lowest cost, self-only plan (single coverage) does not exceed a set percentage of their household income (not just wages). This threshold is adjusted annually for inflation: 9.02% in 2025 and 9.96% is 2026.”

Note also, the premium limit applies only to the lowest cost plan; i.e., must cover at least 60% (bronze) of total ‘covered’ benefits costs. Note, most of my clients’ group plans are considered silver (70%) or gold (80%) plans. Even then, in many cases OOP costs significantly exceed premiums.

If an employer-sponsored plan is deemed unaffordable, the employee may qualify for a premium tax credit through the Health Insurance Marketplace. 

Once upon a time (long before the ACA), I had an article published proposing a more radical income based – or at least tiered – premium sharing arrangement. In the +/-25 years since floating that idea, it was only adapted by one client. 

He’s retired. And me? 

Still tilting at windmills!