2019 ACA Affordability Percentage
The 2019 ACA Affordability Percentage is 9.86%.
Effective 2019-01-01Source: Rev. Proc. 2018-34 (IRS)Verified 2026-09-03
Required contribution percentageSource: Publication 974 (2019), Premium Tax Credit (PTC) (IRS)Verified 2026-09-03
Compared with 2018
| Item | 2018 | 2019 | Change |
|---|---|---|---|
| Required contribution percentage | 9.56% | 9.86% | +0.3% (+3.1%) |
Who it applies to
Employers and individuals determining whether employer-sponsored health coverage is affordable under the Affordable Care Act (Section 36B of the Internal Revenue Code)
What changed this year, and why
The ACA required contribution percentage for 2019 is 9.86%, up from 9.56% in 2018.
Common questions
- What is the required contribution percentage used for?
- It determines whether employer-sponsored minimum essential coverage is considered affordable under the ACA. If an employee's required contribution for self-only coverage exceeds 9.86% of household income for 2019, the coverage is not affordable and the employee may qualify for a premium tax credit.
- When does the 2019 percentage take effect?
- It applies to plan years beginning after December 31, 2018.
Every amount on this page is a published figure rather than yours. The Affordable employer coverage calculator takes the number you enter and works it out against them, showing which published figure it used.
The share of household income that makes an offer affordable
An employer offer counts as affordable when the amount you would pay for self-only coverage - called the employee required contribution - is no more than 9.86% of your tax family's household income. Two things matter here. First, the test uses your household income, not your individual wages, so it reflects what your whole tax family earns. Second, the cost is measured for self-only coverage even when you actually need family coverage for a spouse or dependents. That means the affordability calculation ignores the extra price of adding family members. If the self-only share of the premium stays at or below 9.86% of household income, the offer is treated as affordable for you and for every member of your tax family, regardless of how much family coverage would really cost.
Your em- ployer coverage is generally considered affordable for you and for a family member if your share of the annual cost for self-only coverage, which is sometimes referred to as the employee required contribution, is not more than 9.86% of your tax family’s household income for 2019.
Publication 974 (2019), Premium Tax Credit (PTC) (IRS)
An affordable offer blocks the premium tax credit
Getting an offer of employer coverage that counts as minimum essential coverage does not automatically block your premium tax credit. The offer has to clear two additional hurdles: it must be affordable, and it must provide minimum value. Only when both conditions are satisfied are you treated as having eligible employer coverage and ineligible for the credit. If the offer fails either test, you can still receive the premium tax credit for a qualified health plan. There is one important exception for people who actually enroll: if you or a family member signs up for employer coverage that qualifies as minimum essential coverage, that person loses access to the credit even when the plan is unaffordable or lacks minimum value. Enrollment, rather than a mere offer, is what locks in that result.
Even if you had the opportunity to enroll in coverage offered by your em- ployer that qualifies as MEC, you are considered eligible for an employer-sponsored plan (and cannot get the PTC for your coverage in a qualified health plan) only if the em- ployer-sponsored coverage is affordable (defined later) and the coverage provides minimum value (defined later).
Publication 974 (2019), Premium Tax Credit (PTC) (IRS)
The second test an employer plan has to fail
A plan provides minimum value only when it pays at least 60% of the total allowed cost of benefits for a standard population and also supplies substantial coverage of inpatient hospitalization and physician services. The 60% threshold is effectively checked through the employee's expected cost-sharing: deductibles, co-pays, and co-insurance together may not absorb more than a minority share of the cost of the benefits. Both parts of the test - the 60% share and the substantial coverage of hospital and physician care - must be met. A plan that fails either part does not provide minimum value, and that failure, on its own, is enough to let a worker qualify for the premium tax credit even when an offer of employer coverage exists. The SBC (Summary of Benefits and Coverage) that an employer provides will indicate whether the plan satisfies this test.
How to determine if a plan provides minimum value. An employer-sponsored plan provides minimum value only if the plan pays at least 60% of the total allowed costs of benefits for a standard population and provides sub- stantial coverage of inpatient hospitalization services and physician services.
Publication 974 (2019), Premium Tax Credit (PTC) (IRS)
A waiting period is not coverage you can use
A waiting period before employer coverage takes effect does not count as a month when you are eligible for that coverage. If you cannot receive benefits under the employer plan in a given month - for example, because you are still in the waiting period before the plan becomes active - you are not treated as eligible for employer coverage that month and can receive the premium tax credit for a qualified health plan, provided you meet the other eligibility rules. The key point is that eligibility is measured by whether you can actually use the benefits, not by whether you have been offered a plan that will start later. Once the waiting period ends and you can receive benefits, the normal affordability and minimum-value tests apply.
You are not considered eligible for employer coverage, and can get the PTC for your coverage in a qualified health plan if you are otherwise eligible, for a month when you cannot receive benefits under the em- ployer coverage (for example, you are in a waiting period before the employer coverage becomes effective).
Publication 974 (2019), Premium Tax Credit (PTC) (IRS)
Which plans are eligible employer-sponsored coverage
Not every health plan offered through work counts as eligible employer-sponsored coverage. A plan qualifies only when it is both an employer-sponsored plan and minimum essential coverage. The employer-sponsored plans that can meet this definition include insured group health plans in the group market, self-insured group health plans for employees, certain expatriate health plans for employees, and the Nonappropriated Fund Health Benefits Program of the Department of Defense. These plans may also include retiree or COBRA coverage. Once such a plan also satisfies the requirements of minimum essential coverage, it is referred to as an eligible employer-sponsored plan. Plans limited to excepted benefits - such as stand-alone vision or dental, workers' compensation, or disease-specific coverage - do not qualify, no matter how they are offered.
Employer-sponsored plans that are MEC are also refer- red to as eligible employer-sponsored plans.
Publication 974 (2019), Premium Tax Credit (PTC) (IRS)
COBRA or retiree coverage from a former employer only counts against you while you are enrolled in it
If your employment ends and your former employer offers you continued coverage such as COBRA or retiree coverage, that offer only counts against you for purposes of the Premium Tax Credit during the months you are actually enrolled in it. The same rule applies to a family member who could enroll in the former employer's plan because of their relationship to you. So if you are offered COBRA but choose not to take it, you are not treated as eligible for that employer coverage when the Marketplace evaluates whether you qualify for the credit. This matters because being eligible for affordable employer coverage that meets minimum value generally makes you ineligible for APTC; but if you are merely eligible to elect COBRA or retiree coverage without enrolling, the 9.86% affordability test does not apply to that coverage for the months you decline it.
Coverage after employment ends. If your employ- ment with an employer ends and you are offered employer coverage by your former employer (for example, COBRA or retiree coverage), you are considered eligible for that employer coverage for PTC purposes only for the months that you are enrolled in the employer coverage. This same rule applies to an individual who may enroll in the cover- age by reason of a relationship to a former employee.
Publication 974 (2019), Premium Tax Credit (PTC) (IRS)
Affordability is judged on your income estimate at enrollment, not what your return later shows
When you enroll in a qualified health plan, the Marketplace judges affordability based on its estimate of your household income at that time, not on what your tax return later shows. Your employer coverage is treated as unaffordable if the Marketplace determines your required contribution would be more than 9.86% of the income it estimates for you. As a result, you can qualify for advance premium tax credit even if your actual household income on your return turns out to be higher, and the required contribution would not have exceeded 9.86% of that actual amount. However, this protection does not apply if you failed to provide current information during each annual re-enrollment period or if you gave the Marketplace incorrect information about your required contribution with intentional or reckless disregard for the facts.
Determining affordability at the time of enrollment. Your employer coverage is not considered affordable, if, when you enroll in a qualified health plan, the Marketplace determines that your required contribution for employer coverage will be more than 9.86% of what the Market- place estimates will be your household income and there- fore that you are eligible for APTC for coverage in the qualified health plan.
Publication 974 (2019), Premium Tax Credit (PTC) (IRS)
There is no line for the percentage itself - it enters your return as a multiplier on a worksheet
The required contribution percentage never appears as its own line on Form 8962 or anywhere else on your return. If you were offered a QSEHRA instead of employer coverage, the percentage only shows up inside Worksheet N, Worksheet To Determine if the QSEHRA Is Considered Affordable: an amount from your return is multiplied by this year's rate, 9.86%, written as a decimal, and that result is compared against the QSEHRA's permitted benefit to decide whether the arrangement counted as affordable. There is no box labeled with the percentage itself anywhere on the form - it exists only inside this worksheet's arithmetic, which is why searching the form directly for it finds nothing.
Worksheet N. Worksheet To Determine if the QSEHRA Is Considered Affordable Keep for Your Records
Publication 974 (2019), Premium Tax Credit (PTC) (IRS)
Give the Marketplace bad numbers on purpose or carelessly, and the safe harbor does not protect you
If you give the Marketplace incorrect information on purpose or carelessly, you lose the protection that lets the Marketplace's estimate control affordability. Normally, if the Marketplace estimates your household income and finds your employer coverage unaffordable, you can qualify for advance premium tax credit even if your actual return shows higher income. But if you provided incorrect information about your required contribution with intentional or reckless disregard for the facts, that safe harbor does not apply and affordability is judged on the household income shown on your actual tax return. Intentional disregard means you knew the information was inaccurate. Reckless disregard means you made little or no effort to determine whether it was accurate and your lack of effort was substantially different from what a reasonable person would do.
However, the exception described un- der Estimated household income at least 100% of the fed- eral poverty line in the Form 8962 instructions does not apply if, with intentional or reckless disregard for the facts, you provide incorrect information to the Marketplace for the year of coverage.
Publication 974 (2019), Premium Tax Credit (PTC) (IRS)
How each figure was verified
Each number below was read from a stored copy of the document named beside it, and checked to occur word for word in the quoted sentence. The digest is of that stored text.
Publication 974 (2019), Premium Tax Credit (PTC) (IRS)
- Required contribution percentage
Your employer coverage is not considered affordable, if, when you enroll in a qualified health plan, the Marketplace determines that your required contribution for employer coverage will be more than 9.86% of what the Market- place estimates will be your household income and there- fore that you are eligible for APTC for coverage in the qualified health plan.