The Premium Tax Credit (PTC) is a federal subsidy available through the New York State of Health (NYSOH) Marketplace, designed to make health insurance more affordable for individuals, including employees of small businesses. Super Senior Services is dedicated to guiding employers and their workers to leverage this credit, ensuring excellence in coverage and affordability.
What is the PTC?: The PTC reduces monthly health insurance premiums for eligible employees purchasing individual plans through NYSOH. Unlike most tax credits, it can be applied as an advance payment directly to the health plan, lowering costs immediately. Eligibility depends on income, household size, and whether employees have access to affordable employer-sponsored coverage. In 2025, employees with incomes between 100% and 400% of the federal poverty level (approximately $15,060–$60,240 for an individual) may qualify, though those below 150% may also access enhanced subsidies under the American Rescue Plan.
How Employees Qualify: Employees cannot claim the PTC if their employer offers “affordable” coverage, defined as employee-only coverage costing less than 9.12% of their household income in 2025. If your business offers group plans through Super Senior Services, we ensure clarity on affordability to help employees determine eligibility. For Medicare-eligible employees (65+ or disabled), we assess whether individual Marketplace plans with PTC are more cost-effective than employer-sponsored plans, especially if they’re ineligible for group Medicare Advantage due to regulatory constraints. Employees must also not be enrolled in other coverage, like Medicaid or Medicare, to qualify, though we coordinate dual-eligibility scenarios for disabled workers.
Employer Role: As an employer, you don’t directly apply for the PTC, but Super Senior Services helps you structure group plans to avoid disqualifying employees from subsidies unnecessarily. For example, offering high-premium plans may push low-income workers toward Marketplace plans with PTC. We use tools like the NYSOH Employer Health Insurance Affordability Calculator to estimate eligibility, ensuring transparency. During our annual benefit reviews, we evaluate your group plan’s cost-sharing to balance your budget and employee access to subsidies.
Why Choose Us?: Super Senior Services excels in navigating the PTC’s complexities. We provide personalized consultations to explain how your group plans impact employee eligibility, particularly for seniors transitioning to Medicare. Our expertise ensures your workforce, including disabled employees, accesses affordable coverage, whether through your plan or NYSOH. By integrating PTC guidance with our Medicare-focused group offerings, we deliver comprehensive, cost-effective solutions that prioritize health and financial security.
The PTC empowers your employees to afford quality health insurance, and Super Senior Services is your partner in making it work. Our commitment to excellence means we’ll tailor your group insurance strategy to maximize benefits for both you and your workers. Contact us to explore how the PTC fits into your employee benefits package today.