How do we ensure the plan is affordable for employees across income levels?

Affordability is not just about premiums; it is about access. The most effective benefit plans keep out-of-pocket costs low for everyday care, meet ACA affordability standards, and offer flexible options that support employees at every income level.

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Start with ACA affordability compliance
Under the Affordable Care Act (ACA), coverage is considered affordable when the employee’s share of the lowest-cost, self-only premium is no more than 8.39 percent of their household income (2024 limit).

Tip: Use one of the IRS safe harbors (W-2, Rate of Pay, or Federal Poverty Line) to confirm compliance, especially for lower-wage employees.

Make everyday care free or predictable
Out-of-pocket costs are the biggest barrier for lower-income workers. Focus on $0 access for essential, high-value services:

• Primary care visits (virtual or in-home)
• Preventive screenings and labs
• Prescriptions and mental health support

Impact: Employees get care early, stay healthier, and avoid costly emergency or hospital visits later.

Choose the right contribution strategy
Your premium contribution split plays a major role in affordability:

• Contribute a higher percentage (75 to 90 percent) of employee-only premiums for lower-wage teams.
• If you use fixed-dollar contributions, review them annually to maintain ACA compliance.
• For mixed-income workforces, consider tiered contributions that provide more support to lower-earning employees.

Best practice: Test your contribution model each year using ACA safe harbor calculations.

Offer flexible coverage options
Give employees meaningful choices without adding unnecessary complexity:

• MEC plus primary care for affordability and compliance.
• CHOICE (ICHRA) plus Vitable for predictable, defined contributions.
• Buy-up plans for employees who want broader coverage.

Impact: Every employee can find a plan that fits their budget while maintaining access to real care.

Go beyond premiums to remove financial barriers
True affordability means eliminating unexpected costs:

• Keep preventive and primary care at $0.
• Cap out-of-pocket expenses for urgent or chronic conditions.
• Provide transparent pricing and simple navigation tools.

Tip: Clear, consistent communication helps employees understand what is covered and how to use their benefits.

Vitable makes healthcare affordable for all employees by including $0 access to primary care, mental health, and prescriptions in every plan. With predictable, flat-rate pricing for employers and no surprise costs for employees, Vitable helps businesses meet ACA standards while providing care that is accessible for everyone, from hourly staff to salaried employees.

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Affordability starts with accessible, $0 everyday care and flexible, compliant plan design. Keep premiums within ACA limits, eliminate cost barriers for essential services, and offer options that reflect the needs of a diverse workforce. With Vitable’s primary-care-first model, you can deliver benefits that work for every employee without increasing total spend.

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