When "Affordable" Isn't Affordable: Closing the Real-World Gap
Let's talk about one of the biggest misconceptions in our industry: affordability.
On paper, it looks simple. The Affordable Care Act defines "affordable" as coverage that doesn't exceed a set percentage of an employee's income (8.39% of household income in 2025 under the Federal Poverty Level Safe Harbor).
But in the real world? For someone earning $17 an hour, supporting a family, and juggling rent, groceries, and gas, "affordable" isn't always affordable.
That gap between technical compliance and actual affordability is where most brokers lose both trust and opportunity.
The Story Behind the Numbers
A national landscaping company in Arizona recently shared their challenge with us. They offered a solid major medical plan that met ACA affordability requirements. The employer contribution was generous. The math checked out perfectly.
But 46% of their employees still waived coverage.
When we asked why, the answer was straightforward: "Even after my employer pays their part, I still can't afford $170 every paycheck."
To that employee, it's not a compliance formula. It's a choice between healthcare and keeping the lights on. And that's the reality brokers need to help employers understand.
What Happens When Compliance Doesn't Equal Coverage
Here's the thing: Employers can be 100% ACA-compliant on paper and still have nearly half their workforce uninsured.
They avoid penalties under §4980H(b) but end up with an unprotected employee population. That can mean higher turnover, lower morale, and reputation issues down the line.
This happens when brokers and employers treat affordability as a math problem instead of a people problem.
The Growing Affordability Gap
As wages rise and inflation continues to squeeze household budgets, the affordability gap keeps getting wider. Employees are being priced out of traditional coverage faster than ever.
Brokers who stick to "check-the-box" ACA solutions are going to miss what might be the biggest opportunity over the next year: helping clients close the gap between what's legally affordable and what employees can actually manage.
That's where MEC and MV plans come in.
How MEC and MV Plans Help
Minimum Essential Coverage (MEC) plans meet employees where they are. They keep employers compliant with ACA §4980H(a), and just as importantly, they give workers access to care they can actually use and afford.
Add a Minimum Value (MV) plan to the mix, and you've got a tiered solution that works for everyone:
MEC for everyone
MV for full-timers
Major medical for the core group
Now every employee, from hourly workers to management, has an option that fits their situation. That kind of structure doesn't just handle compliance. It shows employees you're paying attention, which tends to stick with people.
What Changed for One Florida Broker
One of our partner brokers in Florida told me something I haven't forgotten: "I used to assume employees waived coverage because they didn't care. Now I know it's because they couldn't afford it."
Once he started positioning MEC alongside traditional plans, things shifted. His waiver rates dropped. His clients' ACA risk went away. And his revenue went up, not from chasing new business, but from actually solving problems for existing clients.
That's what's happening in the benefits space right now.
How to Start the Conversation
Here's a straightforward approach you can use during Q4 renewals:
Ask about affordability, not just compliance.
"How many employees waived because the premium was too high?"
Show the math in real terms.
Compare payroll deductions to hourly wages. That makes it real.
Present MEC as a practical option.
Talk about inclusion, affordability, and protection for the whole workforce.
This isn't about pushing another product. It's about helping employers see what they're missing and giving employees options that actually work.
How We Approach This at Evolved Benefits
At Evolved Benefits, we help brokers turn compliance into something more useful. We build MEC and MV strategies that address affordability at every income level.
Whether it's a franchise group, a staffing company, or a manufacturer, our approach stays the same: If affordability is getting in the way, let's figure out how to fix that.
What This Means for Brokers
Compliance keeps employers safe. Affordability keeps employees engaged. Brokers who can handle both are going to have a good 2026.
As you work through this renewal season, ask your clients one question: "How many of your employees are waiving because they can't afford your plan?"
Then show them how to close that gap. Because affordability on paper doesn't help anyone. Access does.