Do substitute teachers get health insurance? The ACA 30-hour rule, how summer break counts for school employees, and what changed for 2027 Marketplace coverage

Sometimes, depending on your hours, your employer and your state. Federal law does not require a district to insure every substitute. Under the Affordable Care Act, an employer with at least 50 full-time employees can owe the IRS a payment when someone averaging 30 hours a week, or 130 hours in a month, goes without an affordable offer and gets a premium tax credit instead. School employers get a summer rule: when they average hours over a past period, summer weeks are left out or credited at your usual rate. Some states run school health plans with their own lines, and those differ widely. If no offer comes, the Marketplace is the usual route. Open enrollment for 2027 coverage starts November 1, the credit again stops at 400% of the poverty line, and there is no longer a cap on paying it back.

We read every page cited here on October 26, 2026. This post reports what the IRS, HealthCare.gov, three state programs and one staffing company publish. It is not legal, tax or benefits advice. Your district's HR or benefits office decides how it counts your hours and what it offers.

The federal line: 30 hours a week, at large employers

The ACA's employer rules apply to an "applicable large employer," one that had "an average of at least 50 full-time employees (including full-time equivalent employees)" in the prior calendar year, the IRS says. For those employers, an employee is full-time for a month if they average "at least 30 hours of service per week" or have "130 hours of service in the month."

The rules do not order an employer to insure anyone. They set a payment the employer may owe when a full-time employee gets a premium tax credit for Marketplace coverage, for example after no offer, or after an offer that was unaffordable or fell short of minimum value. The IRS says an employer "need not offer coverage to its part-time employees" to avoid that payment, and that employers "always may make additional employees eligible for coverage."

How a district counts a substitute's hours

The regulation counts "each hour for which an employee is paid, or entitled to payment, for the performance of duties for the employer." For employees not paid by the hour, the employer may count actual hours, credit "eight hours of service for each day" worked, or credit 40 hours for each week worked. At eight hours a day, four days a week is 32 hours, over the line, and three days is 24, under it. In a month, 17 days is 136 hours and 16 days is 128, just short of 130.

The district also picks the method. Under the monthly method, each month stands alone. Under the look-back method, the district averages your hours over a past "measurement period" and treats you as full-time, or not, for a later "stability period." The IRS says this method has special rules for "variable-hour employees, seasonal employees, and employees of educational organizations." For a new employee whose hours the employer cannot predict, the first measurement period can run "no less than three consecutive months and no more than 12 consecutive months," followed by a stability period of at least six months. So a new substitute's first measurement can take up to a year.

How summer break counts for school employees

For an employee of an educational organization, the regulation calls at least four consecutive weeks with no hours an "employment break period." A summer off is one. Under the look-back method, a school employer averages your hours with that break left out, or credits the break at the weekly rate you worked the rest of the period, up to 501 hours of break in a calendar year. The regulation's example is a school employee who averaged 38 hours a week through late May, then had 15 weeks off. The school credits 38 hours a week for the break but "is not required to credit more than 501 hours of service for the employment break period." Fifteen weeks at 38 hours would be 570.

Two limits. Under the monthly method, this averaging "does not apply," school or not. And it is written for employers that are educational organizations, so if a staffing agency employs you, ask the agency how it counts summer. Unemployment over the summer follows a different test; see our post on reasonable assurance.

Coming back in the fall: 26 weeks, not 13

A school employer can treat a returning employee as a new hire, with earlier hours no longer counted, after no hours "for a period of at least 26 consecutive weeks immediately preceding the resumption of services." Other employers use 13 weeks. In the regulation's examples, a 15-week summer did not make the employee new, and a break from late May to early December did. A shorter break can count under the rule of parity: at least four weeks, and longer than the time the person had worked before it. A substitute who started in May and had the summer off could be treated as new in the fall. Your district decides whether it uses that rule.

State school health plans draw their own lines

The 30-hour rule is federal. Some states run a health plan for school employees with eligibility rules of its own, and they do not match:

• Washington: the School Employees Benefits Board program covers a school employee "anticipated to work at least 630 hours per school year," under WAC 182-31-040. The state's eligibility sheet says: "It doesn't matter whether you're full-time, part-time or a substitute." Someone not expected to reach 630 hours becomes eligible "on the date they actually worked 630 hours," with benefits from the first day of the next month. Hours in two districts do not add up; the rule bars "stacking of hours from multiple SEBB organizations." At seven paid hours a day, 630 hours is 90 days.
• Texas: the TRS-ActiveCare 2025-26 benefits booklet, the newest we found, lists substitutes among employees who can enroll if they are active, contributing TRS members or are employed by a participating district "for 10 or more regularly scheduled hours each week." It says "individuals who are hired in a substitute position or who have retired under the TRS pension will be considered part-time employees, regardless of the number of hours they work for the participating entity." Part-time employees "are not entitled to state assistance" with the premium, and the employer "may, but isn't required to," help pay it.
• New Jersey: the School Employees' Health Benefits Program covers full-time employees of participating boards of education. Each employer sets its full-time minimum, "but it cannot be less than 25 hours per week." The page says "Certain part-time employees are eligible for coverage" and does not mention substitutes.

To find yours, ask your district's HR or benefits office whether it offers coverage to substitutes, which method it uses, how it counts a day, and whether your state has a school employee plan. If an agency employs you, ask the agency. Kelly Education's benefits page, for one, lists "Kelly-sponsored ACA health care coverage available to eligible employees" without saying there who qualifies. Retired teachers have a separate question, earnings limits, which we covered for California and for Oklahoma and Illinois.

If no employer offers coverage: the Marketplace for 2027

HealthCare.gov's dates for 2027 coverage: open enrollment starts November 1, and December 15 is the "last day to enroll in or change plans for coverage to start January 1." Open enrollment ends January 15, and plans chosen December 16 through January 15 start February 1. If your state runs its own marketplace, check its dates there.

The premium tax credit, which lowers the monthly premium, is generally for household income "at least 100 percent but no more than 400 percent of the federal poverty line," the IRS says. It describes the removal of the 400% ceiling as covering tax years 2021 through 2025. So since 2026, income above 400% of the poverty line gets no credit, and nothing we read changes that for 2027. HealthCare.gov says it will post 2027 income levels on November 1.

Paying it back changed too. If you take the credit in advance and your income comes in higher than you estimated, the extra comes back at tax time. Before 2026, a cap could limit that repayment for households under 400% of the poverty line. Now the IRS says: "There is no repayment cap for tax years after 2025." You "must repay the full amount by which your advance credit payments exceed your Premium Tax Credit." The IRS also says taxpayers "must promptly report changes to the Marketplace," household income among them. A substitute's income moves with the jobs taken, so a November estimate is worth checking during the year.

A job offer can rule the credit out. The IRS says you are generally not eligible if you could have enrolled in employer coverage that is affordable and provides minimum value, even if you did not enroll, and that enrolling in an employer plan generally ends eligibility "even if the employer plan is unaffordable or fails to provide minimum value." Minimum value means the plan "covers at least 60 percent of the expected total allowed costs." Affordable means your share of the lowest-cost self-only plan that meets minimum value is no more than 9.96% of household income for 2026 and 10.22% for plan years beginning in 2027. On $40,000 of household income, 10.22% is $4,088 a year, about $341 a month.

What we can't tell you

We cannot tell you whether your district is a large employer under these rules, whether it covers substitutes, which method it uses or how it credits a day. Its HR or benefits office decides those. We could not find TRS-ActiveCare's 2026-27 booklet, so the Texas terms are from 2025-26. Washington, Texas and New Jersey are examples, not a survey of every state. We did not cover Medicaid, which your state's Medicaid agency decides, or the dates of state-run marketplaces. For your taxes, the IRS and a tax preparer decide, not this post.

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