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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Different Coverage Options Within Families

By on | 4 Comments

Question: Can I get a premium subsidy through the Exchange if my spouse has affordable coverage from her employer?

Answer: Covered California will have the capability for individual family members to apply for different Health Insurance Affordability Programs. Your family scenario could include your spouse on employer-sponsored coverage, you on a Covered California qualified-plan with a premium subsidy and your child on Medi-Cal. Each family member will have a unique Client Identification Number (CIN). Continuity of coverage for each family member can be maintained because the system can accommodate moving between public and private coverage options according to changes in status or qualifying events (pregnancy, recently unemployed, turned 65, etc.).

4 Comments

Ken, You and your spouse’s income would be considered jointly. You are eligible for advanced tax credits (subsidies) only if your spouse’s group coverage is ruled to be “unaffordable” (that is, the employee’s contribution to the premium exceeds 9.5% of your joint income). Your adult daughter’s income is considered separately, as is her eligibility for a subsidy.

If my wife has employer coverage that does not offer to cover me or my adult daughter that lives with us, can I and my daughter still get subsidies? And how does the FPL get figured in that case if my wife and I file jointly on our taxes? Will only my income be counted and not my wife’s for the purpose of the subsidy, or will it still be based on our combined income although my wife will not be getting any subsidies as she has employer coverage? Also how does my daughter’s income apply?

Yes Sarah. That is correct.

So this is no longer the case, right? If an employer offers coverage that meets the two affordability tests, the employee’s dependents cannot get a subsidy in the exchange. right?

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