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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.


What is Affordable Coverage?

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Question: I read that even if my employer offers health insurance I can buy in the health exchange if it’s not affordable. Is that right?

Answer: Right. If an employer-sponsored plan does not meet the “affordability standard”, an employee and dependents may be eligible for premium subsidies to purchase coverage from Covered California. The affordability standard, according to the ACA, is when the employee’s contribution to coverage cannot exceed 9.5 percent of the household annual income.

But the devil is in the details. Last week the IRS further clarified affordability as being based on what the employee contributes for self-coverage only, not family-coverage. In other words, the affordability of coverage will not take into consideration the portion of the annual premium the employee must pay for family coverage. Also, uninsured children will be ineligible for premium subsidies in the exchange. Bummer!

2 Comments

Are there any rumors this gliche may be remided to where it uses family premium not only self coverage?

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