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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.

How is the 9.5% Affordability Rule Computed?

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Question: Does the 9.5% max that the employer can have the employee pay for health coverage apply to employee only or family coverage. I have a wife and one child and am the only employed member of my family group earning 45k a year, how much could I be charged for Family coverage (assuming the employer wants to stay under 9.5%).

Answer: The 9.5% affordability limit applies to employee-only coverage regardless of other family members insurance status. At an income, of $45,000, your contribution to your employee only monthly premium cannot be more than $356 per month to be considered affordable.


Ted, as Phil described above- the “limitation test” only applies to what YOU are paying, for YOUR own portion of your own insurance (i.e.: employee-only). Which in this case is 0%. And yes- they could someday choose to change their contribution scheme (for all EEs) to an amount less than 100%, such as they are paying now. In that scenario you would be limited to paying any more than 9.5% of your income (again for YOUR employee-only portion), and your wife’s portion of the insurance would still not remain any part of equation. Her rates would not raise because of this provision (it doesn’t work that way), but they might raise due to inflation, and surely (probably) already have over the years.

My salary is $80,000 and I pay $1000.00 per month for my employer health insurance. Is this above my employer max of 9.5%

Thank you

I pay about $175 dollars per pay period (26 per year) to have my wife on my plan. My employer covers me 100%. Does this mean my employer would only factor me and could raise my share to 9.5% of my pay and then raise my dependant rate since it is not factored in?

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