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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.

Coverage for Spouse and Dependents of Employee?

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Question: You have a person who’s on the Exchange with family coverage gets a job with affordable ee not affordable for family coverage “what happens to spouse/children” can they stay on the Exchange?

Answer: In this scenario, the spouse and/or children could continue in the Exchange, but they will no longer be eligible for premium assistance once they have access to employer-based coverage. It does not matter that the family coverage is “not affordable for you. The employer would have to exclude all spouses and children from coverage in its group plan for the dependents to be eligible for subsidized coverage in the Exchange. It is only when the insured’s employee-only cost exceeds 9.5% of income that the coverage is deemed not affordable, making the entire family, including the employee, eligible for premium assistance in Covered California.


If I have insurance coverage through my employer (my individual cost under 9.5% of my income)and coverage available for my spouse to be added but at a rate well over 10% of my income. Is my spouse eligible for insurance under covered california?

“they will no longer be eligible for premium assistance”

The “premium assistance” is the advance tax credit. However, the tax credit may still be obtained after-the-fact when filing one’s income tax return in the following year.

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