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.
Question: Can someone’s dependents qualify for Medi-Cal or subsidies for coverage if the parent has coverage through a small employer that offers affordable coverage and meets minimum standards?
Answer: Dependents under 19 with access to employer-based group health insurance can qualify for Medi-Cal assuming other requirements are met, but those dependents cannot qualify for a subsidy in Covered California.
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The response above is inaccurate. According to IRS Rules published in document 2012-12421:
“Under section 36B(c)(2)(C), an individual who may enroll in an eligible employer-sponsored plan may nonetheless be eligible for a premium tax credit if the employer-sponsored coverage either is unaffordable or fails to provide minimum value.”
Additionally, it should be understood that premium tax credits are available whether a person purchases insurance through the Exchange or not. “ADVANCE” tax credits, payable directly to one’s health insurer, are only available when a consumer enrolls in an individual health plan through the Exchange.
Because the premium tax credit is refundable, a taxpayer could choose not to accept advance payments and receive the credits at the time he/she files the tax return for the year.