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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.


Verification of Employer Insurance?

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Question: I am suppose to submit proof that I do not qualify for employer insurance. I have been paying for an individual Kaiser plan that is up to 270/mo , 80 dr visit, 1500 deductible. Income wise I qualify for a Kaiser enhanced silver plan but because my employer offers non kaiser insurance I haven't taken it because I've have cancer and psoriasis. I was provisionally approved by CalCov and paid $105. My individual plan expires in Feb since I haven't paid January and now I owe them $540 if Cal Covered doesn't go through. What am I suppose to do?

Answer: You say "my employer offers non kaiser insurance I haven't taken it". The ACA and the IRS are very clear on the fact that if you have access to employer-based health insurance, you will not be eligible for a subsidy. You have Covered California coverage for 90 days. Then you will have to decide between employer coverage or unsubsidized individual coverage.

3 Comments

I have a group of about 20 employees and the employer pays 50% of the least expensive plan. Needless to say, it’s not a very rich benefit for the employees. If someone is eligible for a subsidy, can they apply to CovCal and not be breaking any rules?

Yes. That is correct, but I doubt many applicants know what “affordable” means according to the ACA. In actuality, only a small percentage of applicants have unaffordable group coverage.

Phil, please correct me if I am wrong, but my understanding about access to employer-based health insurance is that it still has to be considered affordable. If it is not considered affordable (does not meet the 9.5% rule) then the individual would be able to take a subsidy. The question on the application asks, “Have you been offered AFFORDABLE, minimum standard health insurance for 2014?”

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