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.
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?”