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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.

Dropping Covered CA Plan for Employer Coverage?

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Question: My family of four has a Covered CA plan, which we purchased when both my husband and I were unemployed. I am listed as the subscriber. I recently began work and have employer coverage beginning June 1. If I terminate the entire CC plan will that act as a qualifying event to get off-exchange coverage for my family? I don't want them covered on my employer plan due to cost.

Answer: Once you and your family have been offered employer-based coverage, you are no longer eligible for premium assistance in Covered California. You are obligated to contact Covered California and change your status. You may opt out your family from your employer coverage, but they will only be eligible for unsubsidized individual coverage.


Lumace, unless the cost of the employer-sponsored health plan for you alone (“employee self-only cost”) exceeds 9.5% of your household income, it will be considered “affordable” and you will not be eligible for premium tax credits beginning with the month you became eligible for the employer-sponsored plan.

You do not have to drop the CoveredCA plan, but you must report eligibility for the employer plan and terminate the advance premium tax credits which are being applied to your total premium — unless the employer-sponsored plan is “unaffordable”.

Failure to report eligibility and continuing to receive APTCs will cause major problems for you at tax reporting time next year.

With my former employer who did not offer group coverage, I found a plan on the exchange for me and my spouse. Now that I am with a new employer that offers group coverage, will I still be able to decline group coverage and keep my current coverage through the exchange? I was given only two options that are really expensive, 700 a month through the employer( three quarters of one paycheck) compared to 150 through the exchange. What would my options be?

The questions was: “If I terminate the entire CC plan will that act as a qualifying event to get off-exchange coverage for my family?”

The answer is: YES. You may obtain off-exchange coverage for any of your family members. There are no premium tax credits available for off-exchange coverage.

Your new employment constitutes a “Qualifying Life Event” and that allows anyone or everyone in your household to obtain new coverage.

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