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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.

No Hospitalization Coverage with Employer's Plan?

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Question: If my employer offers health ins without hospitalization can I still buy into the market place? I have a new job that gives Health Ins with no Hospitalization coverage. They meet the min requirements because they cover preventive care. But the min value part that covers hospitalization is not covered. You can purchase the plan and will not have to pay the penalty for not having insurance because they cover preventive care. But my concern is I will not be able to purchase health care on the market place because I am offered this by my employer.

Answer: Apparently, your employer has a limited-benefit minimum essential coverage (MEC) employer-based health plan - a loophole to avoid penalties for not offering required health insurance - and it protects you the employee from individual mandate penalties. However, you are still eligible for enrollment in Covered California and you may qualify for premium assistance if you meet residence and income guidelines. If you enroll in Covered California, your employer may be fined $3,000.


Can someone who is offered employer-sponsored coverage qualify for a premium tax credit?

In most cases, no. An offer of employer-sponsored coverage generally makes an employee ineligible for premium tax credits. The exception is if the employer-sponsored coverage is unaffordable or fails to meet the minimum value standard. If the coverage is affordable and adequate, the employee will be ineligible for premium tax credits regardless of whether the employee chooses to enroll in the employer-sponsored coverage. However, if the employer’s health plan does not offer adequate coverage or is not affordable, the employee can choose to enroll in coverage in the Marketplace and can qualify for premium tax credits.

Employer-sponsored coverage meets the minimum value test and is considered adequate if it covers at least 60 percent of the expected cost of benefits, on average. Employer-sponsored coverage is considered to be affordable if the contribution required to cover the employee is less than 9.5 percent of the employee’s household income. Employer-sponsored coverage must meet both of these tests; otherwise, the employee may forgo the employer’s offer and potentially qualify for premium tax credits in the Marketplace (an event referred to as “jumping the firewall.”)

The response answering the question is incorrect. If an employee is being offered an employer sponsored coverage that meets MEC guidelines that employee is already receiving a contribution towards their health insurance premiums and thus DISALLOWING premium assistance from the exchange.


The IRS already recognizes (since 2012) same-sex marriages for tax filing purposes, i.e same-sex married couples can file jointly. I don’t see why subsidies based on household income would pose any problem for same-sex couples. I’ll try to get an answer from CC, but don’t hold your breath.

Have you any information on Covered California’s position with regard to Domestic Partnerships. Previously you could not enroll with joint income and domestic partnership for same sex couples as the Federal Government who provides the subsidies did not recognize. Now that the Supreme Court has ruled on the issue, will the Exchange be able to process this change? Would it be considered a Special Enrollment option?

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