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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.

Spouse Not Covered by Employer

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Question: Both my spouse and I are insured through Covered California. My job is offering me 100% medical coverage but nothing for my spouse. Are they eligible to still go through CA for insurance?

Answer: If your spouse has access to coverage through your employer, he or she is no longer eligible for subsidized coverage through Covered California even though the employer makes no contribution toward the spouse's coverage. If your employer-sponsored coverage is not offered to the spouse and dependents, then he or she is still eligible for subsidized coverage.

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An employer invariably “offers” coverage to dependents, whether it chooses to pay some or all of the dependents’ premiums or not. It is the “offer” of coverage, not the the premiums or their affordability, that makes the dependents ineligible for advahce premium tax credits (APTCs). As long as the employee’s share of the “employee-only” premium is less than 9.5% of adjusted gross income, the cost of health insurance is considered “affordable,” whether or not the employee can afford to pay for dependents.

In response to this question, coverage may be obtained through Covered CA or on the exchange, because no APTCs are available.

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