Employees who are offered health coverage by their employer that is affordable and meets minimum value standards do not qualify for financial help to lower the cost of a Covered California health plan.
You may still buy a Covered California health plan, but you will have to pay the full cost of that plan. Also, if you turn down your offer of affordable employer-sponsored coverage and enroll in a plan through Covered California with financial help, you may have to pay back some or all of the premium tax credits when you file your federal taxes.
Our Affordability Tool can determine if coverage offered through your employer is affordable.
What is affordable and minimum value coverage?
Most health plans offered by employers are considered affordable and meet the minimum value standard.
A health plan meets minimum value standards if it pays at least 60 percent of the total cost of medical services. It must also provide enough coverage for hospital and doctor services. In other words, it must be similar to a Bronze plan with Covered California.
The affordability threshold percentage changes every year. For 2024, employer-sponsored coverage is considered affordable if the employee’s share of the premium for the lowest-cost plan to cover the employee only (not including the family) is not more than 8.39 percent of the employee’s household income.
If the lowest-cost health plan offered by your employer to cover only you costs more than 8.39 percent of your household income, you can apply for a Covered California plan with financial help.
If the lowest cost health plan option is 8.39 percent or less for the employee only, but over 8.39 percent to cover the other family members, those family members may qualify for financial help to lower the cost of a Covered California plan.
In addition, if the plan offered by your employer (or a family member’s employer) for self-only coverage or the plan available to you is through a family plan as a family member of the employee, costs more than 8.17 percent of your household income (for 2024):
- You may qualify for an exemption to avoid the state tax penalty if you go without coverage.
- You may qualify to buy a minimum coverage plan with a high deductible through Covered California.
- Children under 19 may qualify for Medi-Cal or CCHIP (County Children’s Health Initiative Program), depending on household income.
- Consider buying a full-priced individual or family plan for your spouse and children through Covered California. Use the Shop and Compare Tool to compare prices.
To find out if your employer-sponsored plan is considered affordable, use the Affordability Tool or print or download the Employer Coverage Worksheet.
Go to the Glossary to learn more about affordable coverage and minimum-value standards.
Employer Coverage Worksheet
FAQs
You can still sign up for a health plan through Covered California. You will have to pay full price unless your employer-sponsored coverage is considered not affordable and does not meet minimum value standards.
Does Covered California offer financial assistance? ›
Lawfully present individuals who meet all other eligibility requirements, such as income requirements and California state residency, may be eligible for financial help to purchase a health insurance plan through Covered California.
Can you apply for Covered California if you already have insurance? ›
If the plan provided by your job is affordable and meets minimum standards, as most do, you won't qualify for financial help through Covered California if you decide to switch.
What income disqualifies you from Covered California? ›
The limits are based on both household income and household size. In 2024, an individual in a one-person household is eligible for some degree of Covered California subsidies if they earn up to $33,975 Meanwhile, that limit rises to $69,375 for a household size of 4.
Can I decline my employer's health insurance and get covered in California? ›
The insurance from your job is not “affordable” according to the law. If the premium (the monthly payment) that you, as an employee, must pay for your own coverage is more than 9.5% of your income and your income is below the Covered California limit, you can get help buying insurance through Covered California.
Can I enroll in Covered California if I lose my job? ›
You can get health coverage!
If your job was affected by COVID-19, or if you lack income because your hours were cut or you're no longer working, Covered California is here for you.
Who is eligible for the Covered California subsidy? ›
The Covered California income limits require consumers to have a household income that ranges from 0% to 400% of the Federal Poverty Level (FPL) in order to qualify for assistance on a government health insurance plan. See the Covered California 2024 income limits chart below.
Why am I not eligible for Covered California? ›
You do not have other health coverage (such as free Medi-Cal or employer-sponsored insurance) that prevents you from qualifying for insurance through Covered California. Covered California stated that you are not a California resident. Covered California stated that you did not pay your premiums by your due date.
Why do I owe money for Covered California? ›
And if the government determines that you received too much APTC (because your income changed and you didn't tell Covered California), you may have to pay back some of the money you received. This is called “reconciliation.”
How quickly does Covered California kick in? ›
For most qualifying life events, your coverage will start on the first day of the following month after you select a plan. Want to get started with Covered California?
Royalty or residual income statement or 1099-MISC. Letter, deposit, or other proof of deferred compensation payments. Social Security Administration Statements (Social Security Benefits Letter). Retirement, Survivors Disability Insurance (RSDI), Social Security Retirement, Social Security Disability Insurance (SSDI).
Can you have two health insurances Covered California? ›
In California, qualified group health insurance plans co-ordinate benefits with each other. This means that you can get coverage under your health plan and additional sharing of claims cost under your spouse's group plan if you are enrolled on both.
Can you get covered in California if your employer offers insurance? ›
If the lowest-cost health plan offered by your employer to cover only you costs more than 8.39 percent of your household income, you can apply for a Covered California plan with financial help.
What happens if my income increases while on Covered California? ›
If your income is more than what you told us on your application, you may have to repay some or all of the advanced premium tax credits that you got. There are limits to the amount you may need to repay, depending on your income and if you file taxes as “Single” or another filing status.
Does Covered California check your assets? ›
asset information? eligibility for Medi-Cal. For new Medi-Cal applications only, current asset limits are $130,000 for one person and $65,000 for each additional household member, up to 10. Starting on January 1, 2024, Medi-Cal applications will no longer ask for asset information.
What is the law on employers providing health insurance in California? ›
Health insurance in California
While health insurance isn't required by state law, federal law requires employers with 50 or more full-time equivalent employees (FTEs) to provide health insurance benefits with minimum essential coverage (MEC).
Can I lose my health insurance while on workers comp in California? ›
Big businesses generally cannot cancel your health insurance coverage. However, if you work for a small business, it could legally stop your coverage. You have protections in California against retaliation. For example, your employer cannot discontinue your coverage because you filed a workers' compensation claim.
Does Covered CA contact your employer? ›
Covered California will send a notice to the employers of those consumers who provided contact information in the application.
Can I get Medi-Cal if my employer offers insurance? ›
Note: You can choose to get Medi-Cal even if you have employer-sponsored coverage. If you have both at the same time, Medi-Cal may decide it is cost-effective for them to pay your portion of your employer-sponsored health insurance's premium.
