Exceptions to the Employer Sponsored Coverage “Affordability” Rule


Most individuals and families that are offered insurance at work or through a family member’s job do not qualify for a tax credit through the California state exchange: Covered California. However, there are a few exceptions. Situations that fit the scenarios below may be eligible for a subsidy through Covered California.

Employer Sponsored Health Insurance that is not “Affordable.”

If the health plan offered at work doesn’t pass the employer sponsored affordability test, then you may qualify for a subsidy through Covered California.

Waiting or Probationary Periods

If you have been offered employer health benefits but are required to wait the customary 30 to 90 days before benefits kick in, then you may be able to take advantage of the financial assistance through Covered California for the duration of your waiting period.

COBRA Health Insurance in California

COBRA is often expensive, but allows you to keep your group health plan for a period of time once leaving your place of employment. Before you decide to sign up for COBRA, know your options. If your income qualifies you, you may be eligible to purchase a plan through Covered California with premium savings. Be aware that if you are already enrolled on COBRA, you cannot switch onto a health plan through Covered California until the next open enrollment period.

Retiree Health Insurance Offered by a Former Employer

Those that are offered retiree health coverage may be considered for premium assistance. If this is your situation, give us a call at 1-877-752-4737 and we’d be happy to help you further.

Income Can Still Qualify You for Medi-Cal

Some or all of your family may still qualify for the Medi-Cal program if your income lands within a certain range of the Federal Poverty Level guidelines. This is regardless of whether you are offered insurance through your job or a family member’s job. Some families that are offered “affordable” insurance at work find it a cost effective option to keep their insurance at work for themselves but enroll their children in the Medi-Cal program if qualified.

Not sure how Obamacare affects your health care plans in California? Learn how the ACA works in California, including benefits, costs and enrollment.

Covered California is the Golden State’s official health exchange marketplace where individuals, families and small businesses can find high-quality, low-cost California government health insurance.

Learn about Obamacare income guidelines in California using our income limits chart, and see if you’re eligible for government assistance.

Learn about the Covered California website. Find easy online enrollment. Set up your account, log in, buy insurance and more on the California health marketplace website.