Employer Coverage and Financial Help
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.
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 2023, 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 9.12 percent of the employee’s household income.
If the lowest-cost health plan offered by your employer to cover only you costs more than 9.12 percent of your household income, you can apply for a Covered California plan with financial help.
If the lowest cost health plan option is 9.12 percent or less for the employee only, but over 9.12 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 2023):
- 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.
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