Employer Coverage and Financial Help

Employees who are offered health coverage by their employer that is affordable and that meets minimum value standards are not eligible for financial help to help pay premiums for an individual Covered California health plan. You can buy a Covered California health plan, but you will have to pay the full cost without tax credits. If your employer offers you affordable and minimum value coverage, but you turn it down, sign up for an individual plan through Covered California, and receive financial help to pay for that plan, you may have to pay back some or all of the tax credits or subsidy you received when you file your state and federal taxes.

What is affordable and minimum value coverage?

Most health plans offered by employers are affordable and offer minimum value. 

A health plan meets minimum value requirements if it is designed to pay at least 60 percent of the total cost of medical services for a standard population and includes substantial coverage of inpatient hospital and physician services. In other words, it must at least be equivalent to a Bronze plan.     

Employer insurance is considered affordable if your share of the premium for the lowest-priced plan available to cover you — not your family — is 9.83 percent for 2021 or less of your household income.

If the lowest-priced [HC(1] insurance offered by your employer to cover only you costs more than 9.83 percent of your household income in 2021 (9.61 percent in 2022), you and the rest of your household can apply for a Covered California plan with financial help.

If the lowest-priced insurance offered by your employer to cover only you costs less than 9.83 percent of your household income in 2021 (9.61 percent in 2022), you and the rest of your household cannot receive a Covered California plan with financial help.

• 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. Visit the Shop and Compare Tool to see rates.

In addition, if the insurance offered by your employer for self-only coverage or the insurance available to you is through a family plan as a family member of the employee, costs more than 8.27 percent of your household income in 2021, or 8.09 percent in 2022:  

• You may qualify for an exemption to avoid the state tax penalty if you go without insurance.
• You may qualify to buy a minimum coverage plan with a high deductible.
• 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. Visit the Shop and Compare Tool to compare prices.   

Get more information about what affordable coverage and minimum-value coverage mean when we talk about health plans offered by your employer.