I Cannot Afford the Health Insurance at my Job – What Can I Do?
The new health care law requires most people to have health coverage or face a tax penalty. If you cannot afford
the health insurance available through your job, you might have other options to get coverage that you can
afford.
Am I required to take my job’s insurance?
Most employers do not require you to sign up for their insurance. You might have to show that you have some
other health coverage such as Medi-Cal, Medicare, or insurance through a family member. Check with your
employer to see what its rules are. Your employer must apply its rules the same to everyone.
What else is available?
Medi-Cal
If you qualify for Medi-Cal you may be able to get your health care for free. Eligibility is based on how much
money you make and your family size. If you earn less than $1,342 a month as one person or $2,743 as a family of
four, you probably qualify for free Medi-Cal. Certain people, such as children and people with disabilities can get
Medi-Cal with higher household income, but they might have to pay for part of their care.
Help Paying for Covered California Insurance
If you are offered insurance through your job, you can still get help paying for insurance through Covered
California if:
1. The insurance from your job does not pay for enough services.
If the insurance from your job does not cover enough of your care, it is not considered “minimum essential
coverage.” You may be able to get help buying insurance from Covered California instead. If you think the
insurance from your job does not meet the requirements for “minimum essential coverage” call Covered
California or go to CoveredCA.com
OR
2. 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. You will get help paying for your insurance through Covered California if you earn
less than $3,830 a month as one person or $7,850 as a family of four.
Example: Big Box Store offers insurance to its employees. Your share of the premium is $300 a month.
You earn $2,500 a month. Since $300 is 12% of $2,500, you can get help paying for health insurance
through Covered California and you will probably pay less than buying it through your job.
What if the insurance from my job is considered “affordable” but I still cannot afford it?
If the amount of the premium that you must pay for your own coverage is more than 8% of your income and you
are not eligible for help through Covered California, you can get an exemption for yourself and your family from
Health and Human Services. If you have an exemption, you do not have to purchase health coverage, but you will
still be uninsured. See the Health Consumer Alliance Fact Sheet “Do I Have to Get Health Coverage?”
Example: The same Big Box Store offers you insurance at a rate of $215 a month. You earn $2,500 a
month. $215 a month is 8.6% of $2,500. You cannot get help buying insurance from Covered California
because the cost to you of your insurance is less than 9.5% of your income.
You can still buy insurance through Covered California or through another insurer if that is cheaper than the
insurance from your job, but you will not get help (“tax credits”) paying for it. If you buy insurance through
Covered California and later become eligible for the tax credits, you can start getting help paying for your
insurance right away.
What if the insurance offered to me is “affordable”, but I cannot afford to cover the rest of my family?
The amount that you pay as an employee for your health care is usually cheaper than the amount you pay for
your spouse or children. Unfortunately, in deciding whether your job’s insurance is affordable, the decision is
based on the cost of insurance premium offered to the employee, not the cost of the insurance premium for
other members of the family.
Even if the insurance premium for your other family members would cost more than 9.5% of your total household
income, if the insurance premium that you, the employee, would pay is less than 9.5% of your total household
income, they cannot get help if they buy insurance directly from Covered California. You should check to see if
you or other members of your family are eligible for Medi-Cal. In a family of four making up to $5,287 a month,
the children can get Medi-Cal. There are other Medi-Cal programs that let you have more monthly income and
would cost less.
You should also compare prices with other insurance that is available through Covered California or other health
insurance companies in your area to buy your family members separate health insurance.
Resources:
Apply for Medi-Cal or Covered California insurance at www.coveredca.com or at your local county social services
office.
April 2014
Note: The rules about whether your job’s insurance is “affordable”
apply even if you do not sign up for it.
