If the employer provides health insurance to the employee and the employee falls within the 138%-250% of the FPL, does the employee qualify for cost-sharing reductions?

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Home »Frequently Asked Questions »If the employer provides health insurance to the employee and the employee falls within the 138%-250% of the FPL, does the employee qualify for cost-sharing reductions?Covered CA

If the employer provides health insurance to the employee and the employee falls within the 138%-250% of the FPL, does the employee qualify for cost-sharing reductions?

An individual would not be eligible for the cost-sharing reductions if the employer provides minimum essential coverage that is affordable and of minimum value. Affordable means the employee’s portion of the premium, for employee-only coverage, is 9.5% or less of the employee’s income. Minimum value means the plan has at least a 60% actuarial value, i.e. for an average population, it is expected to pay at least 60% of allowed costs.

It is also important to note that the cost-sharing reductions are only available in the silver tier of Covered California’s Individual Marketplace.

There may be a more recent answer to this question. Contact Claremont for an update.