The California Department of Insurance says most people in the state get their health insurance through their jobs. In reality, the sources of insurance for Californians are a mixed bag.
It’s true that most Californians are insured. The California Legislative Analyst Office (LAO) said in December 2022 that about 92% of Californians have health insurance. The LAO is the legislature’s nonpartisan fiscal and policy advisor. That percentage is way up from 2013 when 19% of Californians lacked insurance coverage.
The sources of coverage, based on a 2021 estimate, are varied. They include:
- employer-sponsored insurance
- subsidized individual market insurance
- unsubsidized individual market insurance
- Medi-Cal (California’s version of the federal Medicaid program that provides health insurance to eligible low-income individuals)
- Medicare (providing insurance primarily to the elderly)
- a combination of Medi-Cal and Medicare
- other public insurance
If you’re working, you probably don’t qualify for free or subsidized health coverage. So, what should you do?
1: Talk with your employer.
Depending on your group size and the type of organization you work for, you may have direct access to your company’s leadership. In other cases, your first point of contact might be your HR team or your immediate supervisor or manager. Ask if you can schedule a meeting to discuss how offering employee benefits could help you – and all of your work colleagues and dependents.
If your employer has 50 or more full-time employees, the Affordable Care Act (ACA) says the business is an Applicable Large Employer (ALE). That means it is subject to the ACA’s shared responsibility provisions.
ALEs must offer full-time employees the opportunity to enroll in “affordable” Minimum Essential Coverage (MEC). Otherwise, the employer is subject to an ACA penalty. The penalty depends:
- how long the employer has been an ALE (and how long it went without offering coverage);
- the number of employees at the business.
For more information about affordability and penalties, visit the IRS web page on Employer Shared Responsibility Provisions.
If your employer does not have at least 50 full-time employees, that does not mean it is not an ALE. It could be part of larger group of related businesses. Together, they may be considered an ALE, which triggers the same coverage mandate described above. For more information about Controlled Groups, read the PeopleKeep article, How does the employer mandate apply to controlled groups?
Your employer may think paying the ACA penalty is less expensive than the cost of health insurance with employees. That is not necessarily true. Read on (see point 3, below) to learn more. Find out how an insurance broker can provide insight on the advantages of offering employee benefits. It can be good for your employer – and for you and other employees.
You might also suggest your employer read our post, Understanding the Hidden Costs of Not Offering Employee Benefits.
2: Talk with your spouse.
If you don’t have access to health insurance and other benefits through your employer, you may be able to get coverage through your spouse. (If you’re unmarried and under age 26, you may be able to get coverage through a parent. Visit healthcare.gov for more information.)
If you declined coverage at your spouse’s prior open enrollment, he or she may need to wait to add you during the next open enrollment.
3: Talk with a broker.
A broker can compare coverage options to find one that strikes the right balance between costs and benefits. One of the fastest-growing health insurance programs in the Golden State is CaliforniaChoice. It’s a multi-carrier exchange that lets employees choose from eight health plans and 130+ coverage options. That makes it easy to find a plan that’s right for your individual or family health insurance needs – and budget.
A broker will also discuss the tax advantages available to employers that offer health insurance and other benefits. He/she/they will also share how health insurance can help a business attract and affect worker retention, while still controlling costs.
If your employer doesn’t have a benefits broker, you can suggest a visit to MyCalChoice.com. The site makes it easy to search for a local broker who knows the health plans in your area as well participants in different provider networks.
Contrary to what you might think, using a broker does not cost you anything. What you and your employer pay for coverage is the same whether you go directly to a carrier, buy coverage online, or use a broker.
Our blog post, Your Guide to Managing Health Insurance Costs, offers other employer tips, too.