Open enrollment starts 11/01 and ends on 01/31 every year. Applications submitted before 12/15 will have a 01/01 effective date. Applications submitted between 12/16 and 01/15 will have a 02/01 effective date and any applications submitted between 01/16 and 01/31 will have a 03/01 effective date.
If you have a life qualifying event, you qualify for a 60-day “special enrollment period” and may enroll during that time.
For 2018, if you’re a single individual making less than $48,240/yr or a family of four earning less than $98,400/yr, you may qualify for a subsidy. Visit the Shop and Compare Tool page to see if you qualify.
Most Americans are required to have health insurance under the Affordable Care Act. If you choose to remain uninsured, you may face a tax penalty. Learn more about the penalty for remaining uninsured.
All Covered California plans come with children’s (under 19) dental and vision coverage included in every plan. In addition, Covered California offers optional individual or family dental & vision plans that provide benefits for adults.
Click below to learn more about:
Most people become eligible for Medicare on the 1st of the month that they turn 65 as long as they have worked for 10 years (40 quarters) and paid Medicare taxes.
Click here to visit Medicare.gov to see the period when you will be eligible to enroll.
Original Medicare only
Original Medicare with a Prescription Drug Plan (PDP) and/or a Medicare Supplement (Medigap) Plan.
Medicare Advantage Plan with or without drug coverage (MA or MAPD) as a replacement for Original Medicare.
Click here to visit Medicare.gov and learn more about your Medicare coverage options.
Most people don’t have to pay for Medicare Part A (Hospital Insurance). You will get “premium-free” Medicare Part A if you or your spouse (living, deceased or divorced) paid Medicare taxes during at least 10 years of work.
For Medicare Part B (Medical Insurance), most people will pay the 2018 standard premium amount of $134/mo. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
Click here to see the Part B premium chart at Medicare.gov.
No, however a Medicare Supplement (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.
A Medigap policy is different from a Medicare Advantage Plan (MAPD). Those plans are ways to get Medicare benefits as a replacement for Original Medicare, while a Medigap policy supplements your Original Medicare benefits.
Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
Click here to visit Medicare.gov and learn more aboutMedicare Supplement (Medigap) policies.
If you don’t take any prescription drugs, you do not need to enroll in a Prescription Drug Plan (PDP). However, if you don’t enroll in a PDP or a Medicare Advantage Plan (MAPD) w/ drug coverage when you first become eligible, you could be charged a late enrollment penalty when you do enroll at a later date.
Click here to learn more about the Part D (Drugs) Late Enrollment Penalty.
In order for a small business to establish group coverage, there must be at least 2 eligible employees (30+ hours/week) with at least one W-2 employee that is not the spouse or domestic partner of the owner.
In California if an employer offers group coverage to their employees, they are only obligated to contribute towards medical coverage and not any other ancillary benefit like dental, vision or life insurance.
The minimum contribution is 50% of the least expensive, employee-only medical plan. This means they are not obligated- but may wish- to offer a contribution of more than 50% to employees, or coverage to dependents at any percentage.
The rates are based on age and it is not unlikely to have an employer contribution of less than $100 ppm (per person, per month).
Yes you can write-off 100% of the employer contributions you make for employee coverage as a business expense.
More importantly, you can set up the premiums to be deducted on a “pre-tax” basis. This benefits both you and your employees:
- Employees pay less in taxes because the insurance premiums are taken out before taxes are calculated. Average employee savings is about $400/year.
- Employers pay less in payroll taxes because the taxable payroll amount is reduced. Average employer savings is about $125/employee/year.
Not unless you have 50 or more FTE (full-time equivalent) employees. To calculate your FTEs, see below:
Included in FTE calculation:
- Full-time (FT) employees working 30+ hours/week or 130+ hours/month.
- Part-time (PT) employees working less than 30+ hours/week or 130+ hours/month but more than 120 days/year.
Excluded from FTE calculation:
- Seasonal employees working less than 120 days/year.
STEP 1: Calculate “FT” FTEs
This is easy as all “FT” employees are considered FTEs.
Example: 40 FT employees = 40 “FT” FTEs
STEP 2: Calculate “PT” FTEs
Add up the total monthly hours of all your PT employees and divide that by 130. This will give you the number of your “PT” FTEs.
Example: 1,430 hours / 130 = 11 “PT” FTEs
STEP 3: Add “FT” & “PT” FTEs
40 “FT” FTEs + 11 “PT” FTEs = 51 FTEs (50+ you must offer coverage)
Domestic health insurance typically covers little to nothing when you are traveling out of the country. Even when there is coverage, finding a reliable doctor can be a challenge in the event of an emergency.