HomeCovered CA > Individual > Rates


Penalties for No Coverage – Starting in January 2014, most people over the age of 18 will be required to have public or private health insurance or pay a financial penalty.  The penalty will be phased in over 3 years and will increase each subsequent year. In 2014, the penalty will be 1% of your income or $95, whichever is greater.  By 2016, the penalty will be 2.5% of your income, or $695, whichever is greater. If you fall below 138% ($15,971) of the federal poverty level you qualify for free medical insurance through Medi-Cal (with some exceptions).  The Affordable Care Act sets a monthly maximum that individuals will have to pay for health insurance based on where their income falls in relation to federal poverty levels. 

Federal Poverty Level ($11,490)Up to 150% ($17,235)200% ($22,980)250% ($28,725)400% ($45,960)
Percent of Income4%6.3%8.05%9.5%
Max Monthly PortionUp to $57Up to $121Up to $193Up to $364


Under the new Affordable Care Act, if you are paying more than 9.5% of your income towards health care premiums, then your plan is not considered ‘affordable.’  If you obtain health insurance directly through your employer, in all likeliness your employer is subsidizing your health care premium, thus making it ‘affordable.’  In many instances, the employer only subsidizes the employee and not any additional family members.  In this case, you would have to check and see if you are paying more than 9.5% of your adjusted gross income towards the policy for all family members.  If the premium is indeed more than 9.5%, then you are not being offered ‘affordable’ health care and you should seek coverage through Covered California for a subsidy.  Covered CA also provides small businesses tax credits with affordable health care options, so if you would like us to reach out to your employer on your behalf, then just let us know.





Premium assistance amounts are based on the second lowest Silver Plan per carrier.  The premium assistance will pay the difference between the full cost of the second lowest Silver plan and the individuals monthly maximum portion.  Costs of each plan will vary based on zip code and age. Not all 12 Covered CA health insurers are available in each region.  Each region/zip has specific companies available to its residents. Review metal tiered plans by each carrier.

We’d love to hear from you

Contact Us

Recent News

Common ERISA Penalties by the DOL

The Department of Labor recently released their inflation-adjusted penalties for ERISA, the Family Medical Leave Act, and the Genetic Information Nondiscrimination Act.

SPD Requirements – Erisa Wrap Compliance

The Employee Retirement Income Security Act (ERISA) oversees group benefit plans, and with the onset of the Affordable Care Act, the ERISA Summary Plan Description (SPD) requirements are in the spotlight.