First passed in 2010, and constantly changing, the rules of the Affordable Care Act is healthcare reform that impacts how employers provide benefits for employees. As group insurance experts, the consultants of Healthfirm Benefits strive to stay knowledgeable in all state and federal laws concerning employee benefits, and we are mindful of new rules and regulations as they are established, including those of the Affordable Care Act.
We provide the following services to ensure employers avoid penalties and remain compliant with the ACA.
Individuals and Small Businesses may be eligible for a tax credit under ACA healthcare reform laws. Thus, the credit is applied as a discount on your monthly insurance premium. Accordingly, to see if you are eligible for a tax credit, please use the Subsidy Calculator provided by the Health Insurance Marketplace. Or, if you are a business, use the Small Business Tax Credit Calculator provided by the Health Insurance Marketplace. In any case, both businesses and individuals must purchase benefits through the Health Insurance Marketplace to secure their tax credit.
EMPLOYERS: Employers who have more than 50 full-time equivalent employees must offer those employees benefits that pay for 60% of the minimum essential benefits. Accordingly, if you are in non-compliance, you will incur a penalty of $2,140 per year multiplied by the number of full-time employees, and excludes the first 30 employees. Additionally, the penalty is increased each year by the growth in insurance premiums. However, note you may also incur a penalty when at least one of your employees receives a premium tax credit in the Health Insurance Marketplace (Exchange).
INDIVIDUALS: Following is information on the Individual Mandate of the ACA. However, note the tax penalty for individuals has been recently repealed. The penalty, prior to 2019, affects individuals who fail to obtain qualifying health insurance. Individuals can have coverage through their employer, or through an individual policy to satisfy the requirement. Accordingly, if you do not have qualifying health insurance, the tax penalty will be $695 for adults. Additionally, the penalty is $347.50 for each child. However, the maximum family penalty is the greater of 2.5% of income, or three times the adult penalty, which is $2,085. Consequently, your penalty will be applied on your annual tax return.
Your employer paid benefits must comply with the “Essential Benefits” of ACA. Specifically, to be in full compliance with the law, your insurance policy must cover at least 60% of the costs of the following essential benefits. If you purchase an individual policy from the marketplace, it’s likely that your policy will also contain these benefits.