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The Affordable Care Act

The Affordable Care Act (ACA), otherwise known as Obamacare, is here.  Its goal is to make sure that everyone has access to affordable healthcare insurance. 

Individuals

If you do not have employer sponsored health insurance, you now have the option to purchase directly from an insurance company, or through the new Exchange/Marketplace.

  • Individuals may purchase insurance through the new Exchange/Marketplace and Open Enrollment began October 1, 2013 and continues through March 31, 2014. 
  • If you do not have coverage through your employer and choose to not purchase insurance you will be assessed a penalty.  The penalty for not complying with the mandate must make a “shared responsibility payment” (a penalty) to the Federal Government.  The penalty will be the greater of and phased in according to the following table:

2014

 

2015

 

2016

$95 or 1.0% of “excess income”

 

$325 of 2% of “excess income”

 

$695 or 2.5% of “excess income”

Capped at $285 per family

 

Capped at $975 per family

 

Capped at $2,085 per family

 

Regardless of which plan you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses.

  • Subsidies are available to qualifying taxpayers.
  • If your employer offers minimum essential coverage and you choose to enroll through the exchange, you will lose the pre-taxable benefit for your health insurance. 
  • If you need in-person assistance, please visit the following link to find an approved navigator in your area http://www.insureks.org/allagents.php
  • When comparing premium rates, be sure to consider the benefits, plan provider networks, and out of pocket costs.

Small Businesses (Under 50 Full-time Equivalent (FTE))

Small Businesses under 50 FTE are not required to provide health insurance for employees, however, if you do, the following must be taken :

  • Employers that provide group health insurance that are Non-Grandfathered must provide the minimum essential coverage to their employees.
  • Insurance can be purchased direct from an insurance carrier or through the Small Business Health Options Program (SHOP). 
  • For qualified employees to receive the tax premium assistance credit, the group plan must be purchased through the SHOP.

Large Businesses (Over 50 FTE)

  • Large businesses are not required to comply with ACA until 2015. 
  • A “large employer” is defined in the ACA (as related to the employer penalty) as an employer who employed an average of at least 50 full-time equivalent employees (FTEs) on business days during the preceding calendar year.
  • To avoid a potential penalty, employers who do provide health insurance coverage must provide affordable and adequate coverage to employees and their dependents.

 

  • Potential Penalties

If you do not provide health insurance - the monthly penalty is 1/12 x $2,000 x (Number of full-time employees – 30)

If you provide health insurance, and one or more employee is enroller through an exchange plan - the monthly penalty is: 1/12 x $2,000 x (Number of full-time employees – 30)

If you provide health insurance, and one or more employee is enroller through an exchange plan and receives a credits: the monthly penalty is 1/12 x $3,000 x (Number of full-time employees who receive credits for exchange coverage)

 

The Information provided is for informational purposes only and is not all inclusive of the Affordable Care Act