Will the ACA eliminate small employer insurance coverage?
No. The law does not eliminate small group insurance. The law provides tax credits to employers who offer health insurance to their employees.
Employers with 25 or fewer employees with average annual wages of less than $50,000, may be eligible for a special tax credit of up to 50% of the amount the employer contributes toward employee insurance premiums (for employers who pay at least fifty percent of their employees’ monthly health insurance premiums)
https://www.ehealthinsurance.com/affordable-care-act/faqs
When can small employers enroll in coverage through the SHOP Marketplace?
Small employers can buy coverage for their employees through the SHOP Marketplace at any time during the year.
http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/
I live in State A but my small business is in State B. I want to buy group coverage for my employees through the SHOP Marketplace. In what state should I buy health benefits?
You should buy group coverage through the SHOP Marketplace in State B, where your business is located.
http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/
COBRA
Can I still go on COBRA?
Yes. What’s nice about the Affordable Care Act is that is gives people on COBRA the ability to apply for individual coverage without concern that their application can be declined. And, people who opt out of COBRA and buy an individual insurance policy may qualify for low-income subsidies to help the pay for cost of their plan.
https://www.ehealthinsurance.com/affordable-care-act/faqs
I have COBRA and it’s too expensive. Can I drop it during Open Enrollment and enroll in a Marketplace plan instead?
During Open Enrollment, you can sign up for a Marketplace plan even if you already have COBRA. You will have to drop your COBRA coverage effective on the date your new Marketplace plan coverage begins. After Open Enrollment ends, however, if you voluntarily drop your COBRA coverage or stop paying premiums, you will not be eligible for a special enrollment opportunity and will have to wait until the next open enrollment period. Only exhaustion of your COBRA coverage triggers a special enrollment opportunity.
http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/
I have COBRA and am finding it difficult to afford, but Open Enrollment is over. Can I drop my COBRA and apply for non-group coverage outside of Open Enrollment?
No, voluntarily dropping your COBRA coverage or ceasing to pay your COBRA premiums will not trigger a special enrollment opportunity. You will have to wait until you exhaust your COBRA coverage or until the next Open Enrollment (whichever comes first) to sign up for other non-group coverage.
http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/
I’m leaving my job and will be eligible for COBRA. Can I shop for coverage and subsidies on the Marketplace instead?
Yes, leaving your job and losing eligibility for job-based health coverage will trigger a special enrollment opportunity that lasts for 60 days. You can apply for Marketplace health plans and (depending on your income) for premium tax credits and cost sharing reductions during that period. If you enroll in COBRA coverage through your former employer, however, you will need to wait to the next Marketplace open enrollment period if you want to switch to a Marketplace plan.
http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/
WELLNESS PROGRAMS
My employer offers a workplace wellness program that increases premiums for employees who don’t participate and/or can’t meet certain health targets, such as normal weight or blood pressure. Is this allowed?
Yes, as long as your employer workplace wellness program meets certain requirements, it can increase your premium by as much as 30 percent of the cost of the health plan if you don’t participate or meet required health targets. (Or, if one of the health targets involves tobacco use, the penalty can be as much as 50 percent of the cost of the health plan.) Some of the key requirements include:
- The health plan must offer you a reasonable alternative way to avoid the penalty (for example, it might require that you participate in an exercise program, or it might require you to meet a less stringent target level for the required health measures)
- If you are unable to meet the health targets due to a medical reason, the health plan must offer you an alternative way to avoid the penalty that is medically appropriate for you
The health plan must give you at least one chance every year to be re-evaluated.
http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/
My employer health plan has a wellness feature that requires me to pay a higher premium if I don’t meet certain health targets. I don’t think I’ll be able to afford the premiums if I don’t participate or miss the mark. Can I leave my employer-sponsored plan and get one on the health insurance marketplace?
It depends. If your premium contribution with the wellness penalty would be more than 9.5% of your income, then your employer plan would be considered un-affordable and you would be eligible to apply for premium tax credits in the Marketplace. This test applies whether you are actually penalized or not, and in advance of the penalty being applied (for example, if your employer gives you time to try to meet the health standard that triggers a penalty or reward).
Adapted from http://kff.org/health-reform/faq/health-reform-frequently-asked-questions
LARGE EMPLOYERS
I work full time for a large employer (more than 50 full time employees). Is my employer required to offer me health benefits?
Your employer is not required to offer health benefits. However, starting in 2015, large employers that don’t offer health benefits to their full-time employees and to their dependent children may be liable for a tax penalty. If your employer doesn’t offer you health benefits, you can apply for coverage in the Marketplace; and, if your income is between $15,521 and $46,680 of the federal poverty level, you may apply for a premium tax credit that may reduce the cost of coverage in the Marketplace.
Note that a full-time employee is one who works, on average, at least 30 hours per week. If your hours vary during the year, your employer may have some options in determining your status as a full-time or part-time worker. Your employer can tell you whether you are a full or part-time worker.
I work full time for a large employer (more than 50 full time employees) and I’m married and we have kids. Is my employer required to offer health benefits that cover my spouse and kids?
Your employer is not required to offer health benefits. However, starting in 2015, large employers that don’t offer health benefits to their full-time employees and to their dependent children may be liable for a tax penalty. Large employers do not face a tax penalty if they don’t offer health benefits to the spouses of their workers.
If your employer doesn’t offer coverage to your spouse or children, they can apply for coverage in the Marketplace and, if your family income is between 100% and 400% of the federal poverty level, a premium tax credit that may reduce the cost of coverage in the Marketplace.
If your employer offers health benefits that are affordable and meet minimum value to you and your spouse and children, you still may choose to purchase coverage through a Marketplace, but your family will not be eligible for premium tax credits to help pay for the coverage.
I work part-time for a large employer. Is my employer required to offer me health benefits? What about benefits for my spouse and kids?
No, large employers are not required to offer health benefits to part time employees and there is no penalty for large employers that don’t offer health benefits to part-time employees or their dependents. If you work part-time and you are not offered health benefits, you (and your family) can apply for coverage in the Marketplace; and, if your income is between 100% and 400% of the federal poverty level, you can apply for a premium tax credit that may reduce the cost of coverage in the Marketplace.
Note that a part-time employee is one that works, on average, fewer than 30 hours per week. If your hours vary during the year, your employer may have some options in determining your status as a full-time or part-time worker. Your employer can tell you whether you are a full or part-time worker.
I work for a large employer (more than 50 full time employees) but my hours vary during the year. I work full-time during the summer but part-time the rest of the year. Does my employer have to offer me health benefits?
Beginning in 2015, employers must offer health benefits to employees who work, on average, at least 30 hours per week. Check with your employer/human resources department to find out if your hours worked over the year meet this threshold. If your hours vary during the year, your employer may have some options in determining your status as a full-time or part-time worker. Your employer can tell you whether you are a full or part-time worker.
I work full time for a small business (fewer than 50 employees). Does my employer have to offer me health benefits?
No, small businesses are not required to offer health benefits to either full-time or part-time employees, or to their dependents. Small businesses are not subject to tax penalties when they don’t offer health benefits. If your small employer doesn’t offer health benefits, you (and your family) can apply for coverage in the Marketplace; and, if your income is between 100% and 400% of the federal poverty level, you can apply for a premium tax credit that may reduce the cost of coverage in the Marketplace.
My large employer offers health benefits to me. My wife works and has coverage through her job. To figure out whether my coverage is affordable, do I just count my income or do I count my wife’s salary, as well?
If you are considering applying for premium tax credits for coverage in the Marketplace, the test for whether your employer coverage is affordable is based on the cost of self-only coverage in the lowest cost plan your employer offers, compared to your household income (and not just your salary).
EMPLOYEES AND EXCHANGE COVERAGE
My employer offers health benefits but doesn’t contribute much toward the premium. I can’t afford my share. Can I apply for coverage and subsidies in the Marketplace instead?
You can always shop for health coverage in the Marketplace. However, if you’re offered employer health benefits, you can’t qualify for premium tax credits in the Marketplace unless your employer coverage is considered unaffordable. If your share of the premium for self-only coverage in your employer plan is 9.5% or more of your household income, it is considered unaffordable, and you can apply for premium tax credits in the Marketplace.
My employer offers health benefits to me and my family. The company pays the entire cost of my coverage but contributes nothing toward the cost of covering my family. We can’t afford to enroll my wife and kids. Can they get coverage and subsidies in the Marketplace instead?
You can always shop for health coverage in the Marketplace. However, your employer-provided coverage is considered “affordable.” That’s because the affordability of employer sponsored coverage is only measured with respect to self-only coverage. Because your employer pays the entire cost of the employee-only coverage, you are technically considered to have affordable coverage (even though practically speaking, it was unaffordable to you.) As a result, neither you nor your wife and children are eligible to apply for premium tax credits in the Marketplace.
Depending on your family income, your children might qualify for the Children’s Health Insurance Program in your state. Check with your state Marketplace to find out if your children may be eligible for CHIP.
I’m offered health benefits at work, but they’re not very good. I’m applying for better coverage and subsidies in the Marketplace. The application asks whether I’m offered job-based health coverage that meets minimum value. What does that mean?
The term “minimum value” means that your job-based plan would cover at least 60% of an average group of people’s covered health costs. Most employer plans will meet this test, but some may not. The Marketplace application includes a form with questions about job-based coverage. You should take this form to your employer and has them to fill it out. With that information the Marketplace will determine whether the plan meets minimum value. If it doesn’t, you may be able to qualify for premium tax credits to help pay for Marketplace coverage.
My employer offers a plan with very limited benefits. It only covers preventive services and a few doctor visits each year. I want better coverage. Can I apply for coverage and subsidies in the Marketplace?
You can apply for coverage in the Marketplace and you may qualify for premium tax credits if your employer plan doesn’t meet the Affordable Care Act’s standard for minimum value. If your employer plan only covers preventive services and a few doctor visits, it probably doesn’t meet the minimum value standard, and so you could be eligible for premium tax credits to help buy a Marketplace plan. However, if the mini-med plan is only one choice that your employer offers, and if another plan your employer offers would be affordable and meet the minimum value standard, then you will not qualify for premium tax credits in the Marketplace.
INSURANCE PENALTY
What’s the penalty for not having health insurance?
If you’re uninsured for more than three months in 2014, you may incur the tax penalty and that penalty would be applied when you file your 2014 income tax return.
The penalty is phased-in over a three-year period.
- In 2014, the penalty will be the greater of 1.0% of taxable income or $95 per adult and $47.50 per child (up to $285 per family).
- In 2015, the penalty will be the greater of 2.0% of taxable income or $325 per adult and $162.50 per child (up to $975 per family).
- In 2016, the penalty will be at the greater of 2.5% of taxable income or $695 per adult and $347.50 per child (up to $$2,085 per family).
- After 2016, the penalty will be increased annually by the increase to the cost-of-living.
Households with incomes above $46,680 of FPL will be exempt from paying tax penalties if insurance in their area costs more than 8% of their taxable income, after taking into account employer contributions or tax credits.
Adapted from https://www.ehealthinsurance.com/affordable-care-act/faqs
I’m uninsured. Am I required to get coverage in 2015?
Everyone is required to have health insurance coverage – or more precisely, “minimum essential coverage” – or else pay a tax penalty, unless they qualify for an exemption. This requirement is called the individual responsibility requirement, or sometimes called the individual mandate.
http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/
How do I prove that I had coverage and satisfied the mandate?
When you file your 2014 tax return (most people will do this by April 15, 2015) you will have to enter information about your coverage (or your exemption) on the return. You should get a notice from your insurance provider by January 31, 2015, describing your coverage status during the previous year.
http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/
I had several short coverage gaps in a year – I was uninsured in March, then again in August. Since the total gap was less than 3 months, am I exempt from the penalty?
The rule for short coverage gaps is that only the first short coverage gap in a year will be recognized. You wouldn’t be penalized for lacking coverage in March, but you may owe a penalty for your second gap in coverage in August if you don’t otherwise qualify for an exemption during that period.
http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/
Apparently my family isn’t eligible for subsidies in the Marketplace because I am eligible for self-only coverage at work that is considered affordable. But we can’t afford to buy Marketplace coverage on our own. Will I have to pay a penalty because my family members are uninsured?
No. Because the amount you would have had to pay to actually cover your spouse and kids was more than 8% of your family income, they won’t be penalized for not having health coverage.
If I owe a penalty, when and how do I have to pay it?
If you do not maintain minimum essential coverage in 2014 and you don’t qualify for an exemption you will need to pay a “shared responsibility payment” to the IRS on your 2014 tax return. If you are like most people, you will need to submit your return by April 15, 2015.
http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/
On what grounds can I apply for a hardship exemption to the individual mandate?
You may apply for a hardship exemption if you have experienced difficult financial or domestic circumstances that prevent you from obtaining coverage – such as homelessness, death of a close family member, bankruptcy, substantial recent medical debt, or disasters that substantially damage a person’s property. People may also apply for a hardship exemption if obtaining coverage would be so burdensome as to cause the applicant to experience other serious deprivation of food, shelter, or other necessities. Consult your Marketplace for more information about hardship exemptions.
http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/
How do I apply for an exemption?
- For some types of exemptions, you must apply through the health insurance Marketplace; for other types, you must apply when you file your taxes; some types of exemptions can be claimed either way.
- The religious conscience exemption and most hardship exemptions are available only by going to a health insurance marketplace and applying for an exemption certificate.
- The exemptions for members of Indian tribes, members of health care sharing ministries, and individuals who are incarcerated are available either by going to a Marketplace and applying for an exemption certificate or by claiming the exemption as part of filing a federal income tax return.
- The exemptions for unaffordable coverage, short coverage gaps, certain hardships and individuals who are not lawfully present in the United States can be claimed only as part of filing a federal income tax return. The exemption for those under the federal income tax return filing threshold is available automatically. No special action is needed.
http://kff.org/health-reform/faq/health-reform-frequently-asked-questions