SMALL BUSINESSES AND THE AFFORDABLE HEALTH CARE ACT

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1 Walt Whitmer Sr. Extension Associate Department of Agricultural Economics, Sociology, and Education SMALL BUSINESSES AND THE AFFORDABLE HEALTH CARE ACT

2 Small Business Basics Employ 3.2 million workers in Pennsylvania Currently only 48% report they can afford to offer health insurance Pay an average of 18% more for coverage because they lack the bargaining power of large corporations

3 Overview Small Business Health Options (SHOP) Marketplace Starting in 2014 small businesses (<50 FTEs) can use SHOP to offer coverage to their employees. Coverage starts as soon as Jan. 1, 2014 (if enrolled by Dec. 15 th ) Businesses with fewer than 25 FTEs may qualify for a small business tax credit of up to 50% to help offset the costs of insurance (up to 25% for tax-exempt) Businesses can compare range of options (among Qualified Health Plans QHPs) through SHOP before making decisions Must get coverage through SHOP to qualify

4 Employer Provisions/Qualifications Small employers (< 50 FTE) are not mandated to offer health insurance to full-time employees But their workers may be mandated to purchase and may get offset costs through the Premium Tax Credit Calculating SHOP eligible businesses employee base 50 full-time equivalents (FTEs) Includes part-time employees, but not seasonal employees (those working fewer than 120 days per year) have at least one eligible employee on payroll (in addition to proprietor and spouse) SHOP eligibility expands to up to 100 employees no later than 2016

5 Calculating FTEs Jim has 42 full-time employees (> 30 hrs.) and 12 half-time employees Calculation: 42 full-time 6 half-time FTEs (12 x.5) 48 total FTEs Jim qualifies for SHOP but NOT for Small Business Tax Credit

6 Sole Proprietorships (Schedule C) Sole proprietors are considered individuals and are may be subject to ACA individual mandate Can shop for coverage for farmer, family, or business owner on Exchange or privately Compare costs of current individual policy (if any) to policies available on Exchange May have cost savings vs. policies offered in private market

7 Small Business Tax Credit Have an average of fewer than 25 FTE employees (excluding owners, owners family members, and seasonal employees) Have average annual employee wages below $50,000 Employers pay at least 50% of single health care coverage for each of their employees Tax credit amounts will depend on the number of employees and average employee wages

8 Employer Provisions/Qualifications If offering coverage - offer must be to all full-time employees (> 30 hours/ week) Are not required to offer coverage to part-time employees (< 30 hours/week) If employer offers insurance, SHOP requires that 70% must enroll Except for first enrollment period (Nov. 15-Dec. 15 each year)

9 Suggestions for Employers Explore your options and costs through SHOP Determine which if any of plans you may want to provide to their employees and/or their families (dependent coverage not required) Create roster with basic information for each employee Assess premium variations for their pool of employees (individual premiums reflect age, geographic location, and tobacco use)

10 Suggestions for Employers Consult with a professional advisor if business is close to 50 FTE employees Do the math: pay or play? (2015) Develop a plan to optimize requirements within your business model Obtain a health insurance plan if you decide to cover employees. Make sure it: meets the 60/40 rule costs less 9.5% of your least (lowest) paid employee s salary

11 If Employer Chooses to Offer a QHP Decide on which QHP to offer their employees (and/or dependents). In 2014 you can offer only one plan (reference plan) to employees Starting in 2015, multiple plans allowed Determine percentage of the cost of the QHP to contribute towards employee premiums Decide how employees will pay a share of the premium (same or variable)

12 Enrollment Changes Changes in roster or eligibility allowed throughout year (Special Enrollment) proscribed individual changes (marriage, births, changing eligibility, relocation, etc.) 30 day notification requirements 90 day waiting periods allowable for new employees Does not change COBRA requirements

13 Additional Business Considerations A health care plan group cannot consist solely of S corporation shareholders or spouses If a business grows beyond 50 FTE employees after enrollment employer is not disqualified for the SHOP (for that specific year) Multi-state employers may establish one SHOP plan in the state/shop service area of the corporate headquarters Employers will not be reassessed for eligibility in SHOP until their annual renewal

14 RECAP - Enrollment Steps Employer decides on reference plan, creates employee roster and applies in SHOP Employees enroll in SHOP Employers and employees pay premiums to QHP issuers directly. In 2015 employers pay through SHOP An employer submits the first month s premium after employees enroll, employer reviews and approves the completed application Provide annual open enrollment period

15 SHOP Assistance Options Do it yourself Get assistance: Certified Navigators, Application Counselors, In-person Assistors, Brokers and Agents Additional information providers Ask if information and assistance providers are certified

16

17 Useful Links & Resources SHOP site Penn State Extension Small Business and Tax Credit IRS.gov Care-Tax-Credit-for-Small-Employers FTE Calculators (examples only)

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