Treasury Department Proposes Rule Implementing Premium Tax Credits Under the Affordable Care Act

Size: px
Start display at page:

Download "Treasury Department Proposes Rule Implementing Premium Tax Credits Under the Affordable Care Act"

Transcription

1 AUGUST Treasury Department Proposes Rule Implementing Premium Tax Credits Under the Affordable Care Act BY ALDEN J. BIANCHI, MINTZ LEVIN The Patient Protection and Affordable Care Act 1 (the Act) transformed the regulation of health insurance markets and health care financing in the United States. The Act includes provisions under which certain low-income individuals may qualify for premium tax credits that assist them with enrolling in qualified health plans offered through state-based insurance exchanges. Premium assistance tax credits serve two purposes under the Act: first, they enable low-income individuals to comply with the Act s individual mandate, i.e., the requirement that US citizens and resident aliens obtain and maintain health insurance coverage; and, second, the determination of assessable payments imposed on certain large employers that offer coverage to their full-time employees depends on the number of full-time employees who qualify for, and accept, the credit. The Treasury Department recently issued a proposed regulation (the proposed rule ) implementing the Act s premium tax credits. Background Beginning in 2014, individuals and small businesses will be able to purchase private health insurance through state-based insurance exchanges. Tax credits under the Act are intended to assist individuals and families with purchasing affordable health insurance coverage by reducing out-of-pocket premium costs. State-based insurance exchanges will make advance determinations of eligibility for individuals seeking financial assistance based on information submitted at the time of enrollment. Once an individual qualifies, advance payments are made monthly to the health insurance issuer of the health plan in which the individual chooses to enroll. To be eligible for a premium tax credit, an individual: Must have a household income for the taxable year between 100% and 400% of the federal poverty line (FPL) for the individual s family size; May not be claimed as a dependent by another taxpayer; and Must file a joint return if married. Household income means modified adjusted gross income of all individuals in a family unit who are required to file an income tax return. Modified adjusted gross income means adjusted gross income increased by certain foreign and tax-exempt interest income received by the individual during the taxable year. The amount of premium assistance credit is the sum of the premium assistance amounts for all coverage months in the taxable year. A coverage month is any month for which an individual or any family member is covered by a qualified health plan through an exchange and the premium is paid by the individual or through an advance credit payment. A coverage month generally does not, however, include a month in which the individual is eligible for minimum essential coverage. Minimum essential coverage for this purpose includes government-sponsored coverage (e.g., Medicare, Medicaid, CHIP, TRICARE, and veterans health care). Employer-sponsored plans also may be minimum essential coverage, provided that the employee s share of the premiums is affordable and the coverage provides minimum value. An individual is treated as eligible for employer-sponsored minimum essential coverage if the

2 individual actually enrolls in an eligible employer-sponsored plan, even if the coverage does not meet the affordability and minimum value requirements. Determining the Amount of the Credit The premium assistance credit amount is the sum of the premium assistance amounts for all coverage months in the taxable year. It is the lesser of: 1. The premiums for the month for one or more qualified health plans that cover an individual or family member; or 2. The excess of the adjusted monthly premium for a benchmark plan over 1/12 of the product of the individual s household income and the applicable percentage for the taxable year. The adjusted monthly premium is the premium an insurer would charge for the plan adjusted only for the ages of the covered individuals. The benchmark plan is the second-lowest-cost silver plan offered by the exchange. The Act directs exchanges to make available four levels of plans: bronze, silver, gold and platinum. A bronze level plan covers 60% of plan costs; silver 70%; gold 80%; and platinum 90%. An individual s applicable percentage is designated by the Act, and it increases as the individual s household income as a percentage of the FPL for the individual s family size increases. For 2014, the applicable percentage is 2% for individuals with household income up to 133% of the FPL and increases in the following ranges from 3% to 9.5% for individuals with household incomes between 133% and 400% of the FPL: Household Income as a Percentage of FPL Initial Percentage / Final Percentage Less than 133% 2.0% / 2.0% At least 133% but less than 150% 3.0% / 4.0% At least 150% but less than 200% 4.0% / 6.3% At least 200% but less than 250% 6.3% / 8.05% At least 250% but less than 300% 8.05% / 9.5% At least 300% but less than 400% 9.5% / 9.5% The applicable percentages may be adjusted after Individuals are required to pay the difference between the premium assistance amount and the premium for the plan they choose. Example: Assume individual A has household income of $50,353 (275% of the FPL); that she has a family of three; that the second-lowest-cost silver plan in A s service area charges a premium of $12,000 for family coverage; and that A qualifies for and enrolls in family coverage. A s initial percentage is 8.05%, and her final percentage is 9.5%. Since 275% is halfway between 250% and 300%, individual A s applicable percentage is 8.78%

3 (which is halfway between 8.05% and 9.5%). Individual A s premium credit for the year is $7, i.e., the lesser of (1) $12,000 (annual premium for the qualified health plan that covers A s family) or (2) $12,000 minus (household income of 50,353 x an applicable percentage of 8.78%). Reconciliation An individual who qualifies for the premium tax credits must reconcile the actual credit for the year with the amount of advance payments made on his or her behalf. If a credit amount exceeds the amount of the advance payments for the taxable year, the individual may be eligible for an income tax refund. Conversely, if an individual s advance payments exceed the credit amount, the individual must repay the excess as an additional income tax liability. But the Act places a graduated set of caps on the additional tax liability for individuals with household income under 400% of the FPL, ranging from $600 to $2,500 (one-half that amount for single taxpayers) depending on FPL. These amounts are adjusted to reflect changes in the cost of living beginning in Information Reporting Each exchange must report to the IRS, and to the individuals who receive the credit, certain information relating to health plans provided through the exchange, including the amount of any advance credit payments. The Proposed Rule Applicable Taxpayers The proposed rule provides that an individual is eligible for the premium tax credit for a taxable year if the individual is an applicable taxpayer and he or she, or a member of his or her family: 1. Is enrolled in one or more qualified health plans through an exchange; and 2. Is not eligible for minimum essential coverage other than coverage in the individual market. To qualify as an applicable taxpayer, an individual must have household income that is at least 100% but not more than 400% of the FPL. A lawfully present alien with household income under 100% of the FPL and not eligible for Medicaid is treated as having household income of 100% of the FPL for this purpose. Premium assistance amounts for these individuals are computed based on actual household income. Special rules apply in the case of individuals (other than lawfully present aliens) with household incomes below 100% of the FPL. These individuals are not eligible for the premium tax credit because they are eligible to receive assistance through Medicaid. An exchange may, however, approve an individual for advance credit payments based on projecting a level of household income for the taxable year that makes the individual ineligible for Medicaid. If the projection turns out to be inaccurate, i.e., the individual s actual household income for the taxable year is under 100% of the FPL, the individual would not be an applicable taxpayer, and would not be eligible for the credit under the general rule. The proposed rule nevertheless treats an individual with household income below 100% of the FPL as an applicable taxpayer if, when the individual enrolls in a qualified health plan, the exchange projects household income for the individual as between 100% and 400% of the FPL.

4 Individuals who are incarcerated (other than pending disposition of charges) or who are not lawfully present in the United States may not enroll in a qualified health plan through an exchange. These individuals may, however, have family members who are eligible for exchange coverage. The proposed rule, therefore, provides that an individual who is not lawfully present in the United States or is incarcerated, although not eligible to enroll in a qualified health plan, may be an applicable taxpayer if a family member is eligible and enrolls in a qualified health plan. Minimum Essential Coverage As proposed, an individual generally is eligible for government-sponsored minimum essential coverage for any month that the individual meets the requirements for such coverage. For this purpose, an individual is eligible for minimum essential coverage under a veterans health care program only if the individual is enrolled in a veterans health care program that is specifically identified as offering minimum essential coverage in accordance with regulations to be issued. Employer-Sponsored Coverage Minimum essential coverage generally includes coverage under an eligible employer-sponsored plan. An eligible employer-sponsored plan is defined to mean: a group health plan or group health insurance coverage offered by an employer to an employee which is a governmental plan or any other plan or coverage offered in the small or large group market, or a grandfathered plan offered in the group market. This provision had been the source of some confusion. How does one read the phrase group health plan or group health insurance coverage offered by an employer? Is an eligible employer-sponsored plan (1) any group health plan or (2) any group health insurance coverage offered by an employer to the employee that is a governmental plan or any other coverage? Or did Congress intend that the words group health plan be limited by which is a governmental plan or any other plan or coverage offered in the small or large group market within a State? If the latter reading is correct, then no self-funded plan could qualify as minimum creditable coverage. The preamble to the proposed rule suggests that the former reading is the correct one. 2 Under the proposal, continuation coverage required under federal law or required under a state law that provides comparable continuation coverage is eligible employer-sponsored coverage, but only if the individual enrolls in the coverage. Affordability An employer-sponsored plan is not affordable if the employee s required contribution exceeds 9.5% of the applicable taxpayer s household income for the taxable year. (This percentage may be adjusted after 2014.) The required contribution for this purpose is the portion of the annual premium that would be paid by the individual for self-only coverage. The proposed rule follows the statute by providing that an employer-sponsored plan also is affordable when the employee s required contribution for self-only coverage under the plan does not exceed 9.5% of the individual s household income for the year, even if the employee s required contribution for family coverage does exceed 9.5% of the applicable taxpayer s household income for the year. However, the preamble to the proposed rule notes that, for other purposes under the Act, the regulators may choose to determine affordability based on the employee s required contribution for employer-sponsored family coverage. The proposed rule establishes an employee safe harbor for individuals who were offered eligible employer-sponsored coverage that ultimately proves to be affordable based on household income for the taxable year, but who declined the offer because, at the time of enrollment in a qualified health plan, the

5 exchange determined that the employer coverage would be unaffordable. Under the safe harbor, an eligible employer-sponsored plan is treated as unaffordable for an entire plan year. Thus, for the months during the plan year (which may coincide or overlap with the taxable year), an individual will not lose credit eligibility because, as a result of changes during the taxable year, the employer coverage would have been affordable based on the household income for that taxable year. A separate safe harbor is prepared for applicable large employers that might otherwise be subject to the Act s employer responsibility mandate. (Applicable large employers i.e., those with 50 or more full-time equivalent employees that offer health coverage to their full-time employees and their dependents are subject to an assessable payment if at least one full-time employee is certified to receive a premium tax credit or cost-sharing reduction because the employer-sponsored coverage either does not provide minimum value or is unaffordable to the employee.) Under the employer safe harbor, an employer that meets certain requirements, including offering its full-time employees (and their dependents) the opportunity to enroll in eligible employer-sponsored coverage, will not be subject to an assessable payment with respect to an employee who receives a premium tax credit or cost-sharing reduction if the employee portion of self-only premium for the lowest-cost plan providing minimum value does not exceed 9.5% of the employee s W-2 wages from the employer. Minimum Value An individual who is eligible for employer-sponsored group health plan coverage may still qualify for the premium tax credit if the plan fails to provide minimum value. A plan provides minimum value if the plan s share of the total allowed costs of benefits provided under the plan is at least 60% of those costs. It will be up to the Department of Health and Human Services to establish rules governing the determination of the percentage of the total allowed costs of benefits. The preamble to the proposed regulation reports that the Department of Health and Human Services is contemplating whether to provide appropriate transition relief with respect to the minimum value requirement for employers currently offering health care coverage. Computing the Premium Tax Credit An individual s premium tax credit is the sum of the premium assistance amounts for each coverage month in the taxable year, based on household income, family size, applicable percentage, benchmark plan premium, and actual plan premium. Household income is prorated for each month to determine the monthly premium assistance amount. The applicable percentage is the same for each month because it is derived from annual household income and family size. The monthly premium for the applicable second-lowest-cost silver plan offered through an exchange is the benchmark for computing an individual s monthly premium assistance amount. To determine the amount of premium tax credit, an individual must compute the difference between the premium for this plan and the applicable percentage of the individual s household income. Special rules are proposed where an exchange offers multiple categories of coverage (e.g., plans may offer other categories of coverage based on family composition, such as children only, two adults, or one adult plus children). The proposed rule defines family coverage as any health insurance that covers more than one individual. Under the proposed regulations, the applicable benchmark plan for an individual is determined by finding the second-lowest cost plan at the silver level that would cover those family members actually enrolled in a qualified health plan.

6 Reconciling the Credit and Advance Credit Payments The proposed rule describes the requirements for reconciling advance payments of the credit with the actual credit amount and determining the amount of any resulting additional credit or additional income tax liability. The credit is computed by using the household income and family size for the taxable year, but premium assistance amounts for different coverage months may be based on different applicable benchmark plans if, for example, the individual s family composition changes during the taxable year. Effective Date The proposed rule anticipates that the regulation under the Act s premium tax credit standard will apply for taxable years ending after December 31, Endnotes 1 Pub. L. No (2010), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L (2010)), the Medicare and Medicaid Extenders Act of 2010 (Pub. L (2011)), and the Department of Defense and Full-Year Continuing Appropriations Act of 2011 (Pub. L (2011)). 2 See 76 Fed. Reg. 159, p. 50,933 ( Regulations under section 5000A are expected to provide that an employer-sponsored plan will not fail to be minimum essential coverage solely because it is a plan to reimburse employees for medical care for which reimbursement is not provided under a policy of accident and health insurance (a self-insured plan).

IRS Proposes Rules for Federal Subsidy of Health Insurance Purchased in State Exchanges

IRS Proposes Rules for Federal Subsidy of Health Insurance Purchased in State Exchanges IRS Proposes Rules for Federal Subsidy of Health Insurance Purchased in State Exchanges August 2011 The Internal Revenue Service (IRS) on August 12, 2011 issued proposed regulations relating to the federal

More information

Health Insurance Premium Tax Credit

Health Insurance Premium Tax Credit Health Insurance Premium Tax Credit Starting in 2014, individuals and families can take a new premium tax credit to help them afford health insurance coverage purchased through an Affordable Insurance

More information

ACTION: Notice of proposed rulemaking and notice of public hearing. SUMMARY: This document contains proposed regulations relating to the health

ACTION: Notice of proposed rulemaking and notice of public hearing. SUMMARY: This document contains proposed regulations relating to the health [4830-01-p] DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 [REG-131491-10] RIN 1545-BJ82 Health Insurance Premium Tax Credit AGENCY: Internal Revenue Service (IRS), Treasury. ACTION:

More information

The Insurance Mandates of the Affordable Care Act

The Insurance Mandates of the Affordable Care Act 1 A. Affordable Care Act Individual Mandate The Insurance Mandates of the Affordable Care Act 1. All citizens of the United States are subject to the individual mandate as are all permanent residents and

More information

Federal Register / Vol. 76, No. 159 / Wednesday, August 17, 2011 / Proposed Rules

Federal Register / Vol. 76, No. 159 / Wednesday, August 17, 2011 / Proposed Rules 50931 of protection because the term price election is not applicable to all plans of insurance. List of Subjects in 7 CFR Part 402 Crop insurance, Reporting and recordkeeping requirements. Accordingly,

More information

Premium Tax Credits: Answers to Frequently Asked Questions

Premium Tax Credits: Answers to Frequently Asked Questions Updated July 2013 Premium Tax Credits: Answers to Frequently Asked Questions Beginning in 2014, millions of Americans will become eligible for a new premium tax credit that will help them pay for health

More information

Potential Penalties for Employers under the Pay or Play Rules

Potential Penalties for Employers under the Pay or Play Rules The Affordable Care Act (ACA) brings many changes to employers and health plans. One such change essentially amounts to a requirement for some employers to offer a certain level health care to their employees

More information

Helbling Benefits Consulting Your Health Care Reform Partner

Helbling Benefits Consulting Your Health Care Reform Partner Helbling Benefits Consulting Your Health Care Reform Partner Will you be hit with penalties due to health care reform? Once the employer mandate becomes effective, some employers may have to pay a penalty

More information

Patient Protection and Affordable Care Act (H.R. 3590)

Patient Protection and Affordable Care Act (H.R. 3590) on Health Reform Passing comprehensive health care reform has been a priority of the President and Congress. The U.S. House of Representatives passed the Affordable Health Care for America Act on November

More information

Instructions for Form 8962

Instructions for Form 8962 2014 Instructions for Form 8962 Premium Tax Credit (PTC) Department of the Treasury Internal Revenue Service Complete Form 8962 only for health insurance! coverage in a qualified health plan (described

More information

Understanding the Affordable Care Act Premium Tax Credit

Understanding the Affordable Care Act Premium Tax Credit Understanding the Affordable Care Act Premium Tax Credit Most Americans are Required to Have Health Care Coverage The Affordable Care Act (ACA), or health care law, requires most U.S. citizens and legal

More information

IRS Virtual Town Hall Series: Tax Impacts of Health Insurance Coverage for Individuals & Families in 2014

IRS Virtual Town Hall Series: Tax Impacts of Health Insurance Coverage for Individuals & Families in 2014 IRS Series: Tax Impacts of Health Insurance Coverage for Individuals & Families in 2014 The information contained in this presentation is current as of 10/23/2013. For the latest information about tax

More information

What s News in Tax Analysis That Matters from Washington National Tax

What s News in Tax Analysis That Matters from Washington National Tax What s News in Tax Analysis That Matters from Washington National Tax The Impact of the Affordable Care Act on International Assignees and Their Health Care Plans Employers and individuals in the United

More information

PRIVATE HEALTH INSURANCE. Early Evidence Finds Premium Tax Credit Likely Contributed to Expanded Coverage, but Some Lack Access to Affordable Plans

PRIVATE HEALTH INSURANCE. Early Evidence Finds Premium Tax Credit Likely Contributed to Expanded Coverage, but Some Lack Access to Affordable Plans United States Government Accountability Office Report to Congressional Committees March 2015 PRIVATE HEALTH INSURANCE Early Evidence Finds Premium Tax Credit Likely Contributed to Expanded Coverage, but

More information

Health Care Law: What s New for Individuals & Families

Health Care Law: What s New for Individuals & Families Health Care Law: What s New for Individuals & Families PUBLICATION 5187 TAX YEAR 2014 Affordable Care Act (ACA) Get forms and other information faster and easier at: IRS.gov (English) IRS.gov/Spanish (Español)

More information

Year-end Checklist for 2015 Compliance

Year-end Checklist for 2015 Compliance Brought to you by Fringe Benefit Plans, Inc. / (407) 862-5900 Year-end Checklist for 2015 Compliance The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the

More information

How To Calculate Health Insurance Premiums In The American Health Insurance Exchange

How To Calculate Health Insurance Premiums In The American Health Insurance Exchange Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA) Bernadette Fernandez Specialist in Health Care Financing Thomas Gabe Specialist in Social Policy December 30, 2011

More information

Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (PPACA)

Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (PPACA) Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (PPACA) Chris L. Peterson Specialist in Health Care Financing Thomas Gabe Specialist in Social Policy April 28, 2010 Congressional

More information

Summary of Potential Employer Penalties Under the Patient Protection and Affordable Care Act (PPACA)

Summary of Potential Employer Penalties Under the Patient Protection and Affordable Care Act (PPACA) Summary of Potential Employer Penalties Under the Patient Protection and Affordable Care Act (PPACA) Hinda Chaikind Specialist in Health Care Financing Chris L. Peterson Acting Section Research Manager

More information

Understanding the Health Insurance Marketplace. August 2013

Understanding the Health Insurance Marketplace. August 2013 Understanding the Health Insurance Marketplace August 2013 Objectives This session will help you Explain the Health Insurance Marketplace Identify who will benefit Define who is eligible Explain the enrollment

More information

Two New Reporting Requirements Beginning in 2016 But Are Important Now

Two New Reporting Requirements Beginning in 2016 But Are Important Now Two New Reporting Requirements Beginning in 2016 But Are Important Now Recently, the IRS published final regulations implementing two new information reporting requirements under ACA that are first due

More information

Treasury, IRS Release Final Rules on Employer Information Reporting Requirements Under Health Care Law

Treasury, IRS Release Final Rules on Employer Information Reporting Requirements Under Health Care Law March 6, 2014 Treasury, IRS Release Final Rules on Employer Information Reporting Requirements Under Health Care Law The Department of the Treasury and the IRS late yesterday (March 6, 2014) released long

More information

How To Write The Health Care Law

How To Write The Health Care Law Federal Register / Vol. 77, No. 100 / Wednesday, May 23, 2012 / Rules and Regulations 30377 Controlling agency. FAA, Atlanta ARTCC. Issued in Washington, DC, on May 17, 2012. Ellen Crum, Acting Manager,

More information

Currently, for the very low-income, Medicaid is available for children, parents, and individuals who are disabled, elderly, or pregnant.

Currently, for the very low-income, Medicaid is available for children, parents, and individuals who are disabled, elderly, or pregnant. 0 Currently, for the very low-income, Medicaid is available for children, parents, and individuals who are disabled, elderly, or pregnant. Parents are typically covered at very low income levels, and most

More information

Health Reform. Senate Leadership Bill Patient Protection and Affordable Care Act (H.R. 3590)

Health Reform. Senate Leadership Bill Patient Protection and Affordable Care Act (H.R. 3590) on Health Reform Comprehensive health reform legislation is currently being debated in Congress. On November 7, 2009, the U.S. House of Representatives passed the Affordable Health Care for America Act

More information

HEALTH REFORM AND MULTIEMPLOYER PLAN COVERAGE 2014 AND BEYOND

HEALTH REFORM AND MULTIEMPLOYER PLAN COVERAGE 2014 AND BEYOND WWW.BKLAWYERS.COM HEALTH REFORM AND MULTIEMPLOYER PLAN COVERAGE 2014 AND BEYOND ABA SECTION OF LABOR AND EMPLOYMENT LAW EMPLOYEE BENEFITS COMMITTEE MID- WINTER MEETING 201 BLITMAN & KING LLP Franklin Center,

More information

Tax Implications of Health Care Reform

Tax Implications of Health Care Reform Tax Implications of Health Care Reform Presented by: Art Sparks, CPA Partner Certified Public Accountants Summary Summary The Patient Protection and Affordable Care Act (PPACA) and the companion Health

More information

Since Congress passed the Patient Protection and

Since Congress passed the Patient Protection and A Primer on New Applicable Large Employer Reporting Requirements under the ACA by Kathy A. Lawler and Madeline Sexton Lewis Since Congress passed the Patient Protection and Affordable Care Act (ACA) in

More information

Private Health Insurance: Changes Made by the Reconciliation Act of 2010 to Senate-Passed H.R. 3590

Private Health Insurance: Changes Made by the Reconciliation Act of 2010 to Senate-Passed H.R. 3590 Private Health Insurance: Changes Made by the Reconciliation Act of 2010 to Senate-Passed H.R. 3590 Hinda Chaikind Specialist in Health Care Financing Bernadette Fernandez Analyst in Health Care Financing

More information

Patient Protection and Affordable Care Act Compliance Checklist for Employers

Patient Protection and Affordable Care Act Compliance Checklist for Employers October, 2014 Patient Protection and Affordable Care Act Compliance Checklist for Employers Under the Employer Mandate in the Affordable Care Act, effective January 1, 2015, employers with 50 or more full-time

More information

Things Small Businesses Need To Know About Health Care Reform

Things Small Businesses Need To Know About Health Care Reform 7 Things Small Businesses Need To Know About Health Care Reform Make sure your business meets the requirements of the Affordable Care Act on schedule 7 Things Small Businesses Need To Know About Health

More information

Health Care Reform: 2015 Refresher of the Affordable Care Act (ACA)

Health Care Reform: 2015 Refresher of the Affordable Care Act (ACA) Health Care Reform: 2015 Refresher of the Affordable Care Act (ACA) Brought to you by Aon Presented by: Ryan Comstock & Shawna Brown This information is provided for informational purposes only and is

More information

Legislative Changes For PY2015. Melodye Mitchell, Branch Chief EFS Development Services melodye.a.mitchell@irs.gov

Legislative Changes For PY2015. Melodye Mitchell, Branch Chief EFS Development Services melodye.a.mitchell@irs.gov Legislative Changes For PY2015 Melodye Mitchell, Branch Chief EFS Development Services melodye.a.mitchell@irs.gov Who is eligible for premium tax credit? A Premium Tax Credit (PTC) may be requested through

More information

IRS Virtual Town Hall Series: The Premium Tax Credit What You Need to Know

IRS Virtual Town Hall Series: The Premium Tax Credit What You Need to Know IRS Series: The Premium Tax Credit What You Need to Know 1 The information contained in this presentation is current as of 5/29/2014. For the latest information about tax provisions of the Affordable Care

More information

The Health Insurance Premium Tax Credit. Topics. What is the Premium Tax Credit? 10/1/2014

The Health Insurance Premium Tax Credit. Topics. What is the Premium Tax Credit? 10/1/2014 The Health Insurance Premium Tax Credit Kristy Maitre Tax Specialist Center for Agricultural Law and Taxation October 8, 2014 Topics Definitions Premium Tax Credit Basics Determining the amount of the

More information

Presented by South Dakota Community Action Partnership

Presented by South Dakota Community Action Partnership Presented by South Dakota Community Action Partnership The project described was supported by Funding Opportunity Number CA-NAV-13-001 from the U.S Department of Health and Human Services, Centers for

More information

HEALTHCARE REFORM: WHAT YOU NEED TO KNOW

HEALTHCARE REFORM: WHAT YOU NEED TO KNOW WHAT IS HEALTHCARE REFORM? Healthcare reform refers to the healthcare law passed in 2010 that significantly changed health policy in the United States. Healthcare reform includes numerous requirements

More information

Prescribed Side Effects of the Patient Protection and Affordable Care Act (PPACA): Healthcare Reform Update

Prescribed Side Effects of the Patient Protection and Affordable Care Act (PPACA): Healthcare Reform Update August 14, 2013 Presented by: Jay Hutto, CPA Prescribed Side Effects of the Patient Protection and Affordable Care Act (PPACA): Healthcare Reform Update Click HERE to listen to webinar. August 14, 2013

More information

And Changes under Healthcare Reform affecting businesses

And Changes under Healthcare Reform affecting businesses And Changes under Healthcare Reform affecting businesses 1 Individual Mandate 2 First there were two choices Under the Affordable Care Act every individual must have Minimum Essential Healthcare Coverage

More information

Health Insurance Premium Credits Under PPACA (P.L. 111-148)

Health Insurance Premium Credits Under PPACA (P.L. 111-148) Health Insurance Premium Credits Under PPACA (P.L. 111-148) Chris L. Peterson Specialist in Health Care Financing Thomas Gabe Specialist in Social Policy April 6, 2010 Congressional Research Service CRS

More information

How the Affordable Care Act Affects Medical Support Orders in Oklahoma Frequently Asked Questions Spring, 2014 1

How the Affordable Care Act Affects Medical Support Orders in Oklahoma Frequently Asked Questions Spring, 2014 1 How the Affordable Care Act Affects Medical Support Orders in Oklahoma Frequently Asked Questions Spring, 2014 1 General 1. Did Oklahoma expand Medicaid? No, Oklahoma did not expand Medicaid. 2. Who is

More information

Health Insurance Basics and the Federal Marketplace in Indiana. Module #3 Training Resource for Indiana Navigators

Health Insurance Basics and the Federal Marketplace in Indiana. Module #3 Training Resource for Indiana Navigators Health Insurance Basics and the Federal Marketplace in Indiana Module #3 Training Resource for Indiana Navigators 2 Module #3 Overview After reviewing this module, you will be able to: Explain basic health

More information

Health Policy Essentials: Private Health Insurance. Bernadette Fernandez, Annie Mach, & Namrata Uberoi February 13, 2015

Health Policy Essentials: Private Health Insurance. Bernadette Fernandez, Annie Mach, & Namrata Uberoi February 13, 2015 Health Policy Essentials: Private Health Insurance Bernadette Fernandez, Annie Mach, & Namrata Uberoi February 13, 2015 Briefing Agenda What is the purpose of private health insurance (PHI)? How is PHI

More information

Health Care Reform: Ready or Not, Here it Comes! Presented by:

Health Care Reform: Ready or Not, Here it Comes! Presented by: Broader Perspective. Business Solutions. Health Care Reform: Ready or Not, Here it Comes! Presented by: Ryan Fridborg, MAOD, SPHR Executive Vice President, Employee Benefits rfridborg@boltonco.com Marilyn

More information

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts.

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. ADAP PREMIUM PLUS UNDERSTANDING YOUR HEALTH INSURANCE OPTIONS 1 DISCLAIMER The Florida ADAP is providing this presentation solely as an educational service to the community. The information provided in

More information

IRS Health Coverage Reporting Instructions Leave Many Questions Unanswered

IRS Health Coverage Reporting Instructions Leave Many Questions Unanswered September 23, 2014 If you have questions, please contact your regular Groom attorney or one of the attorneys listed below: Katie Bjornstad Amin kamin@groom.com (202) 861-2604 Christine L. Keller ckeller@groom.com

More information

Affordable Care Act and Employers

Affordable Care Act and Employers Affordable Care Act and Employers Important Details about Health Care Reform The Affordable Care Act (ACA, i.e., federal health care reform) makes significant changes to health insurance practices nationwide.

More information

The Affordable Care Act: What Does it Mean for Individuals and Families?

The Affordable Care Act: What Does it Mean for Individuals and Families? The Affordable Care Act: What Does it Mean for Individuals and Families? FIRM Team Fact Sheet 13-04 Available at http://www.firm.msue.msu.edu David B. Schweikhardt Adam J. Kantrovich Brenda R. Long Michigan

More information

Health Insurance Marketplace 101. Find health care options that meet your needs and fit your budget.

Health Insurance Marketplace 101. Find health care options that meet your needs and fit your budget. Health Insurance Marketplace 101 Find health care options that meet your needs and fit your budget. March 2014 The Health Care Law In March 2010, President Obama signed the Affordable Care Act into law

More information

SURVIVAL GUIDE FOR SMALL BUSINESS

SURVIVAL GUIDE FOR SMALL BUSINESS HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS New York edition NAVIGATING NEXT STEPS IN HEALTH CARE REFORM PAGE 2 www.discovermvp.com There s a constant stream of changes and updates related

More information

GUIDE TO HEALTH CARE REFORM S TAX PENALTIES

GUIDE TO HEALTH CARE REFORM S TAX PENALTIES The GUIDE TO HEALTH CARE REFORM S TAX PENALTIES Calculate Your Health Insurance Tax Penalty 2 Introduction The Affordable Care Act (ACA) requires certain employers and employees to purchase health insurance

More information

Instructions for Form 8965

Instructions for Form 8965 Department of the Treasury Internal Revenue Service Instructions for Form 8965 Health Coverage Exemptions (and instructions for figuring your shared responsibility payment) For each month you must either:

More information

It goes by many names: Patient Protection and Affordable Care Act (PPACA) or ACA or Obama Care or simply Healthcare Reform.

It goes by many names: Patient Protection and Affordable Care Act (PPACA) or ACA or Obama Care or simply Healthcare Reform. WHAT IS HEALTHCARE REFORM? Healthcare Reform (HCR) is a law passed by Congress that provides many different requirements. A very important aspect of the law is that it is designed to provide individuals

More information

Federally-facilitated Marketplace Agent and Broker Training Outline and Summary

Federally-facilitated Marketplace Agent and Broker Training Outline and Summary DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 Center for Consumer Information & Insurance Oversight Federally-facilitated

More information

Wells Insurance. 2015 ACA Compliance Update

Wells Insurance. 2015 ACA Compliance Update Wells Insurance 2015 ACA Compliance Update Wells Insurance Today s Agenda Cost-Saving Strategies Deadlines & Implications for you Plan Design Changes Reinsurance Fees Employer Penalty Rules Reporting of

More information

Shared Responsibility: What It Means for Your Business

Shared Responsibility: What It Means for Your Business Shared Responsibility: What It Means for Your Business The provisions of the Affordable Care Act (ACA) apply to nearly all companies in the United States. The ways they apply, however, can be different

More information

Private Health Insurance Provisions in the Patient Protection and Affordable Care Act (PPACA)

Private Health Insurance Provisions in the Patient Protection and Affordable Care Act (PPACA) Private Health Insurance Provisions in the Patient Protection and Affordable Care Act (PPACA) Hinda Chaikind Specialist in Health Care Financing Bernadette Fernandez Analyst in Health Care Financing Mark

More information

SURVIVAL GUIDE FOR SMALL BUSINESS

SURVIVAL GUIDE FOR SMALL BUSINESS HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS Vermont edition NAVIGATING NEXT STEPS IN HEALTH CARE REFORM There s a constant stream of changes and updates related to health care reform,

More information

Employer Tax Penalties Linked to Employees Receiving Tax Credits. Calculation of Non-deductible Excise Taxes Under IRC 4380H

Employer Tax Penalties Linked to Employees Receiving Tax Credits. Calculation of Non-deductible Excise Taxes Under IRC 4380H Washington Council Employer Tax Penalties Linked to Employees Receiving Tax Credits Employers will face taxes under IRC 4980H if they do not offer minimum essential coverage or if the coverage they offer

More information

2015 TAX UPDATES. TaxSmarter.com

2015 TAX UPDATES. TaxSmarter.com 2015 TAX UPDATES TaxSmarter.com NEW TAX LAWS FOR 2015 Standard Deduction: $12,600 MFJ or QW (increase of $200) $9,250 - Head of Household (increase of $150) $6,300 - Single or MFS (increase of $100) Additional

More information

Health Care Reform PPACA. General Assembly Greensboro, NC 2013

Health Care Reform PPACA. General Assembly Greensboro, NC 2013 Health Care Reform PPACA General Assembly Greensboro, NC 2013 Near-term Provisions 1 These fees apply to both insured and self-insured plans. Additional Coming Changes PPACA Patient Protection and Affordable

More information

Employer Reporting of Health Coverage Code Sections 6055 & 6056

Employer Reporting of Health Coverage Code Sections 6055 & 6056 Brought to you by Hickok & Boardman HR Intelligence Employer Reporting of Health Coverage Code Sections 6055 & 6056 The Affordable Care Act (ACA) created new reporting requirements under Internal Revenue

More information

Section 2: INDIVIDUALS WHO CURRENTLY HAVE

Section 2: INDIVIDUALS WHO CURRENTLY HAVE Section 2: INDIVIDUALS WHO CURRENTLY HAVE COVERAGE OR AN OFFER OF COVERAGE FROM THEIR EMPLOYER Section 2 covers enrollment issues for individuals who have coverage or an offer of coverage whether through

More information

Exchange 101. August 2013

Exchange 101. August 2013 Exchange 101 August 2013 455430 27517 Penalties for individuals 2017 and beyond: Annual adjustments 2016: Greater of $695 or 2.5% of taxable income 2015: Greater of $325 or 2% of taxable income 2014: Greater

More information

Introduction. Affordable Care Act Overview of Changes

Introduction. Affordable Care Act Overview of Changes Introduction Affordable Care Act Overview of Changes Presented by: Tim Dillingham, CLU Benefit Resource Group, Inc. 201 E Broad Street, Suite 1 Linden, MI 48451 810-735-6500 810-735-6610 (fax) tim@benefitresourcegroup.net

More information

Whether to Buy Health Coverage or Pay the Penalty

Whether to Buy Health Coverage or Pay the Penalty Whether to Buy Health Coverage or Pay the Penalty By Eddie Adkins and Lynn Ettinger Deciding whether to pay for health insurance or forgo it and pay a penalty is easy for many people. They think, Without

More information

How To Get Rid Of The Health Insurance Mandate In The United States

How To Get Rid Of The Health Insurance Mandate In The United States on Health Reform Comprehensive health reform legislation is currently being debated in Congress. On November 7, 2009, the U.S. House of Representatives passed the Affordable Health Care for America Act

More information

Find health care options that meet your needs and fit your budget.

Find health care options that meet your needs and fit your budget. Health Insurance Marketplace 101 Find health care options that meet your needs and fit your budget. October 2015 Objectives This session will help you Explain the Health Insurance Marketplace Define who

More information

MODULE 16: MEDICARE AND THE HEALTH INSURANCE MARKETPLACES

MODULE 16: MEDICARE AND THE HEALTH INSURANCE MARKETPLACES MODULE 16: MEDICARE AND THE HEALTH INSURANCE MARKETPLACES Objective This module will educate HIICAP counselors about how Medicare is affected (and not affected) by the health insurance Marketplaces. What

More information

2014 RETURNS. Publication 5157 (10-2014) Catalog Number 66653D Department of the Treasury Internal Revenue Service www.irs.gov

2014 RETURNS. Publication 5157 (10-2014) Catalog Number 66653D Department of the Treasury Internal Revenue Service www.irs.gov 5157 VITA/TCE Affordable Care Act Volunteer Income Tax Assistance (VITA) / Tax Counseling for the Elderly (TCE) 2014 RETURNS Take your VITA/TCE training online at www.irs.gov (keyword: Link & Learn Taxes).

More information

HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS. New York Edition

HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS. New York Edition HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS New York Edition NAVIGATING NEXT STEPS IN HEALTH CARE REFORM PAGE 2 www.discovermvp.com There s a constant stream of changes and updates related

More information

Legislative Brief: 2015 COMPLIANCE CHECKLIST. Laurus Strategies

Legislative Brief: 2015 COMPLIANCE CHECKLIST. Laurus Strategies Laurus Strategies Legislative Brief: 2015 COMPLIANCE CHECKLIST The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted over four years ago.

More information

4/8/2013. Health Care Reform and the. NYS Exchange. Dr. Arthur Vercillo, MD Regional President April 8, 2013. Health Care Reform and the NYS Exchange

4/8/2013. Health Care Reform and the. NYS Exchange. Dr. Arthur Vercillo, MD Regional President April 8, 2013. Health Care Reform and the NYS Exchange Health Care Reform and the NYS Exchange Presentation to the Health Planning Council Advisory Board April 8, 2013, Ithaca NY By Dr. Arthur Vercillo, MD Additional resources on next to last slide. Health

More information

THE AFFORDABLE CARE ACT ( ACT ), NEW EMPLOYER MANDATES, AND IMPACTS ON EMPLOYER- SPONSORED HEALTH INSURANCE PLANS

THE AFFORDABLE CARE ACT ( ACT ), NEW EMPLOYER MANDATES, AND IMPACTS ON EMPLOYER- SPONSORED HEALTH INSURANCE PLANS Community THE AFFORDABLE CARE ACT ( ACT ), NEW EMPLOYER MANDATES, AND IMPACTS ON EMPLOYER- SPONSORED HEALTH INSURANCE PLANS Prepared for the 2014 Massachusetts Municipal Association Annual Meeting On March

More information

HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS. Vermont Edition

HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS. Vermont Edition HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS Vermont Edition NAVIGATING NEXT STEPS IN HEALTH CARE REFORM There s a constant stream of changes and updates related to health care reform,

More information

Senate HELP Committee Affordable Health Choices Act (S. 1679) June 9, 2009 (passed by Committee July 15, 2009)

Senate HELP Committee Affordable Health Choices Act (S. 1679) June 9, 2009 (passed by Committee July 15, 2009) on Health Reform This side-by-side compares the leading comprehensive reform proposals across a number of key characteristics and plan components. Included in this side-byside are proposals for moving

More information

ACA Penalties Individual Shared Responsibility Provision. Kristy Maitre Tax Specialist Center for Agricultural Law and Taxation October 9, 2014

ACA Penalties Individual Shared Responsibility Provision. Kristy Maitre Tax Specialist Center for Agricultural Law and Taxation October 9, 2014 ACA Penalties Individual Shared Responsibility Provision Kristy Maitre Tax Specialist Center for Agricultural Law and Taxation October 9, 2014 Enrollment period You can generally buy Marketplace health

More information

Introduction to the New Health Care Laws Michelle Walker, Rocky Mountain Health Plans January 14, 2015

Introduction to the New Health Care Laws Michelle Walker, Rocky Mountain Health Plans January 14, 2015 Introduction to the New Health Care Laws Michelle Walker, Rocky Mountain Health Plans January 14, 2015 Agenda Basics of Health Care Reform Changes in Individual Healthcare Coverage Mandates Affordability

More information

OVERVIEW OF PRIVATE INSURANCE MARKET REFORMS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND RESOURCES FOR FREQUENTLY ASKED QUESTIONS

OVERVIEW OF PRIVATE INSURANCE MARKET REFORMS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND RESOURCES FOR FREQUENTLY ASKED QUESTIONS OVERVIEW OF PRIVATE INSURANCE MARKET REFORMS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND RESOURCES FOR FREQUENTLY ASKED QUESTIONS Brief Prepared by MATTHEW COKE Senior Research Attorney LEGISLATIVE

More information

How To Get Health Care Reform For The United States

How To Get Health Care Reform For The United States Federal Health Care Reform: Implications for New York Division of Coverage and Enrollment Office of Health Insurance Programs Health Bureau Insurance Department June 2010 Federal Health Care Reform: Where

More information

Treasury and IRS Issue Final Regulations for Reporting Compliance With Affordable Care Act Mandates

Treasury and IRS Issue Final Regulations for Reporting Compliance With Affordable Care Act Mandates Treasury and IRS Issue Final Regulations for Reporting Compliance With Affordable Care Act Mandates April 2014 The Treasury Department and the Internal Revenue Service (IRS) issued final regulations on

More information

This notice describes and requests comments on several possible approaches to

This notice describes and requests comments on several possible approaches to Minimum Value of an Employer-Sponsored Health Plan Notice 2012-31 I. PURPOSE AND OVERVIEW This notice describes and requests comments on several possible approaches to determining whether health coverage

More information

Reporting Requirements for Employers and Health Plans

Reporting Requirements for Employers and Health Plans Brought to you by Cross Employee Benefits Reporting Requirements for Employers and Health Plans The Affordable Care Act (ACA) created a number of federal reporting requirements for employers and health

More information

State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE

State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE Scott Walker, Governor Theodore K. Nickel, Commissioner Wisconsin.gov 125 South Webster Street P.O. Box 7873 Madison, Wisconsin 53707-7873 Phone:

More information

The New Healthcare Law and Its Impact on Small Business

The New Healthcare Law and Its Impact on Small Business U. S. Small Business Administration Washington Metropolitan Area District Office The New Healthcare Law and Its Impact on Small Business Julie C. Verratti Advisor U.S. Small Business Administration Julie.Verratti@sba.gov

More information

Part II Exemptions & the Individual Shared Responsibility Payment

Part II Exemptions & the Individual Shared Responsibility Payment Part II Exemptions & the Individual Shared Responsibility Payment Tara Straw November 4, 2014 Steps in the Tax Return Related to the ACA 2 There is a requirement to have health insurance coverage starting

More information

Employee Benefits Compliance

Employee Benefits Compliance Employee Benefits Compliance Pay or Play Delay, Does it Apply and Strategies to Comply Wells Fargo Insurance 2014 Issues and beyond. U.S. citizens and legal residents are required to have "minimum essential

More information

NOT ALL OF THE COLORADO MARKETPLACE S INTERNAL CONTROLS WERE EFFECTIVE IN ENSURING THAT INDIVIDUALS WERE ENROLLED IN QUALIFIED HEALTH PLANS ACCORDING

NOT ALL OF THE COLORADO MARKETPLACE S INTERNAL CONTROLS WERE EFFECTIVE IN ENSURING THAT INDIVIDUALS WERE ENROLLED IN QUALIFIED HEALTH PLANS ACCORDING Department of Health and Human Services OFFICE OF INSPECTOR GENERAL NOT ALL OF THE COLORADO MARKETPLACE S INTERNAL CONTROLS WERE EFFECTIVE IN ENSURING THAT INDIVIDUALS WERE ENROLLED IN QUALIFIED HEALTH

More information

Health Reform Changes: What s New for 2014? New Hampshire Insurance Department September 11, 2013

Health Reform Changes: What s New for 2014? New Hampshire Insurance Department September 11, 2013 Health Reform Changes: What s New for 2014? New Hampshire Insurance Department September 11, 2013 1 New Hampshire Insurance Department Presentation Overview What s New in 2014 Key Questions for Individuals

More information

Health Care Law Implementation: What Nonprofits Need to Know WELCOME!

Health Care Law Implementation: What Nonprofits Need to Know WELCOME! Health Care Law Implementation: What Nonprofits Need to Know WELCOME! Health Care Law Implementation: What Nonprofits Need to Know (PPACA) Health Care Law Implementation: What Nonprofits Need to Know Heather

More information

Overview of Private Health Insurance Provisions in the Patient Protection and Affordable Care Act (ACA)

Overview of Private Health Insurance Provisions in the Patient Protection and Affordable Care Act (ACA) Overview of Private Health Insurance Provisions in the Patient Protection and Affordable Care Act (ACA) Annie L. Mach Analyst in Health Care Financing Namrata K. Uberoi Analyst in Health Care Financing

More information

Christy Tinnes, Brigen Winters and Christine Keller, Groom Law Group, Chartered

Christy Tinnes, Brigen Winters and Christine Keller, Groom Law Group, Chartered Preparing for Health Care Reform A Chronological Guide for Employers This Article provides an overview of the major provisions of health care reform legislation affecting employers and explains the requirements

More information

Application of Market Reform and other Provisions of the Affordable Care Act to HRAs, Health FSAs, and Certain other Employer Healthcare Arrangements

Application of Market Reform and other Provisions of the Affordable Care Act to HRAs, Health FSAs, and Certain other Employer Healthcare Arrangements Application of Market Reform and other Provisions of the Affordable Care Act to HRAs, Health FSAs, and Certain other Employer Healthcare Arrangements Notice 2013-54 I. PURPOSE AND OVERVIEW This notice

More information

Notice 2015-87 I. PURPOSE AND OVERVIEW

Notice 2015-87 I. PURPOSE AND OVERVIEW Further Guidance on the Application of the Group Health Plan Market Reform Provisions of the Affordable Care Act to Employer-Provided Health Coverage and on Certain Other Affordable Care Act Provisions

More information

EMPLOYEE S GUIDE TO HEALTH CARE REFORM S TAX CREDITS

EMPLOYEE S GUIDE TO HEALTH CARE REFORM S TAX CREDITS The EMPLOYEE S GUIDE TO HEALTH CARE REFORM S TAX CREDITS Calculate Your Health Insurance Tax Credit 2 Introduction Beginning in 2014, massive tax credits will become available to help individuals buy health

More information

PREPARE FOR AFFORDABLE CARE ACT NOW & AVOID PENALTIES!

PREPARE FOR AFFORDABLE CARE ACT NOW & AVOID PENALTIES! PREPARE FOR AFFORDABLE CARE ACT NOW & AVOID PENALTIES! Ken Laks, Tax Specialist Eric Dielmann, Employee Benefit Specialist PRESENTED BY WHY WORRY? Employer Mandate has Been Postponed until 2015! Guaranteed

More information

U.S. Department of Labor TECHNICAL RELEASE 2013-03 DATE: SEPTEMBER 13, 2013 SUBJECT: I. PURPOSE AND OVERVIEW

U.S. Department of Labor TECHNICAL RELEASE 2013-03 DATE: SEPTEMBER 13, 2013 SUBJECT: I. PURPOSE AND OVERVIEW U.S. Department of Labor Employee Benefits Security Administration Washington, D.C. 20210 TECHNICAL RELEASE 2013-03 DATE: SEPTEMBER 13, 2013 SUBJECT: APPLICATION OF MARKET REFORM AND OTHER PROVISIONS OF

More information