And Changes under Healthcare Reform affecting businesses

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1 And Changes under Healthcare Reform affecting businesses 1

2 Individual Mandate 2

3 First there were two choices Under the Affordable Care Act every individual must have Minimum Essential Healthcare Coverage or Pay a Tax Penalty. 3

4 Minimum Essential Coverage Minimum Essential Coverage is some form of major medical healthcare coverage such as: Medicare TRICARE or VA Medical Benefits Must be comprehensive, not limited in scope. Medicaid hawk-i Employer based health insurance from a family member Major medical health insurance purchased on the individual market 4

5 Tax Penalty If an individual does not have Minimum Essential Coverage they must pay the greater of the two penalties on their taxes. In years after 2016 the penalty is indexed to the rate of medical inflation. Parents are responsible for their children too! Minimum $95 $325 $695 Percent of Income After Filing Threshold 1% 2% 2.5% 5

6 Do I need to make any changes to avoid the penalty? Are you uninsured? Call the Marketplace Do you like your current health insurance? You can keep it, or shop around on the Marketplace Are you on Medicare? No change needed Are you on Medicaid? No change needed Are you on IowaCare? IowaCare ends on December 31, All IowaCare members will receive instructions on how to find new health care coverage. 6

7 The Iowa Health Insurance Marketplace Iowa is using the Federal Health Insurance Marketplace. The Marketplace is a place for people to look for affordable minimum essential coverage There is a single application process for Medicaid (including the Iowa Health and Wellness Plan), hawk-i, Tax Credits, and Cost Sharing Subsidies. Applicants shopping for insurance on the Marketplace will have the choice of multiple private insurers. 7

8 Household Size Federal Poverty Guidelines (FPL) If your income and household size fall within this chart you may get benefits. 100% 133% 150% 200% 300% 400% 1 $11,490 $15,282 $17,235 $22,980 $34,470 $45,960 2 $15,510 $20,628 $23,265 $31,020 $46,530 $62,040 3 $19,530 $25,975 $29,295 $39,060 $58,590 $78,120 4 $23,550 $31,322 $35,325 $47,100 $70,650 $94,200 5 $27,570 $36,668 $41,355 $55,140 $82,710 $110,280 6 $31,590 $42,015 $47,385 $63,180 $94,770 $126,360 7 $35,610 $47,361 $53,415 $71,220 $106,830 $142,440 8 $39,630 $52,708 $59,445 $79,260 $118,890 $158,520 Each Additional Person $4,020 $5,347 $6,030 $8,040 $12,060 $16,080 Based on Modified Adjusted Gross Income. 8

9 Modified Adjusted Gross Income? Modified Adjusted Gross Income is the amount of gross income earned, with a few things added in and deducted. There are some deductions taken away, such as business expenses. There is some money that is normally non-taxed added in, such as non-taxable interest. The take away is that if you are near the income cut off, you still might qualify for assistance. The only way to find out is to apply. 9

10 Health Premium Tax Credits Certain people may qualify for tax credits to help them purchase insurance They must: Have a household income between 100% and 400% of the federal poverty guidelines. Not have Minimum Essential Coverage from some other source. Be lawfully present in the U.S., and may not be incarcerated. A person may still qualify for tax credits if coverage from their spouses employer is not Affordable or does not provide Minimum Value. 10

11 How much can I save with a Health Premium Tax Credit? Tax Credit = cost of the silver benchmark plan a households required contribution. The silver benchmark plan is the second least expensive silver plan in the marketplace. A household s required contribution is a fixed percentage of the household income. This is a sliding scale based upon the annual income. Go to to estimate your tax credit! % of FPL Initial Contribution Less than 133 2% 2% % 4% % 6.3% End Contribution % 8.05% % 9.5% % 9.5% 11

12 What is considered Affordable under the law? What is Minimum Value? An Employer s plan is Affordable if the cost to insure the employee only is less than 9.5% of the employee s household income. An Employer s plan provides Minimum Value if it covers 60% of the expected medical expenses. 12

13 Things to consider with a Health Premium Tax Credit The tax credit may be taken and applied towards any of the plans available on the market place. The tax credit may be paid monthly to the insurance company to reduce your premium or taken at the end of the year as a lump sum. The amount of the tax credit is capped at the cost of the actual plan purchased. 13

14 The Final Tax Credit is Figured at the End of the Year If you overestimate your income you may get a refund at the end of the year. If you underestimate your income you may owe the government money. The amount you need to pay back is limited by income and household size. (see table) If your income changes during the year, let the Marketplace know! FPL % Single Family Less than 200% $300 $ % - 300% $750 $1, % - 400% $1,250 $2,500 14

15 15

16 How do I sign up? Go to or call You can only sign up during Open Enrollment or Special Enrollment. Open Enrollment for the first year is from October 1 st 2013 till March 31 st, Open Enrollment for 2015 starts October 15 th 2014 through December 7 th If you don t sign up during the open enrollment you might be able to sign up during a special enrollment period. Navigators, Certified Application Counselors and Insurance Agents are available to assist you with enrolling, be it in person or over the phone. 16

17 Special Enrollment Period May enroll or change Qualified Health Plan Within 60 days in individual market and 30 days in small group market from qualifying event Loss of minimum essential coverage Gaining or becoming a dependent Gaining lawful presence Special Enrollment Period Qualifying Events Enrollment errors of the Marketplace * Granted on a case by case basis. Material contract violations by Qualified Health Plans Gaining or losing eligibility for premium tax credits or cost sharing reductions Relocation resulting in new or different Qualified Health Plan selection Exceptional circumstances* 17

18 1-50 Full Time Equivalent employees 18

19 Defining Small Employers and Full Time Employees Small Employers employer 50 or fewer full time equivalent employees. Full Time Equivalent Employees (FTEs) are employees that work an average of 40 or more hours a week. If you own multiple businesses the employees are added up between businesses. Seasonal employees that work more than 120 days a year count as employees. Hours of service for part time employees are added together. Owners and their immediate family are not considered employees. Small employers are NOT required to offer health insurance. 19

20 Calculating FTEs To calculate your FTEs add up the total hours of service for your employees. Example: Hours worked, vacation & sick leave. Hours any particular employee works over 40 per week are excluded from the calculation. A person who works significant overtime is not 1.5 FTEs. Certain seasonal workers hour s are excluded. Hours worked by the business owner or their immediate family are excluded. Divide the total number hours of service by 2080, the result is the number of FTEs employed. 20

21 21

22 The Iowa Small business Health Options Program (SHOP). SHOP is the website where Small Employers can; Compare insurance plans, Apply for tax credits, Plan their business health insurance expenditures, Set contribution rates and, Purchase insurance for their employees. In 2014, all Small Employers (50 or fewer FTEs) may use SHOP. Coming in 2015, employees will be able to choose from multiple plans selected by their employer through SHOP. 22

23 * This is intended to give general guidance and explain the legal frame work. The Iowa Insurance Division is not an expert on Federal Tax law. This presentation is not intended to be legal or tax advice. Attendees are encouraged to seek assistance from their tax advisor. 23

24 Tax Credits for Small Businesses To qualify; The Business must employ 24 of fewer full time equivalent employees (FTE), and must pay an average annual wage of under $50,000 per FTE, and The employer must also cover at least 50% of the health insurance premiums for their employees. For you can file for the tax credit with the IRS. 24

25 Tax Credits for Small Businesses Starting in 2014; The health insurance must be purchased through the SHOP to qualify for tax credits. You CAN ONLY apply for the tax credits through SHOP. Starting in tax year 2014, the credit is only available for 2 consecutive tax years. 25

26 Calculating Average Wage To calculate the average annual wage; Add up the wages paid to your employees Divide the compensation paid to the employees by the number of FTEs employed. *The chart on the right can be found on the IRS website at s-utl/3_simple_steps.pdf 26

27 Tax Credits for Small Businesses Already Available Tax Credits are available to pay for a percentage of the health insurance premiums covered by the employer. The percentage varies depending upon the tax year, and whether the employer is forprofit or non-profit. Applicable Percentage For-profit 35% 50% Non-profit 25% 35%

28 Calculating the Credit Businesses with 10 or fewer FTEs with an average annual wage of $25,000 or less get the full tax credit. Multiply the amount of money the Employer spent on health care premiums by the applicable percentage to determine the employers tax credit. 28

29 Tax Credit - Phase Out For businesses that employ more than 10 FTEs or that pay annual average wage of more than $25,000, the tax credit is Phased Out. The Phase Out may reduce or eliminate the tax credit. 29

30 For a More In-Depth Look at how Tax Credits are Calculated Tax-Credit-Questions-and-Answers:-Calculating-the- Credit We have handouts available that go through the calculations. 30

31 DISCLAIMER Again, we are not tax experts, and you should not rely on any information that we present as being binding. All information presented herein is for informational purposes, only. It is strongly recommended that you contact your tax professional or the IRS when making decisions based upon tax information and/or calculations, as these areas are often highly complicated and specialized. In some instances our representations are estimations. 31

32 32

33 How do I sign my business up? On October 1, 2013 you may apply for a SHOP account. You may compare and enroll your business in a plan starting November 1, SHOP will be available year around and businesses can choose when to hold their Open Enrollment period. Go to SHOP Marketplace Line IRS Business Help Line

34 Employers with 50 or more employees 34

35 The Large Employer Mandate Under the Affordable Care Act, starting in 2015 Large Employers are mandated to provide health insurance to their Full Time Employees. You are a Large Employer if you have 50 or more full time employees, based on a 30 hour work week. Count your number of regular 40 hour work week full time employees Add to that the hours of service worked by part time employees in a month divided by 120 Changes must be made to your 2015 health insurance plans, so start planning early. 35

36 The Large Employer Mandate Starting in 2015, your business may be assessed a Tax Penalty: If the health insurance EITHER: Does not offer coverage to at least 95% of its full-time employees (and their dependents), OR The coverage offered to employer s full-time employees is not Affordable or does not provide Minimum Value AND At lease one full-time employee receives a premium tax credit in the individual Marketplace. 36

37 Reminder An Employer s plan is Affordable if the employee s share to insure the employee only (self-only coverage) is less than 9.5% of the employee s household income. An Employer s plan provides Minimum Value if it covers 60% of the expected medical expenses (HHS and IRS have online calculators to determine if an employer s plan meets the 60% value threshold). 37

38 Tax Penalties The penalty is up to $3,000 per year for every employee that purchases insurance on the market that receives a tax credit. 38

39 Will my business be penalized? The U.S. chamber of commerce has a business calculator to help a business determine whether it must offer health insurance to its employees, and if it chooses not to, what tax penalty it may face. 39

40 Large Employer Reporting Requirements For calendar year 2015, you will report on your annual tax return whether and what health insurance you offered your employees. For calendar year 2015, if you provide self-insured health coverage to your employees, you must file an annual tax return reporting certain information for each employee you cover. You may be required to report the value of the health insurance coverage you provided to each employee on his or her form W-2. F For more information, visit 2-Reporting-of-Employer-Sponsored-Health-Coverage 40

41 Highly Compensated Employee Medicare Withholding Beginning Jan. 1, 2013, you must withhold and report an additional 0.9 percent on employee wages or compensation that Exceeds $200,000 for single filers OR Exceeds $250,00 for joint filers 41

42 42

43 Go to healthcare.gov to shop or enroll Call Presented By: 43

44 Self Employed Example 1 House hold of 2 adults making $60,000 per year. Their required contribution is 9.5% or $5,700 per year. The Silver benchmark premium is $7,000 per year. $7,000 (Silver benchmark) - $5,700 (required contribution) = Tax Credit = $1,300 $1,300 in Tax Credits 44

45 Self Employed Example 2 Family of 4, two adults and two children making $40,000 annually. The Silver benchmark premium is $10,781, their required contribution is 5.89% or $2,650 per year. $10,781 (Silver benchmark) - $2,650 (required contribution) = Tax Credit = $8,131 $8,131 in Tax Credits 45

46 Employer Example 1 Employer, in 2013, for profit, spends $10,000 per year on employee health insurance premiums. Employer employs 8 FTEs, with an average annual wage of $24,000. Employers tax credit is 35% * $10,000, or $3,500. Note: some businesses may be able to amend their taxes to receive the tax credit for Contact your tax professional. Contact the IRS Business Help Line

47 Employer Example 2 Employer, in 2014, for profit, spends $12,000 per year on employee health insurance premiums. Employer employs 89FTEs, with an average annual wage of $20,000. Employers tax credit is 50% * $12,000, or $6,

48 Employer Example 3 Employer, for profit, spends $12,000 per year on health insurance premiums. Employer has 15 FTEs, with an average annual wage of $23,000. The base credit is $12,000 * 50% = $6,000. The employer has more than 10 FTEs so the credit is subject to phase out. There are 15 FTEs, 5 in excess of 10. $6,000 (Base Credit) * 5/15 (Employees exceeding 10) = $2,000 $6,000 - $2,000 = Tax Credit of $4,000 48

49 Employer Example 4 Employer, for profit, pays $20,000 per year for employee health premiums. Employer has 19 FTEs with an average annual wage of $30,000. The base tax credit is $20,000 * 50% = $10,000 The employer employs 9 FTEs in excess of 10, and pays $5,000 a year in excess of $25,000 a year. $10,000 (Base Credit) * 9/15 (employees exceeding 10)= $6,000 $10,000 (Base Credit)* $5,000/$25,000 (amount annual average wage exceeds $25,000)= $2,000 $6,000 + $2,000 = $8,000 $10,000 - $8,000 = Tax Credit of $

50 Tax Penalty Calculations Calculation /Scenario One: If coverage is not offered to at least 95% of full-time employees, and any full-time employee receives a premium tax credit in the individual Marketplace: Payment owed: $2,000/year times (the number of full-time employees minus 30) Calculated monthly Calculation Two: If coverage is offered to Full-Time Employees, but it is either not affordable or does not meet minimum value: Payment owed: $3,000/year per full-time employee who receives a premium tax credit in the marketplace (also applies to employer offering coverage to at lease 95% of full-time employees, but less than 100%, for each full-time employee receiving tax credit in the marketplace. This payment is capped at amount in Calculation/Scenario One 50

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