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

Transcription

1 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 Presented by: Jay Hutto, CPA Prescribed Side Effects of the Patient Protection and Affordable Care Act (PPACA): Healthcare Reform Update 1

2 Housekeeping How to ask questions Technology questions CPE Eligibility About Your Presenter Jay Hutto, CPA Partner James Moore, CPAs 2

3 August 14, 2013 Presented by: Jay Hutto, CPA Prescribed Side Effects of the Patient Protection and Affordable Care Act (PPACA): Healthcare Reform Update Health Care Overview The business reporting and penalties have been delayed until January 1, 2015 The individual mandate penalty will be enforced effective January 1, 2014 via the Form 1040 For the Health Care Marketplace (Exchanges), there will be new storefronts, kiosks, call centers, in-person assisters and navigators assisting individuals with obtaining coverage Florida is one of the majority of states that do not have a separate exchange so individuals and small businesses will go to for information 3

4 Health Care Review Medicare Part D (prescription drugs) Additional charge for those with incomes above $170,000 (couples) / $85,000 (single) Medical device manufacturers and importers must pay a 2.3% tax imposed on the sale of any medical device Status of Reform Provides opportunity to obtain health insurance providing essential health benefits with minimal essential coverage PCORI fees for self-insured and health reimbursement accounts (HRAs) are paid on Form 720 and will be included in health insurance premiums for policies with policy years ending after September 30, The fee is $1 per covered person ($2 for plan years after September 30, 2013). Notices of health insurance coverage are required to be provided by employers to employees by October 1, 2013 Medical Loss Ratio (MLR) Insurance Rebates are paid if the health insurance issuer does not spend at least 80% or 85% of premium dollars on medical care starting back in 2012 Cap on out-of-pocket costs extended to

5 Summary of PPACA 2010 and 2011 Small business tax credit since 2010 Dependent coverage up to 26 and no discrimination for pre-existing conditions Over-the-counter drugs (OTCD) are no longer treated as allowable for FSA, HSA, HRA and MSA Increased tax on nonqualifying HSA and MSA distributions to 20% Small Business Health Care Credit Available for certain businesses offering health coverage For uniform non-elective contributions if business has no more than 25 FTE with an average annual wage of no more than $50,000 The maximum credit is the lesser of: Actual insurance paid by the employer, or What the employer would have paid had the employee enrolled in coverage with a small business benchmark premium (Rev. Rul ) Multiplied by the percentages below: : 35% 2014 and beyond: 50% Credit phase-out is the sum of: The credit x (# of FTE 10)/15, and The credit x (average annual wage $25,000)/$25,000 Employer contribution must be at least 50% of the premiums paid for single (employee only coverage) 5

6 Summary of 2012 Reporting of cost of employer-sponsored health coverage (250 or more W-2s) Summary of Benefits and Coverage must be provided Medical loss rebates Electronic medical records (EMR) How will I be affected in 2013? What does this mean for taxpayers? Additional Medicare Tax: For single taxpayer employees earning over $200,000 (married taxpayers filing jointly $250,000) Pay an additional 0.9% Medicare tax over the 1.45% tax currently applicable Tax applies to wages and selfemployment income in excess of threshold Thresholds not affected by inflation Penalty for being married No employer match on 0.9% tax 6

7 Tax on Earnings - Example John Single taxpayer Self-employed $500,000 Excess of Earnings Threshold $500,000 - $200,000 $300, % surtax would apply to $300,000 = $2,700 Additional Tax Medicare Surtax 3.8% of the lesser of 1. Net Investment Income OR 2. The excess (if any) of: - Modified Adjusted Gross Income (MAGI) - Threshold Amount ($200,000 single, $250,000 married) 7

8 3.8% Medicare Surtax Example 1 John Single taxpayer $100,000 of salary $50,000 net investment income 3.8% surtax would NOT apply MAGI is less than threshold MAGI $150, % Medicare Surtax Example 2 Tom & Sandy Married, filing jointly $400,000 salary income $50,000 net investment income Excess of Earnings Threshold $400,000 - $250,000 $150, % surtax would apply to $50,000 = $1,900 Additional Tax AND 0.9% surtax would apply to $150,000 = $1,350 Additional Tax 8

9 Summary of 2013 Medicare payroll tax Unearned income surtax Medical expense deduction exceeds 10% of AGI New FSA contribution limits of $2,500 per year Medical device manufacturer excise tax Notice regarding exchange was delayed from March 1, 2013 to October 1, 2013 Impact for 2014 and After Health insurance exchanges Penalties if no health insurance post 2013 for individual mandates Penalties if large employer and no health insurance for full-time workers post 2014 for employer mandates Reporting requirements post 2014 also for employers Pay or Play penalty for Depends on whether coverage is offered - Penalty can be as high as $2,000 - $3,000 per employee 9

10 Impact for 2014 and After Waiting period 90 days Increase access to Medicaid in certain states based on % of poverty level Pre-existing coverage conditions and no limits Cadillac Health Plan - 40% Excise Tax (2018) Year Provision 2013 Flexible spending arrangement the maximum drops to $2,500 per plan year New HI (hospital insurance tax) on high-income taxpayers (.9% tax on wages in excess of threshold amount) New 3.8% Medicare tax on investment income Medical care itemized deduction threshold increases to 10% of AGI starting in 2013 but remains at 7.5% for those age 65 and older until 2016 Notification to employees by October 1, States will be required to provide federally approved insurance plans or default to federal marketplace Premium assistance credit Excise tax on uninsured individuals on Form Excise tax on applicable large employers Insurer reporting requirements 2017 Increase in medical deduction threshold for taxpayers age 65 and over 2018 Excise tax on high-cost employer plans 10

11 Individual Health Insurance Plans The insurance price is determined by only four criteria: 1. Age Older people will not pay more than three times the amount younger people pay 2. Premium Rating Area High cost areas will have more expensive insurance 3. Number of family members covered 4. Tobacco use Observation: Young adults and men may see an increase in premiums Essential Health Benefits Generally, the following (ten) benefits must be provided with no annual or lifetime limits: 1. Ambulatory services 2. Emergency services 3. Hospitalization 4. Maternity and Newborn care 5. Mental Health and substance abuse 6. Prescription drugs 7. Rehabilitative services 8. Laboratory services 9. Pediatric services including oral and vision care 10. Preventative and wellness services and chronic disease management 11

12 Individual Mandate The requirements & the penalty Premium Assistance Credit Note: Not like a normal credit. The money goes directly to the insurance company. Exceptions Minimum Essential Coverage Penalty for Remaining Uninsured Under 18 is ½ of that imposed on adults Responsible for providing coverage if able to claim a personal exemption Penalty = greater of a percentage of the taxpayer s income or a flat dollar amount The per adult annual penalty is phased in: 2014: Greater of 1% of applicable income* or $ : Greater of 2% of applicable income or $ : Greater of 2.5% of applicable income or $ and beyond: Indexed for inflation from $695 12

13 Premium Assistance Credit Tax credit available for incomes up to 400% of the federal poverty level Currently: $44,680 (single) $92,200 (family of four) Have to obtain insurance through an exchange The taxpayer is only eligible for the credit if the employer coverage is unaffordable If the employee must pay (self-coverage only) premiums that exceed 9.5% of household income Eligibility is determined month-bymonth Premium Assistance Credit Household Income Example Taxpayer buys insurance at the exchange and the exchange makes advanced payments on behalf of the taxpayer (after the exchange determines eligibility). The taxpayer reconciles the actual credit for the tax year computed on his 1040 with the advanced payment amount made on his behalf. If the credit exceeds the amount of advance payments, he gets a refund. If the advanced payments exceed the credit, he owes. Repayment of excess - The repayment limitation is between $600 - $2,500 ($300-$1,250 single) The credit is the lesser of the premiums for the month or a calculation based on your Household Income 13

14 Cost Sharing Reduction Subsidy The Cost Sharing Reduction Subsidy is available to those that qualify with income that does not exceed 250% of the FPL This subsidy allows for a reduction in the amount of out-of-pocket expense they could incur Applies to deductibles and co-pays Must buy insurance through an Exchange to qualify Exemption From Penalty 8% Rule Premiums exceed 8% of Adjusted Household Income Adjusted Household Income is AGI plus: 1. Tax exempt income and 2. Foreign earned income and housing excluded under section 911 Also include the AGI of dependents who are required to file a return If an individual can only buy through an Exchange the cost is based on Bronze level premiums 14

15 Employer Mandate Large employers Had at least 50 FTE (average at least 30 hours per week or 130 hours per month) during the previous calendar year Effective January 1, 2015 Aggregate number of hours of part-time employees number of FTE Exemption applies where the workforce exceeds 50 FTE for no more than 120 days and the employees in excess of 50 were seasonal Employer Mandate Penalties Two Potential Penalties 1. No Coverage Penalty: An employer does not offer minimum essential insurance to at least 95% of its full- time employees (in 2015 this includes dependents) and at least one employee qualifies for the Premium Assistance Credit or Cost Sharing Reduction. The penalty is calculated on a monthly basis and there is a 30 FTE threshold before the penalty is applied. 2. Lacking Minimum Value or Unaffordable Penalty: An employer does offer minimum essential coverage to at least 95% of full- time but at least one employee qualifies for the Premium Assistance Credit or Cost Sharing Reduction. The penalty is assessed monthly with a maximum of the above penalty. 15

16 Example In 2014 ABC, Inc. offers minimum essential coverage and has 100 FTE; 20 of whom receive a premium tax credit for enrolling in a state program. For each employee receiving a premium credit the penalty is $3,000 for a total of $60,000 (20 $3,000) The penalty is capped at the failure to provide coverage rate of 70 (100 30) $2,000 = $140,000 The penalty is assessed monthly Affordable Coverage No more than 9.5% of that employee s annual household income If an employer offers multiple healthcare coverage options: Test applies to the lowest-cost option available to the employee that also meets the minimum value requirement Employers can take advantage of one of the following safe harbors to determine if the coverage is affordable: Form W-2 Determination Federal Poverty Line Method Rate of Pay Method 16

17 Minimum Value Methods for an employer to determine whether the coverage it offers provides minimum value: Minimum value calculator Employers can input information and determine if the plan provides minimum value by covering at least 60% of the expected costs Insurance agent or company Employer Mandate Tax Planning Measurement Period Keep Employees Below 30 Hours Per Week Use Independent Contractors Health Insurance Coverage 17

18 Cadillac Plans Excise Tax 40% tax imposed on high cost employer-sponsored and self-insured plans The tax is levied on insurance companies and plan administrators It is applied to annual insurance premiums for those under 55 that exceed $10,200 for individuals and $27,500 for families For those aged 55 and above, the threshold is $11,850 for individuals and $30,950 for families There are age, gender and other adjustments How to Prepare? 18

19 Questions Jay Hutto, CPA Partner James Moore, CPAs ext