The New Healthcare Law and Its Impact on Small Business

Transcription

1 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

2 These materials are provided for informational purposes only and are not intended as legal or tax advice. Readers should consult their legal or tax professionals to discuss how these matters relate to their individual business circumstances.

3 Affordable Healthcare Act According to the National Federation of Independent Business, since 1986 the NUMBER ONE concern for Small Businesses every year has been access to AFFORDABLE HEALTH CARE. Small Businesses usually pay an average of 18% more than their larger counterparts for the same plan. 3

4 The Affordable Care Act Reduces Premium Cost Growth and Increases Access to Affordable Care Before ACA, Small Employers Faced Many Obstacles to Covering Workers Too few choices Higher premiums and unpredictable rate increases Higher rates for groups with women, older workers & those with chronic health concerns or high-cost illnesses, in most states Waiting periods or no coverage for individuals with Pre-Existing Conditions Today, under ACA, insurance companies: Face limits on administrative spending. Most insurers must now spend at least 80 percent of consumers premium dollars on actual medical care Must disclose and justify proposed rate hikes of 10% or more, which states, or the federal government, may review Starting in 2014, insurance companies: Can t charge higher rates or deny coverage because of a chronic or pre-existing condition Can t charge higher rates for women, and face limits on charging additional premiums for older employees Will pool risks across small groups creating larger pools like large businesses Must not have annual dollar limits on coverage Must offer plans that provide a core package of Essential Health Benefits equal to typical employer plans in the state 4

5 Affordable Healthcare Act January 1, 2014 Individual Shared Responsibility begins Employer Shared Responsibility begins Insurance Marketplaces launch 5

6 How Will My Business Be Affected? Self- Employed It depends. 50 or more 25 to 49 Full-Time Equivalent Employees 11 to or Fewer How many full-time (or full-time equivalent) employees do you have and what are their average salaries? Note: Non-profits and government entities are required to follow the ACA provisions as well. 6

7 Self-Employed Business Owners Self- Employed Have Qualifying Health Insurance 50 or more Full-Time Equivalent Employees 10 or Fewer OR 25 to to 24 Potentially pay an Individual Shared Responsibility Payment 7

8 Self-Employed Business Owners You are required to have health insurance by January 1, 2014 or you will potentially pay an Individual Shared Responsibility Payment ISRP increases each year and is pro-rated by # months without coverage: 2014: $95 or 1% of household income (whichever is greater) 2015: $325 or 2.0% of household income (whichever is greater) 2016: $695 or 2.5% of household income (whichever is greater) Reduce your net earnings from the Self-Employment Tax by how much you spend on your health insurance 8

9 Individual Shared Responsibility: Exemptions Coverage is unaffordable (more than 8% of household income) Spend less than 3 consecutive months without coverage Hardship (e.g., would be eligible for Medicaid but for the state s decision not to expand) Religious beliefs: sect must be legally recognized by Social Security Administration 9

10 Individuals/Self-Employed Business Owners: Tax Credits Purchase Insurance on the Individual Marketplace Income between 100% and 400% of federal poverty level (Based on Modified Adjusted Gross Income: AGI + various non-taxable income) Not eligible for Government Sponsored Program 10

11 50 or more Businesses with 10 or Fewer Employees Generally no requirement to provide health insurance* But if you choose to provide insurance: 25 to 49 Self- Employed Full-Time Equivalent Employees 11 to or Fewer Might be qualified for the Small Business Health Care Tax Credit Must have average annual salaries below $50,000 and Contribute 50% or more toward employees self-only premium costs Businesses with 10 or fewer full-time equivalent employees and average annual salaries of less than $25,000 will qualify for the maximum credit * Members of controlled/common ownership groups might be required to offer insurance 11

12 50 or more 25 to 49 Businesses with 11 to 24 Employees Self- Employed Full-Time Equivalent Employees 11 to or Fewer Generally no requirement to provide health insurance* But if you choose to provide insurance: Might be qualified for the Small Business Health Care Tax Credit Must have average annual salaries below $50,000 and Contribute 50% or more toward employees self-only premium costs To calculate average annual salaries, divide the number of your full-time equivalent employees by the total amount you pay out for salaries * Members of controlled/common ownership groups might be required to offer insurance 12

13 Small Business Health Care Tax Credit In , up to 35% of a for-profit employer s premium contribution Employers can still deduct remainder of contribution Credit can be claimed through 2013 Starting in 2014, the credit goes up to 50% To take advantage of the credit, business must buy coverage through the new small business health insurance Marketplaces known as SHOP and contribute 50% of premium costs Credit can be claimed for any 2 consecutive taxable years beginning in 2014 (or beginning in a later year) through the SHOP Note that this is a Federal credit, and that some states may also have additional tax credits available 13

14 Small Business Healthcare Tax Credit Your business employs fewer than 25 full-time equivalent employees Your employees average annual salaries are less than $50,000 You pay for at least 50% of the healthcare costs Up to 35% Federal Tax Credit in 2013 and 50%* in 2014 * SHOP participants only 14

15 Businesses with 25 to 49 Employees 50 or more 25 to 49 Self- Employed Full-Time Equivalent Employees 11 to or Fewer Generally no requirement to provide health insurance If you choose to provide insurance to your employees you are not eligible for any tax credits on the federal level Your state might have credits available 15

16 Businesses with 50 or More FTE Employees 50 or more Self- Employed Full-Time Equivalent Employees 10 or Fewer Offer Qualifying Health Insurance to 95% of Full-time Employees and their Dependents OR 26 to to 25 Potentially pay a Shared Responsibility Payment 16

17 Definitions Full-time Employee: an employee who is employed on average at least 30 hours a week (or 130 hours of service in a given month) Full-time Equivalent: either one employee who is employed full-time OR two individuals that are part-time, but added together equal one full-time employee 17

18 Employer Shared Responsibility Provisions 96% of American firms are exempt from the Employer Shared Responsibility Provisions (ERSP) 18

19 Employer Shared Responsibility Payments: Two Scenarios Coverage Not Offered to Substantially All Full-Time Employees Coverage Offered to Full- Time Employees, But Either Not Affordable or Does Not Meet Minimum Value Payment applies if any full-time employee receives a premium tax credit in the individual Marketplace Payment owed: $2K/year per fulltime employee ABOVE 30 Payment calculated separately for each month for which coverage not offered ($166.67/month) Payment based on employer s number of full-time employees for that month (minus the first 30) Payment owed: $3K/year per fulltime employee who receives a premium tax credit in Marketplace Payment calculated on monthly basis = $250/month Payment based on number of fulltime employees who actually receive premium tax credit for that month This payment can t exceed payment in Scenario # 1 19

20 Employer Shared Responsibility Payment: Three Scenarios Restaurant Pet Store Law Firm 25 actual FTEs (Wait Staff, GM, etc.) 25 equivalent FTEs (50 part-time Runners, Dishwashers etc.) 35 actual fulltime employees 50 part-time employees 50 actual full-time attorneys

21 Health Insurance Coverage Standards Minimum Coverage Must cover the at least 60% of the plan s total cost of incurred benefits e.g., if a visit to the doctor costs $100, the employee must not pay more than $40 out of pocket HHS is developing a value calculator for employers to input the coverage on their website to determine if it meets the 60% threshold Affordable If the employee s share of coverage would cost more than 9.5% of his/her annual household income then it is not affordable Affordability safe harbor: If the cost to the employee is less than 9.5% of the wages reported on box 1 of the W-2

22 Employer Shared Responsibility Provisions Additional Key Points No requirement to cover part-time employees If employer offers affordable coverage that provides minimum value to a full-time employee and it s declined, there is no liability for that employee No payment is owed if an employee obtains insurance through means other than the insurance Marketplace (e.g., spouse s insurance) Beginning in 2015, employers that offer coverage to fulltime employees must also offer coverage to the dependents of those full-time employees who are children under age 26 (coverage need not be offered to spouses) 22

23 Look-back Measurement and Stability Periods Measurement Period Admin. Period Stability (Coverage) Period Look-back Measurement Period: An employer-selected period of 3 to 12 months used to determine employee full-time status. Stability Period: The period following the measurement period (and any administrative period) during which an employer must treat an employee as full-time if the employee was determined to be full-time during the measurement period. Must generally be the greater of 6 months or equivalent to the measurement period. Administrative Period: An optional period (up to 90 days) between the measurement period and stability period, used to notify and enroll new employees. 23

24 Health Insurance Marketplaces Individual Marketplaces Individuals Self-Employed Small Business Health Options Program (SHOP) Small Businesses with up to 50 FT employees may enroll in 2014 Small Businesses with up to 100 FT employees may enroll starting in 2016

25 Health Insurance Marketplaces Federal (26) Federal-State Partnership (7) State (18)

26 Enrolling in SHOP: Who, When & How When can businesses enroll? Starting October 1, 2013 for coverage beginning January 1, 2014 Thereafter, throughout the year on a monthly basis How can businesses enroll? Through a broker, OR Directly through the SHOP. Visit for more information and to sign-up for alerts 26

27 Minimum Essential Coverage - Options Platinum 90% Gold 80% Silver 70% Bronze 60% Catastrophic Below the age of 30 27

28 Essential Health Benefits Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care 28

29 Qualifying Health Insurance Coverage Medicare Part A Medicaid Employer Sponsored (including COBRA and retiree) Spousal/Parental Coverage Some Veterans coverage TRICARE Purchased on the Individual Marketplace (HHS website) 29

30 Other Information Healthcare plans that were established before September 23, 2010 might be grandfathered Starting in 2014, Health and Wellness program incentives will be in place Beginning January 1, 2013, a 3.8% tax will be assessed on net investment income for taxpayers with Modified Adjusted Gross Income (MAGI) over $200,000 for single filers and $250,000 for married joint filers 30

31 Further Employer Responsibilities W-2 reporting (unless fewer than 250 employees) 0.9% increase in Medicare HI withholding for wages above $200K If covered by ESRP rules, must offer coverage within 90 days of hire Self-insured plans must submit reports to IRS beginning 2015 Summary of Benefits and Coverage forms must be given to employees 31

32 Medicaid With Medicaid Expansion Federal Government pays 100% of the expansion at first and by 2020 will pay 90% Covers family of four with $30,000 income Allows for low income workers to obtain free healthcare and doesn t leave businesses on the hook No Medicaid Expansion State loses out on billions of dollars e.g., Maryland is receiving at least $2.5 billion dollars from the federal government and Virginia is receiving $0 dollars Businesses are required to pay for insurance for low income full-time workers or make shared responsibility payment

33 Small Business Websites Julie C. Verratti