Small Business Tax Credit

Small Business Tax Credit Effective January 1, 2010 Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up to 35% of the employer s contribution to the employees health insurance. Small non-profit organizations may receive up to a 25% credit. Source: www.healthcare.gov 1

Immediate and Retroactive The tax credit for small businesses is effective immediately and retroactive to January 1, 2010. 2

Credit vs. Deduction The tax credit is better than (and in addition to) the deduction that small employers receive for paying a portion of their employees health insurance premium. Deduction reduces the amount you owe in taxes by decreasing your taxable income. Credit is a dollar for dollar reduction of your tax liability. 3

Can Be Carried Back or Forward Credit is nonrefundable (cannot exceed the tax liability for a tax year) the excess credit can be carried back 1 year or carried forward 20 years. Since 2010 is the first year of the credit any excess credit in 2010 cannot be carried back to 2009 since the credit did not exist in 2009. 4

Eligibility Rules For-profit and tax-exempt employers may qualify. All three of the following criteria must be met in order to qualify: 1. The employer must cover at least 50% of health care coverage costs for workers based on the employee-only (single) rate. 2. The employer must have no more than the equivalent of 25 full-time workers (not counting owners or family members). 3. Employees average annual wages (not counting owners or family members) must be below $50,000. Common ownership rules apply 5

Seasonal Workers Disregarded Seasonal workers are disregarded in determining FTEs and average wages unless the seasonal worker works for more than 120 days during a taxable year (premiums paid on their behalf may be counted in determining the amount of credit) 6

Employee Count Rules Number of employees is determined by dividing the total hours of service by 2,080. The result is then rounded to the lowest whole number. 2080 = 40 x 52 7

Average Wages Rules Determined by dividing the total wages paid by the employer during the employer s taxable year to employees by the number of employer s FTEs for the year (rounded down to the nearest $1,000) Example : For the 2010 taxable year, an employer pays $224,000 in wages and has 10 FTEs. The employer s annual wages is $22,000 ($224,000 divided by 10 = $22,400 rounded down to the nearest $1,000) 8

Premium Payments by the Employer Only premiums paid by the employer for health insurance coverage are counted in calculating the credit Example: If an employer pays 80% of the premiums for employee s coverage (with employees paying the other 20%), the 80% paid by the employer is taken into account in calculating the credit (premium paid via section 125 through salary reduction is not treated as paid by the employer) In calculating the credit for the taxable year beginning 2010, an employer may count ALL premiums paid by the employer in the 2010 tax year, including premiums paid in the 2010 tax year BEFORE the reform passed 9

Health Insurance Includes Limited scope dental Limited scope vision Nursing home care Home health care Community based care Coverage for specified disease or illness Hospital indemnity Fixed indemnity Medicare supplemental health insurance Etc. 10

Average Premium The total premium may not exceed the average premium for the small group market in the state (overall cap aggregates all forms of coverage) 11

Two Phases 2010 2013 The maximum credit is worth up to 35 percent of an employer s premium contribution (25 percent for tax-exempt employers). 2014 The maximum credit will increase to 50 percent on Jan. 1, 2014 for small employers who purchase coverage through the Exchange (35 percent for tax-exempt employers). 12

Credit Amount The credit gradually phases out for employers with average wages between $25,000 and $50,000, and for employers with the equivalent of between 10 and 25 full-time workers. 13

Phase Out: Full Time Employees If the FTE count exceeds 10, the reduction is determined by multiplying the otherwise applicable credit amount by a fraction, the numerator being the number of FTEs in excess of 10 and the denominator of which is 15 Example: The fraction to apply to the maximum credit for a group with 11 employees would be 1/15. Each FTE in excess of 10 is approximately worth a 7% reduction to your tax credit 14

Phase Out: Average Wages If average annual wages exceed $25,000, the reduction is determined by multiplying the otherwise credit amount by a fraction, the numerator of which is the amount by which average annual wages exceed $25,000, and the denominator of which is $25,000. Example: The fraction to apply to the maximum credit for a group with average wages of $30k would be 5000/25000 or 1/5. Each $1k in excess of $25k is approximately worth a 4% reduction to your tax credit 15

An Example 12 Full-time employees $26,000 average wages $2,000 monthly premium paid by employer $2,000 x 12 = $24,000 annual premium $24,000 x.35 = $8,400 maximum credit $8,400 x 2/15 = $1,120 decrease for excess employees $8,400 x 1/25 = $336 decrease for excess wages $8,400 - $1,120 - $336 = $6,944 total tax credit 16

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IRS Mailings Over 4 million postcards were sent by the IRS to small businesses that potentially qualify for the small business tax credit Texas was 3rd in total with 292,593. Only California and New York had more 18

What s Different About Texas? Lower cost of living and lower wages 19

Tax Credit Strategies What does this law tell small businesses to do? PAY as much of the premium (including dependent premiums) as you can of health, dental, and vision Consider SB80 qualified plans (100% employer contribution plans) Employers with 10 FTEs or less benefit the most Employers with average salaries $25k or less benefit the most Fund insurance premium BEFORE funding HSA account 20

Claiming the Credit How does an employer claim the credit? The credit is claimed on the employer s annual income tax return. For tax exempt employers, the IRS will provide further information on how to claim the credit. 21

Estimated Tax Payments Can the credit be reflected in determining estimated tax payments for a year? Yes. The credit can be reflected in determining tax payments for the year to which the credit applies in accordance with regular estimated tax rules. 22

Tax Exempt Employers Can a tax exempt employer claim the credit if it has no taxable income for the year? Yes. For a tax exempt employer, the credit is a refundable credit, so that even if the employer has no taxable income, the employer may receive a refund (so long as it does not exceed the income tax withholding and Medicare tax liability). 23

Family Members Do family members of a business owner who work for the business count as employees? Generally, no. A family member of any of the business owners or partners, or a member of such business owner s or partner s household, is not considered an employee for purposes of the credit. Thus, neither the wages nor their hours are counted in determining the number of these business owners and partners are counted in determining either the number of FTEs or the amount of average annual wages, and premiums paid on their behalf are not counted in determining the amount of the credit. For this purpose, a family member is defined as: A child (or descendent of a child) A sibling or step-sibling A parent (or ancestor of a parent) A step-parent A nice or nephew An aunt or uncle A son-in law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-law But not cousins 24

Does Credit Affect Deduction? Does taking the credit affect an employer s deduction for health insurance premium? Yes. In determining the employer s deduction of the health insurance premiums, the amount of premiums that can be deducted is reduced by the amount of the credit. 25

Update The administration, along with Harry Reid and Kathleen Sebelius, Have been working to get the word out about the small business tax credit. Federal officials say that not enough of the 4 million small employers that may qualify are claiming the tax credit. The Texas Department of Insurance launched a program called Healthy Texas January 1, 2011. The purpose of Healthy Texas is to reduce the number of working uninsured in the state of Texas. Many of the same companies that will qualify for the Healthy Texas program will also qualify for Healthy Texas. 26

The Tax Credit and Healthy Texas Average premium in the state is $400 PEPM Healthy Texas premium is discounted the following: Approximately 25%-30% because of the grant Approximately 5-6% due to the unique plan designs Approximately 5-6% due to typical demographics of uninsured (young males) Therefore, equivalent HT premium may be around $232 PEPM If the group qualifies at the maximum level for the small business tax credits then the small business tax credit value on $100 PEPM contribution would be worth $35 PEPM Total ER contribution is now worth $135 leaving the employee monthly contribution at just $97 27

Disclaimer I am not a tax expert. Please consult your CPA for specifics. 28

Small Business SHOP Exchanges 29

Health Insurance Exchanges Effective January 1, 2014 Starting in 2014 if your employer doesn t offer insurance, you will be able to buy insurance directly in an Exchange -- a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through Exchanges, and you will be able buy your insurance through Exchanges too. Source: www.healthcare.gov 30

Exchange Model Act Provides establishment of an health insurance exchange as required by the federal PPACA Facilitates the purchase and sale of qualified health plans in the individual market, including subsidized coverage authorized by the federal act Provides for the establishment of a Small Business Health Options Program (SHOP Exchange) to assist qualified small employers in facilitating the enrollment of their employees in qualified health plans offered in the small group market 31

The Exchange Board per the EMA Staggered 6 year terms 3 persons affiliated with an insurer admitted and authorized to write health insurance in the state 2 health insurance producers licensed to sell health insurance in the state 3 representatives of the general public who are not affiliated with an insurance company or plan, group hospital, or other health care provider, and can reasonably be expected to qualify to purchase individual or group coverage through the exchange. One person representing the state Medicaid Agency The commissioner or his or her delegate 32

Duties of the Exchange Board Within 6 months submit to commissioner plan of operation of the exchange Operation of the exchange Selecting an administrator Creating fund, under mgmt of the board, for administrative expenses Handling, auditing, of money and other assets of the exchange Developing and implementing a program to publicize the exchange, eligibility requirements, coverage, enrollment procedures, and public awareness of the exchange 33

Duties of the Exchange Board Developing and implementing procedures that require only licensed health insurance producers to enroll individuals and employers; and to assist individuals in applying for premium tax credits and cost-sharing reductions, including an educational certification process for insurance producers who wish to participate in the exchange to complete on an annual basis Carry out all functions of the plan and employ and set the compensation of any persons necessary to assist the board in carrying out it s responsibilities and functions 34

Duties of the Exchange Facilitate purchase and sale of qualified health plans Provide for the establishment of a SHOP (Small Business Health Options Program) Exchange to assist small employers in facilitating the enrollment of their employees in qualified health plans May contract with an eligible entity for any function in this act, but a health carrier or an affiliate of a health carrier is not an eligible entity Provide operation of a toll free hotline Provide enrollment periods Maintain website through which enrollees and prospective enrollees may obtain comparative information on plans Assign rating to plans in accordance with criteria developed by the Secretary Coordinate with CHIP or any applicable state or local public program for eligibility and enrollment in that program Establish a electronic calculator to determine the actual cost of coverage after application of any premium tax credit 35

Duties of the Exchange Establish a SHOP Exchange Employers shall specify a level of coverage so that any of its employees may enroll in any qualified health plan offered through the SHOP Exchange at the specified level of coverage Carriers in the SHOP Exchange must maintain a separate risk pool for their employer coverage than from any individual coverage the carrier offers through the exchange 36

Duties of the Exchange Grant certification for individuals exempt from the individual mandate penalty for the following reasons There is no affordable qualified health plan available through the Exchange, or the individual s employer, covering the individual; or The individual meets the requirements for any other such exemption from the individual responsibility requirement or penalty 37

Duties of the Exchange Report Data to the federal Secretary of the Treasury Name and tax ID who are exempt from mandate Name and tax ID who qualified for premium tax credits and reasons Employer did not provide minimum essential coverage Employer provided minimum coverage but it was deemed to be unaffordable to the employee or did not provide the required minimum actuarial value Name and tax ID of Each person who notifies he/she has changed employers Each person who ceases coverage during a plan year and the effective date of that cessation 38

Exchange Duties Select entities qualified to serve as Navigators. Navigators must be health insurance producers licensed and regulated by the state and Commissioner. The Exchange will award grants to enable Navigators to: Conduct public education activities to raise awareness Distribute fair and impartial information concerning enrollment in health plans and availability of premium tax credits Facilitate enrollment in qualified health plans Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange 39

Duties of the Exchange Review the rate of premium growth within and outside of the Exchange, and consider whether to continue limiting qualified employer status to small employers Credit the amount of any free choice voucher to the monthly premium of the plan NO LONGER APPLIES May not use funds for Exchange staff retreats, promotional giveaways, excessive executive compensation or promotion of federal or state legislative and regulatory modifications 40

Health Benefit Plan Certification Must have essential health benefits package Must at least have 1 qualified dental plan Rates and language approved by the commissioner Provide at least a bronze level of coverage unless certified as a qualified catastrophic plan (and only offered to individuals eligible for catastrophic coverage) 41

Health Benefit Plan Certification Offer at least one qualified health plan in the silver level and at least one plan in the gold level through each component of the Exchange in which the carrier participates ( component refers to the SHOP Exchange and the Exchange for individual coverage) Charge same premium inside and outside of the exchange for the same plan 42

The Massachusetts Connector 43

Massachusetts Exchange Massachusetts Health Insurance Connector established in 2006 Separate legal entity from the state Massachusetts Connector Authority 10 member board, with a spot specifically reserved for a member of the Massachusetts AHU Financed through premium surcharges on Commonwealth Care and Commonwealth choice products Individual Mandate Penalty assessed based on income and cost of the lowest-priced Commonwealth Care plan Employer Mandate Offer coverage or a fair share contribution 44

Massachusetts Exchange Connector open to: Individual Market, nongroup Small Group (2-50) Limited large group: all employers establish section 125 plans for employees not eligible/offered group coverage Four Product Tiers: Bronze- low premium, higher cost-sharing Silver- moderate premiums, moderate cost-sharing Gold- high premiums, low cost sharing Young Adult Plans (YAP)- special low-cost and low benefit coverage for those up to age 26 Merged small group and individual market pools Same risk pool inside and outside of connector for each carrier 45

The Utah Exchange 46

Utah Exchange Controlled by Office of Consumer Health Services, part of the Governor s Office of Economic Development State retains budgetary control and authority Connector serves as an informational portal Travelocity model Exchange open to: Small group (2-50) No individual market links individuals to carriers, producers and an insurance plan comparison chart Launching a large group pilot program this year Does not administer additional programs 47

Utah Exchange Exchange functions to allow small employers to offer defined contribution plans Employer contributes specific amount and employee free to choose plan for themselves Allow employees to pull money from multiple sources Individuals can carry plan with them if they change jobs No employer or individual mandate No set product levels or plan choices Small group risk pool combined for inside and outside of the exchange 48

Some Issues EMA takes precedence over state bills therefore, if state bills aren t in compliance Political atmosphere in Texas where will the Zerwas Bill end up? What are the possible scenarios for Texas? What s right for Texas? 49

Premium Justification Plans offering coverage through the exchange would have to submit premium increase justification through the exchange prior to implementation and the exchange could use this information and premium increase patterns to deny a carrier the ability to sell exchange-based policies. 50

Starting Now The legislation gives the Secretary of DHHS, in conjunction with the states, new authority to monitor health insurance carrier premium increases beginning in 2010 to prevent unreasonable increases and publicly disclose such information. Carriers that have a pattern of unreasonable increases may be barred from participating in the exchange. In addition, $250,000,000 is appropriated for state grants to increase their review and approval process of health insurance carrier premium rate increases. 51

Outside Markets ARE Allowed Individual and small group markets outside of the Exchange are specifically permitted. However, individual and small employer subsidies are only available for coverage purchased through the Exchange. 52