When
does enrollment start?
October 1st, 2013
When
does Obamacare take effect?
January 1st, 2014
To
Whom does the ObamaCare Law apply?
Everyone.
What
does Obamacare's "Employer Mandate" require?
The mandate requires employers with 50 or
more employees (or “full-time equivalents”—we’ll get to that next) to offer
coverage or pay a $2,000 fine per employee, not counting the first 30
employees, starting in 2014. Employers
with an average of at least 50 or more full-time equivalent employees on
business days during preceding calendar year. For 2014 only, employers
can elect a 6 month averaging period during 2013 to determine if they meet this
threshold. Full-time under Obamacare is 30 hours per week, not 40.
Part-time workers are aggregated. Seasonal workers are excluded (if
they work up to but less than 120 days per year). Work performed by
employees outside the United States is not counted. All "related
entities" are counted together and form a SINGLE EMPLOYER
What
does the "Individual Mandate" mean?
The law’s
individual mandate will require nearly all legal U.S. residents to obtain
health insurance whether they want it or not, with certain exceptions.
Is
anyone exempt from Obamacare?
Yes.
Exemptions will be granted for financial hardship, religious objections,
American Indians, those without coverage for less than three months,
undocumented immigrants, incarcerated individuals, those for whom the lowest
cost plan option exceeds 8% of an individual’s income, and those with incomes
below the tax filing threshold (in 2009 the threshold for taxpayers under age
65 was $9,350 for singles and $18,700 for couples).
What
are the penalties if you’re not exempt?
Those individuals without coverage
are supposed to pay a tax penalty. Those without coverage pay a tax penalty of
the greater of $695 per year up to a maximum of three times that amount
($2,085) per family or 2.5% of household income. The penalty will be phased-in
according to the following schedule: $95 in 2014, $325 in 2015, and $695 in
2016 for the flat fee or 1.0% of taxable income in 2014, 2.0% of taxable income
in 2015, and 2.5% of taxable income in 2016. Beginning after 2016, the penalty
will be increased annually by the cost-of-living adjustment.
How
are employees counted toward the 50 employee threshold?
The law counts the hours worked, not
the number of full-time employees you have. If a company’s employees worked an
equivalent of 50 full-time employees' hours, the requirement to offer
affordable health care insurance is triggered.
We
have less than 50 full time employees - do we have to comply?
No, but there are parts of the law
which apply to you. Companies who employ fewer than 50 full time
employees are exempt from being required to provide affordable health
insurance. Smaller employers may opt to offer health insurance at a reasonable
cost by participating in a Small Business Healthcare exchange. All
employers regardless of number of employees are supposed to act as a "source
of information for employees. As of March 1, 2014, all employers covered by the
federal Fair Labor Standards Act are required to inform employees about the
existence of the exchange in their state and how employees can access it. The
Department of Labor has indicated that it will provide guidance to employers
and a template for providing such information.
Employers who do offer affordable
health plans to employees are required to begin reporting the value of
employees' health benefits on W-2 forms. This requirement takes effect for
large employers (those who file 250 or more W-2 forms) for tax year 2012 W-2
forms, usually filed in January 2013. The IRS has indicated the reporting is
optional for employers who file fewer than 250 W-2s) until they file their tax
year 2013 forms.
Will
my employer have to pay all of my insurance premiums?
No, but employers with over 50
employees must pay at least 60% of covered health care costs. The
insurance also must meet minimum standards set forth (the minimum benefits of a
"bronze" plan bought on the Obamacare health insurance exchange) and cannot
exceed 9.5% of family income for the employee.
What
if my company doesn't offer me health insurance?
Employees will be affected by health
care reform in several ways, including a requirement that, effective January 1,
2014, all individuals must have health care coverage or pay a tax. Smart
employers will develop a communication strategy in advance of 2014, so they are
not inundated with employee questions later.
Individuals who are not offered affordable health insurance may qualify to
receive a tax credit to purchase health insurance through an exchange if they
have no other insurance and their income is below 400% of the federal poverty
level, which is currently $11,170 for a single person and $23,050 for a family
of four.
Premium subsidies will be available
for individuals and families with incomes between 133 percent and 400 percent
of the poverty level, or $14,404 to $43,320 for individuals and $29,326 to
$88,200 for a family of four.
The subsidies will be on a sliding scale. For example, a family of four earning
150% of the poverty level, or $33,075 a year, will have to pay 4% of its
income, or $1,323, on premiums. A family with an income of 400 % of the poverty
level will have to pay 9.5 percent, or $8,379.
My
company doesn't offer health insurance and I can't afford it. Will I be
fined?
Beginning in 2014, the federal
government will impose new fines on citizens and legal residents who do not
obtain government-approved insurance. Those without insurance will pay a
tax that is the greater of a flat fee, or a percentage of family income. The
flat fee will be phased in over several years. In 2014, the penalty will
be $95 per adult in an uninsured household, increasing to $325 in 2015, then to
$695 in 2016, after which it will increase annually in line with consumer
inflation. For uninsured children, the fine will be half the amount
applied to uninsured adults. If greater, households pay 1 percent of
their income in 2014, 2 percent in 2015, and 2.5 percent in 2016 and thereafter
in lieu of the flat per person fee.
How
will the fines or penalties be enforced? Will I go to jail?
The Department of Labor has updated
its audit procedures to include a review of group health plans’ compliance with
PPACA, in addition to many other benefit laws (including new HIPAA rules, rules
regarding wellness programs and other ERISA requirements).
I'm
a small business and will offer affordable insurance under Obamacare - will we
get a tax credit?
(In 2014, companies with less than
25 employees will qualify for a credit that could be as great as 50% of
premiums if you arrange insurance via one of the Small Business Health Options
Programs, or SHOP Exchanges). The tax break you get will depend on a couple of
variables: the number of employees you have and their average salary.
However, this tax break won’t be offered to sole proprietorship’s. That
factor may encourage you to incorporate or become an LLC. Small Businesses
can apply for tax breaks of up to 35% (25% for non-profits) of the cost of
their employees premiums if they have fewer than 25 full-time employees. To
qualify businesses must pay for at least 50 percent of their employees premiums
and their workers average annual wages can't be more than $50k. By 2014 the tax
credit amount is increased to 50% (35% for non-profit).
What
about pre-existing conditions after Obamacare takes effect?
Under the Affordable Care Act,
people with pre-existing health conditions cannot be denied health insurance as
of 2014, when the law takes full effect. No more “pre-existing conditions”. At
all. People will be charged the same regardless of their medical history.
Can't
my company just fire me or make me work less than 30 hours per week to get
around this?
YES as long they don’t break any
employment termination laws.
Can
I keep the insurance I have now?
A business owner may keep the same
group plan that is in place, but it has to meet the Affordable Act requirements.
As an employee you will have a choice to elect your employers insurance that is
offered or elect the State Exchange coverage and take a tax credit.
What
will happen to annual spending caps?
There will no longer be spending
caps after Obamacare takes effect.
Is
there a limit on how high of an annual deductible insurers can charge?
Obamacare places a limit on how high
the annual deductible insurers can charge their customers.