As your broker, we monitor the status of the ACA on your behalf to keep you informed, and as part of our commitment to reduce your risk and costs associated with your benefit programs, while enhancing employee health and well-being.
Keep up with the moving target that is the Affordable Care Act
Boyce & Associates will assist you with the following ACA compliance:
More On the ACA
Employers: Businesses with 50+ full time equivalent employees must offer a Minimum Essential Coverage (MEC) plan otherwise they could incur a penalty of $2,700 (in 2021) times the number of full time employees (minus the first 30 employees). A $4,060 (in 2021) penalty can also occur if an employee goes to the exchange and gets a subsidy (tax premium credit). Penalties can increase each year by the growth in insurance premiums.
Individuals: Currently, most individuals are not subject to a tax penalty and are not required to purchase health insurance. The ACA “shared responsibility payment” and the individual mandate has been eliminated by the Trump Administration for 2019 and beyond. However, some states have established their own individual mandates, so you still may be subject to your specific state tax penalty, if any. Check with a Boyce & Associates expert for more information.
Medical underwriting used to determine risk and insurance premiums, particularly in the individual insurance market prior to the ACA. Under rules of the ACA, most medical underwriting is no longer allowed, although some premiums may vary based on age and tobacco use.
-Insurance companies can not increase rates or deny coverage because of a pre-existing condition.
-Your dependents can remain on you policy until they turn 26 years old.
-Insurance companies can not consider gender when setting rates.
-Employer renewals must be based on the same rates as new business.
-The waiting period for employer benefits should not exceed 90 days.
Employer paid benefits must comply with the “Essential Benefits” of ACA. Specifically, employers must cover 60% of the costs of the following essential benefits or they may incur a penalty. Individual policies from the marketplace also contain these benefits.
-Ambulatory patient services
-Maternity and newborn care
-Mental health and Substance —Abuse disorder services
-Rehabilitative and habilitative services and devices
-Pediatric services, including oral and vision care
-Preventive and wellness services, and chronic disease management
Boyce & Associates offers qualifying MEC plans and other solutions that meet the requirements of the ACA.
Individuals and Small Businesses may be eligible for a tax credit under ACA healthcare reform laws. Thus, the credit is applied as a discount on your monthly insurance premium. Accordingly, to see if you are eligible for a tax credit, please use the Subsidy Calculator provided by the Health Insurance Marketplace. Or, if you are a business, use the Small Business Tax Credit Calculator provided by the Health Insurance Marketplace. In any case, both businesses and individuals must purchase benefits through the Health Insurance Marketplace to secure their tax credit. However, note that you must purchase benefits through the Health Insurance Marketplace to secure your premium discount.
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