The Affordable Care Act (ACA) has had, from its inception, some strong mixed reviews. Considered by some to be the new “Patient’s Bill of Rights” the law seeks to expand access to care for millions of Americans by offering guaranteed issue insurance policies based on age, tobacco use, and community rating (location of residence) while making the cost for care of older Americans or those with pre‐existing conditions more affordable than ever before.
January of 2014 began the first enrollment period for Americans to purchase insurance within the Insurance Exchange or Marketplace. These households would begin receiving federal subsidies based on their percentage of the federal poverty level in which their household income falls up to a maximum of 400%. An example of this would be a family of four could earn as much as $94,000 annually while receiving help (federal subsidy dollars) to pay their monthly insurance premiums. Families at or below 250% of the federal poverty level could in fact qualify for a second available subsidy called the cost‐sharing subsidy in which families would receive assistance with their out of pocket costs such as deductibles and coinsurance percentages.
Along with the increased access to care and affordability factors, the Affordable Care Act instituted many new requirements on behalf of all employers in America. For those employers who employ 50 full‐time and/or full‐time equivalents (adding total hours of all part‐time workers in month and dividing by 120 for simple math), a health insurance plan deemed affordable (the expected premium an employee is asked to pay is at or below 9.5% of the employee’s earnings) and meets the minimal essential benefits set forth by the ACA must be offered to the eligible employees working 30 hours a week or more. If said employer fails to meet such requirements, the business will be penalized.
Knowing and understanding how the Affordable Care Act can and will affect one’s business and bottom line is the accepted task of our consultants and brokers. Our organization strives to lead the way in guidance and compliance for our employer group clients. We handle most clients with our own internal resources, but utilize the industry’s best vendors whenever necessary for areas like formal compliance testing and reporting.