The New Healthcare Law and Its Impact on Small Business

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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 Affordable Healthcare Act January 1, 2014 Mandatory Coverage for all individuals Employer Shared Responsibility begins Insurance Marketplaces launch 4

5 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. 5

6 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 6

7 Self-Employed Business Owners You are required to have health insurance by January 1, 2014 or you will have to pay an Individual Shared Responsibility Payment unless certain hardship and other exceptions apply. 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 7

8 Individuals/Self-Employed Business Owners: Tax Credits Purchase Insurance on the Individual Marketplace Income between 100% and 400% of federal poverty level Not eligible for Government Sponsored Program 8

9 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 Part-time Employee: an employee who is employed on average 15 hours a week (or 65 hours of service in a given month) 9

10 Businesses with 10 or Fewer Employees Generally no requirement to provide health insurance* Self- Employed But if you choose to provide insurance: Might be qualified for the Small Business Health Care Tax Credit 50 or more 25 to 49 Full-Time Equivalent Employees 11 to or Fewer Must have average annual salaries below $50,000 Businesses with 10 or fewer fulltime 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 10

11 Businesses with 11 to 24 Employees 50 or more Self- Employed Full-Time Equivalent Employees 10 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 To calculate average annual salaries, divide the number of your full-time equivalent employees by the total amount you pay out for salaries 25 to to 24 * Members of controlled/common ownership groups might be required to offer insurance 11

12 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 one of the new small business health insurance Marketplaces known as SHOP 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 12

13 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 13

14 Small Business Health Care Tax Credit The credit can be used for no more than 5 years The maximum credit will be available to employers with 10 or fewer full-time equivalent employees and average annual wages of less than $25,000 The credit completely phases out for firms with 25 or more full-time equivalent employees and average annual salaries above $50,000 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 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 receive premium tax credit for that month This payment can t exceed payment in Scenario # 1 17

18 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.) NO payment required even if the restaurant does not offer insurance to its full-time employees 35 actual full-time employees 50 part-time employees Offer health insurance coverage to all 35 employees but it is unaffordable One of your employees obtains a tax credit PAYMENT OWED for each employee obtaining the tax credit NOTE: this payment is not owed for credits obtained to cover dependents insurance 50 actual full-time attorneys PAYMENT OWED if the firm does not provide the minimum health insurance coverage Payment would be 2k per year per employee above 30, so in this case 20 employees, which is $40,000 The SRP is not tax deductible, but insurance coverage is usually deductible

19 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

20 Employer Shared Responsibility Provisions Additional Key Points There is no payment owed for non-coverage of part-time employees Employer must contribute at least 50% of the premium 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 full-time employees must also offer coverage to the dependents of those fulltime employees who are children under age 26 (coverage need not be offered to spouses) 20

21 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

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

23 More Access to Affordable Care: Health Insurance Marketplaces SHOP = Small Business Health Options Program Part of the new Health Insurance Marketplaces (sometimes called Exchanges ) Provides Essential Health Benefits -- same level of benefits & services that would be covered in most employer-based plans - Most states will use small group health insurance products as benchmark for core package of Essential Health Benefits Helps employers better predict and control health insurance expenses Will pool risks for small groups and reduce administrative complexity Works with new insurance reforms and tax credits to lower barriers to offering health insurance that small employers face 23

24 More Access to Affordable Care: Health Insurance Marketplaces Through a SHOP, smaller employers can: Offer employees a choice of qualified health plans from different private health insurers Decide which qualified health plans to make available to employees - SHOP can allow employers to offer a single plan Decide how much to contribute toward premium costs (must be 50% of total if employer wants to obtain tax credit) Collect employee share of premiums through payroll deduction - Premium contributions can be made with pre-tax dollars Get one monthly bill, make one monthly payment to SHOP Take advantage of Small Business Health Care Tax Credits 24

25 Enrolling in SHOP: Who, When & How Which small businesses are eligible? Businesses with generally 50 or fewer employees (some states may allow businesses with up to 100 employees) In 2016, employers with up to 100 employees will be eligible to participate Once a business enrolls, it can grow and still remain in SHOP 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 25

26 Minimum Essential Coverage - Options Platinum 90% Gold 80% Silver 70% Bronze 60% Catastrophic Free prevention and several primary care visits 26

27 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 27

28 Qualifying Health Insurance Coverage Medicare Part A Medicaid Employer Sponsored (including COBRA and retiree) Some Veterans coverage TRICARE Purchased on the Individual Marketplace (HHS website) 28

29 Individual Shared Responsibility: Exemptions Coverage is unaffordable (more than 9.5% 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 29

30 General Rules and Changes to Health Coverage Beginning in 2014, all individuals are required to have health insurance OR pay a SRP at the end of the year through their income taxes OR qualify for an exemption Insurance companies may not price discriminate on gender Many preventative services (mammograms and heart disease screenings) are now part of mandatory coverage Parents may keep children up to 26 years old on their insurance plans (kicked off the plan on the child s 26 th birthday) Insurance companies must justify increasing premiums more than 10%, and may be subject to approval Starting in 2013 the annual tax deductible cap on Flexible Spending Accounts is $2,500 30

31 Other Information Employers that offer health insurance must report the cost on employees W-2 forms No taxes are levied on employees for the health insurance costs it is simply put on their W-2 forms to show them the value employers are providing Small Employer Exception: the W-2 reporting requirement does not apply to employers who issued fewer than 250 Form W-2s in the prior calendar year Healthcare plans that are not in-line with the ACA but were established before September 23, 2010 are grandfathered in UNLESS the coverage becomes drastically out of line with standards Starting in 2014, incentives to provide workplace health and wellness programs will be in place (e.g., weight loss, fitness, and smoking cessation programs) 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 gets ZERO dollars Businesses are required to pay for insurance for low income full-time workers or make shared responsibility payment

33 Small Business Websites

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