10 things employers should know about the Affordable Care Act


The Affordable Care Act, often referred to as “Obamacare”, has changed the healthcare landscape for the uninsured in the US.  Many, even well-versed health insurance buyers, find the law confusing.  There are ten facts employers with part-time or non-benefits-eligible employees may find useful regarding the individual exchange:

  1. INDIVIDUAL MANDATE: As of 2014, everyone (with limited exceptions) in the United States is legally required to sign up for qualifying health insurance
  2. EMPLOYER MANDATE: Businesses with 50 or more full-time equivalent employees (FTE) are required to provide health insurance to at least 95% of their full-time employees and dependents up to age 26, or pay a fee per employee.  The mandate does not require employers to cover their part-time employees or contractors
  3. FINE FOR NO COVERAGE: Individuals who do not have coverage for 2016 will pay the higher of these two amounts: 2.5% of yearly household income OR $695 per person ($347.50 per child under 18) unless you were denied Medicaid, your state did not expand Medicaid (Medicaid Gap), and/or you do not meet the requirements for a premium subsidy via the Marketplace.
  4. SUBSIDY-ELIGIBILITY: Individuals making up to $47,080 or a family of four with a household income up to $97,000 may qualify for subsidies
  5. ENROLLMENT: 12.7 million Americans are estimated to have enrolled in the Marketplace during 2016 open enrollment
  6. SUBSIDY-GRANTED: 85% of people who selected a marketplace plan for 2015 received financial assistance
  7. AVERAGE SUBSIDY: The average Advanced Premium Tax Credit (APTC) for those enrollees who qualified for the financial assistance in 2015 was $263 per month
  8. DIFFERENCES BETWEEN STATES: Plans, premiums, and subsidies vary by state
  9. SHOPPING EACH YEAR: Individuals are encouraged to shop for health insurance each year to ensure they enroll in the most appropriate plan for their current circumstances.  Additionally, not all plans auto-renew
  10. 2016 OPEN vs SPECIAL ENROLLMENT: The open enrollment period for 2016 coverage ran from November 1, 2015 – January 31, 2016.  For the rest of the year, only individuals with special qualifying circumstances will be able to enroll

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