10 things employers should know about the Affordable Care Act

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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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