ACA healthcare reform.

ACA Healthcare Reform

The Affordable Care Act (the ACA) was passed and made the law in 2010.  While extensive, this bill was intended to make our healthcare system better. However, with 2,700 pages and more than 41 amendments, the law is complex.  Thus, many employers still need help understanding the law.  We can help.

At JS Benefits Group our experts are ACA healthcare reform trained and certified. Additionally, they work hard to stay on top of new industry laws.  As employee benefit specialists, we have a deep understanding of how the law directly affects employers. Thus, we work with businesses to help them comply with the ACA, all while staying productive and profitable.

Need assistance with the ACA?  Please contact us by filling out the form below.  Then we will contact you.

Need help with other HR Compliance?  Visit our HR Consulting page for assistance.

Highlights of the Affordable Care Act (ACA)

Our experts have listed some of the highlights of the ACA.  While this list explains how the law may affect you, we suggest you contact us for more assistance.

EMPLOYERS: For 2025 – Employers who have more than 50 full-time equivalent employees must offer those employees benefits that pay for 60% of the minimum essential benefits. Accordingly, if you are in non-compliance, you will incur a penalty of $2,900 per year multiplied by the number of full-time employees, and excludes the first 30 employees. Additionally, the penalty is increased each year by the growth in insurance premiums. However, note you may also incur a penalty for each full-time employee who receives a premium tax credit in the Health Insurance Marketplace (Exchange).

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 for 2019 and beyond. While some states have established their own individual mandates, Pennsylvania is not one of them, so you won’t face a tax penalty for not being covered.  If you live in any of these states, you may be required to have health insurance or face a fine/tax penalty.

There is no longer a pre-existing condition clause.  In other words, 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.

Insurance companies are required to offer renewals that are the same as new business rates.

The waiting period for employer benefits should not exceed 90 days.

You may be subject to a tax penalty if you do not comply with the ACA.  Thus, to be in full compliance with the law, your insurance policy must cover at least 60% of the costs of the following essential benefits.

-Ambulatory patient services
-Emergency services
-Hospitalization
-Maternity and newborn care
-Prescription Drugs
-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

Business and individuals may be eligible for tax credits under the ACA.  Thus, the credits are 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.  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.

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    Disclaimer.  The information on this page is general information about the ACA.  Accordingly, it has been prepared so you can learn more about us. Thus, it is not meant to be tax or legal advice of any kind.