Top Three Things Small Businesses Should Know About the Affordable Care Act

Meredith Olafson

January 28, 2013

12:53 PM EST


Note: This post was originally published on blog. To see the original post, please click here.

The Affordable Care Act will help small businesses by lowering premium cost growth and increasing access to quality, affordable health insurance. Depending on whether you’re a small employer or a larger employer, different provisions of the Affordable Care Act may apply to you as described below.                                           

1.  Businesses with Fewer than 25 Employees- Small Business Tax Credits

The Affordable Care Act does not require that businesses provide health insurance, but it offers tax credits for eligible small businesses that choose to provide insurance to their employees. To qualify for a small business tax credit of up to 35 percent (up to 25 percent for non-profits), you must have:

Fewer than 25 full-time equivalent employees

Pay average annual wages below $50,000

Contribute 50 percent or more toward employee health insurance premiums

Beginning in 2014, this tax credit goes up to 50 percent (35 percent for non-profits) and is available to qualified small businesses who participate in the Small Business Health Options Program (SHOP) Exchanges.

2.   Businesses with 50 or Fewer Employees- Affordable Insurance Marketplaces

The Affordable Care Act does not require that businesses provide health insurance, but beginning in 2014, small businesses with generally 50 or fewer employees will be able to purchase coverage through SHOP, competitive marketplaces where small employers can go to find health coverage from a selection of providers. The SHOP Marketplaces and Individual Marketplaces for those who are self-employed open on January 1, 2014. Open enrollment begins on October 1, 2013. SHOP will offer small businesses increased purchasing power similar to that of large businesses.

3.  Businesses with 50 or More Employees- Employer Shared Responsibility Provisions

Under the Affordable Care Act, the Federal government, State governments, insurers, employers, and individuals share the responsibility to reform and improve the availability, quality, and affordability of health insurance coverage in the United States. Employers are not required to provide coverage to their employees under the Affordable Care Act.   However, beginning in 2014, businesses with 50 or more full-time employees (or full-time equivalents) that do not offer affordable health insurance that provides a minimum level of coverage to substantially all of their full-time employees (and their dependents) may be subject to an employer shared responsibility payment if at least one of their full-time employees receives a premium tax credit to purchase coverage in an insurance Marketplace.  A full-time employee is generally one who is employed an average of 30 or more hours per week.

If you meet or are close to this threshold level of full-time employees, it’s important to understand how these rules may apply to you and how the employer shared responsibility payments could be triggered.   For more guidance on the employer shared responsibility payments, refer to this FAQ from the IRS.

Meredith Olafson is Senior Policy Advisor for the U.S. Small Business Administration where she oversees the agency’s education and outreach efforts around health care and the Affordable Care Act.

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Changes ahead due to Patient Protection and Affordable Care Act

Posted: 01/29/2013 Last Updated: 23 hours and 9 minutes ago

By: Kristi L. Nelson, Scripps Howard News Service

The far-reaching Patient Protection and Affordable Care Act will mean myriad changes to the way health care is accessed and delivered in this country — and how it affects you could depend on your age, income, health and current insurance status, among other things.

Here’s a look at what changes could be most important to you:

If you don’t already have health insurance: You’re going to have to get coverage next year or likely face a financial penalty that starts at 1 percent of your income (or $95, whichever is more) in 2014, and rises to 2.5 percent of your income by 2016. You could be exempt if you’re American Indian, if health insurance goes against your religious beliefs or if you can show financial hardship. The good news is, thanks to other provisions of the Affordable Care Act, it should be easier and more affordable for people who are uninsured now to get insurance.  

If you are a senior citizen: You should already be seeing some benefits of the reform, including not having to pay for preventive services through Medicare and getting help paying for prescription drugs once you hit the “doughnut hole” in Medicare Part D coverage. By 2020, seniors should be paying only 25 percent of those drugs’ costs. On the other hand, some Medicare benefits are being cut — things like hearing aids, glasses and memberships to fitness centers. And you may find that some illnesses and surgeries that Medicare once would have considered appropriate for an overnight hospital stay are now considered outpatient, which means you may be billed for individual costs that once were part of the hospital “package.” If you do spend time in the hospital, you may notice your providers doing more aggressive follow-up once you are released, to try to prevent you from having to go back into the hospital.  

If you are a young adult: If you’re younger than 27 and not offered insurance through your job, you can remain on your parents’ health insurance policy until your 27th birthday. If that’s not an option for you and you’re young, in good health and don’t expect to need much medical care, you can purchase a “catastrophic” health insurance plan with low premiums but a high deductible — coverage doesn’t kick in until you’ve paid for $6,000 in care yourself.  

If you’re wealthy: You may pay a higher Medicare tax this year. Those with an annual income of more than $200,000 for one person or $250,000 for couples will pay a 2.35 percent Medicare tax, up from 1.45 percent. In five years, the government will start taxing high-dollar, high-coverage employer-sponsored “Cadillac” health plans with a 40 percent excise tax.  

If you’re low income: It’s possible that you’ll qualify for Medicaid in the future even if your income is too high to qualify now. The ACA, in its original form, intended to make it so that all Americans who earned less than 133 percent of the federal poverty line (about $14,000 for a single person, or $29,000 for a family of four) would be eligible to enroll in Medicaid, giving the states 100 percent of the extra money needed for the first three years and gradually requiring the states to fund 10 percent of the expansion in the future. But the U.S. Supreme Court ruled that the federal government could not force states to expand their Medicaid programs just to continue getting funds they were already receiving.  

If you’re middle class: If you’re self-employed or work for a smaller company, you should be able to buy insurance on the health exchange. People who make four times the federal poverty level (about $44,000 for an individual or $88,000 for a family of four) or less may be eligible for subsidies from the federal government, which would be paid to the insurance companies and appear on your bill as a discount. The idea is that people would not pay more than 10 percent of their income toward health insurance (and the lower the income, the less the percentage).  

If you’re an undocumented immigrant: There are no provisions in the ACA for you at all. You wouldn’t be eligible for Medicaid or to buy insurance on the exchange. You can still purchase a policy through a broker, if you can afford one, or pay yourself for care at clinics, hospital emergency rooms and other providers.  

If you typically claim unreimbursed medical expenses on your tax return: You may not get to do so now — they must be 10 percent of your income, up from 7.5 percent in the past.  

If you have a health insurance plan through your large employer: You’re not likely to see many changes right now. Your premiums will likely stay flat or, if the insurance company your plan is through has been making large profits, may drop as the government now regulates what percentage of profit must be funneled back into providing quality or lowering premiums.

Right now, only small businesses and individuals who don’t have insurance through their jobs can buy insurance on the exchange

— but that does mean if you lose your job, you should have an easier time finding affordable health insurance coverage for you and your family.

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