The affordable Care Act was signed into law on March 23, 2010 and upheld by the Supreme Court in June 2012. These reform measures will have wide-spread impacts to most businesses and individuals. In this presentation, we discuss the tax consequences, small business health care credits, fees, and provide a summary of the Affordable Care Act and the status of reform.
Understanding Health Care Reform: A Dose of Accounting Medecine
1. Understanding
PPACA: A Dose of
Accounting Medicine
February 13, 2014 Jay Hutto, CPA/ABV/CFF, CVA
Partner
2. Health Care Update
• Business reporting and penalties have been
delayed until January 1, 2015 for employers
with 100 or more full-time equivalent (FTE)
employees that offer insurance to 70 percent
of workers for 2015 and 95 percent thereafter
• Under new rules, employers with 50 to 99 FTE
employees will be given until 2016 to offer
health care coverage before being subject to
shared-responsibility payments
• Employers with fewer than 50 FTE employees
do not have to offer coverage but will need to
report on workers and health care insurance
coverage in 2015
3. Health Care Overview
• Transition relief offered if employer doesn’t
reduce the size of its workforce or the
overall hours of service of its employees
unless the reductions are for a bona fide
business reason
• The individual mandate penalty was
effective as of January 1, 2014 via the Form
1040
• For the Health Care Marketplace
(Exchanges), there are new storefronts,
kiosks, call centers, and navigators assisting
individuals with obtaining coverage
4. Health Care Review
• Florida is one of the majority of states
that do not have a separate exchange so
individuals and small businesses will go to
www.healthcare.gov for information
• Medicare Part D - Subsidy is reduced for
those with incomes above $170,000
(couples)/ $85,000 (single)
• Medical device manufacturers and
importers must pay a 2.3% tax imposed
on the sale of any medical device
5. Status Of Reform
• Florida has not participated in
Medicaid expansion
• Medical malpractice reform has not
been addressed
• Medical Loss Ratio (MLR) Insurance
Rebates are paid if the health
insurance issuer does not spend at
least 80% or 85% (large plans) of
premium dollars on medical care
starting back in 2012
6. Fees
• PCORI fees for self-insured and health reimbursement accounts (HRAs) are
paid on Form 720 and will be included in health insurance premiums for
policies with policy years ending after September 30, 2012.
– The fee is $1 per covered person ($2 for plan years after September 30,
2013).
• Health Insurance Industry fee – fund premium subsidies and cost-sharing
reductions for exchange participants (2% to 2.5% of premium)
• Reinsurance fee – stabilize premiums in exchange due to high cost claimants
($63 per member per year)
• Risk Adjustment fee – spread the financial risk in the exchange
• Marketplace User fee – fund a self-sustaining exchange going forward
(equates to 3.5% of premiums)
7. Summary Of PPACA – 2010 And 2011
• Small business tax credit since 2010
• Dependent coverage up to 26 and no discrimination for pre-existing
conditions
• Over-the-counter drugs (OTCD) are no longer treated as allowable for
FSA, HSA, HRA and MSA
• Increased tax on non-qualifying HSA and MSA distributions to 20%
8. Small Business Health Care Credit
• Available for certain businesses offering health coverage
• For uniform non-elective contributions if business has no more than 25 full-time
employees (FTE) with an average annual wage of no more than $50,000
• The maximum credit is the lesser of:
– Actual insurance paid by the employer, or
– What the employer would have paid had the employee enrolled in
coverage with a small business benchmark premium (Rev. Rul. 2010-13)
• Multiplied by the percentages below:
– 2010 - 2013: 35%
– 2014 and beyond: 50% (SHOP and 2 yr max)
• The credit is refundable for nonprofits but subject
to the sequestration reduction
9. Small Business Health Care Credit
• Credit phase-out is the sum of:
– The credit x (# of FTE – 10)/15, and
– The credit x (average annual wage –
$25,000)/$25,000
• Employer contribution must be at least
50% of the premiums paid for employee
only coverage
• Tax-exempt employers can qualify
• Any unused credit is carried forward
• Qualified premiums are those paid in a
uniform percentage for all employees
10. Summary Of 2012
• Reporting of cost of employer-sponsored
health coverage
(250 or more W-2s)
• Summary of Benefits and
Coverage must be provided
• Medical loss rebates
• Electronic medical records
(EMR)
11. How will I be affected in 2013?
What does this mean for taxpayers?
• Additional Medicare Tax:
– For single taxpayer employees earning
over $200,000 (married taxpayers filing
jointly $250,000)
– Pay an additional 0.9% Medicare tax over
the 1.45% tax currently applicable
• Tax applies to wages and self-employment
income in excess of threshold
• Thresholds not affected by inflation
• Penalty for being married
• No employer match on 0.9% tax
12. Tax on Earnings - Example
John
• Single taxpayer
• Self-employed
• $500,000
Excess of Earnings Threshold
$500,000
- $200,000
$300,000
0.9% surtax would
apply to $300,000
=
$2,700 Additional Tax
13. Medicare Surtax
3.8% of the lesser of 1. Net Investment Income OR
2. The excess (if any) of:
- “Modified Adjusted Gross
Income” (MAGI)
- “Threshold Amount”
($200,000 single, $250,000
married)
14. Net Investment Income
• Net Investment Income Categories:
1. Passive Income
2. Net Gain from Dispositions of Entity
Interest
3. Investment Income
• Trust threshold for 3.8% tax is $11,000
• Investment fees can reduce net
investment income
15. 3.8% Medicare Surtax – Example 1
John
• Single taxpayer
• $100,000 of salary
• $50,000 net investment
income
• 3.8% surtax would NOT
apply
• MAGI is less than
threshold
MAGI
$150,000
16. 3.8% Medicare Surtax – Example 2
Tom & Sandy
• Married, filing jointly
• $400,000 salary income
• $50,000 net investment
income
Excess of Earnings Threshold
$400,000
- $250,000
$150,000
• 3.8% surtax would apply to
$50,000 =
$1,900 Additional Tax
AND
• 0.9% surtax would
apply to $150,000 =
$1,350 Additional Tax
17. Summary Of 2013
• Medicare payroll tax
• Unearned income surtax
• Medical expense deduction – exceeds
10% of AGI
• New FSA contribution limits of $2,500
per year
• Medical device manufacturer excise tax
• Notice regarding exchange was delayed
from March 1, 2013 to October 1, 2013
18. Impact For 2014 And After
• Health insurance exchanges
• Penalties if no health insurance post 2013 for
individual mandates
• Penalties if large employer and no health
insurance for full-time workers post 2014 for
employer mandates
• Reporting requirements post 2014 also for
employers
• Pay or Play penalty for 2015:
- Depends on whether coverage is offered
- Penalty as high as $2,000 - $3,000 per employee
19. Impact For 2014 And After
• Waiting period – 90 days
• Increase access to Medicaid in
certain states based on % of
poverty level
• Pre-existing coverage
conditions and no limits
• Cadillac Health Plan
– 40% Excise Tax (2018)
20. Group Health Plans for 2014
• Plans through 2013 – Old rules allowed for a company health
insurance plan to provide reimbursement to the employee for
health insurance as long as it was under an accountable plan
and not discriminatory. Otherwise, the reimbursement must
be included in wages.
• Plans for 2014 and future years – There is no pre-tax
reimbursement for individual insurance plan under the ACA.
Employers must have a group health insurance in place to be
tax-free to the employee.
21. Integrated Health Plan
• An HRA is an arrangement that is funded solely by an employer and that
reimburses an employee for medical care expenses incurred by the
employee, or his spouse, dependents, and any children who, as of the
end of the taxable year, have not attained age 27, up to a maximum dollar
amount for a coverage period.
• The ACA provides that an employer-sponsored HRA cannot be integrated
with individual market coverage.
• A group health plan used to purchase coverage on the individual market is
not integrated and will fail to comply with the annual dollar limit prohibition
because an employer payment plan is considered to impose an annual limit
up to the cost of the individual market coverage purchased through the
arrangement and an employer payment plan cannot be integrated with any
individual health insurance policy purchased under the arrangement.
22. Integrated Health Plan (continued)
An HRA is integrated with another group health plan for purposes of the annual dollar limit
prohibition and the preventive services requirements if (1) the employer offers a group
health plan (other than the HRA) to the employee that does not consist solely of excepted
benefits; (2) the employee receiving the HRA is actually enrolled in a group health plan (other
than the HRA) that does not consist solely of excepted benefits, regardless of whether the
employer sponsors the plan (non-HRA group coverage); (3) the HRA is available only to
employees who are enrolled in non-HRA group coverage, regardless of whether the employer
sponsors the non-HRA group coverage (for example, the HRA may be offered only to
employees who do not enroll in the employer’s group health plan but are enrolled in other
non-HRA group coverage, such as a plan maintained by the employer of the employee’s
spouse); (4) the HRA is limited to reimbursement of one or more of the following—co-payments,
co-insurance, deductibles, and premiums under the non-HRA group coverage, as
well as medical care that does not constitute essential health benefits; and (5) under the
terms of the HRA, an employee (or former employee) is permitted to permanently opt out of
and waive future reimbursements from the HRA at least annually and, upon termination of
employment, either the remaining amounts in the HRA are forfeited or the employee is
permitted to permanently opt out of and waive future reimbursements from the HRA. This
opt-out feature is required because the benefits provided by the HRA generally will constitute
minimum essential coverage and will therefore preclude the individual from claiming a
premium tax credit. If minimum value is required, item (4) above is not required.
23. Year Provision
2013 • Flexible spending arrangement the maximum drops to $2,500 per plan
year
• New “HI” (hospital insurance tax) on high-income taxpayers (.9% tax
on wages in excess of threshold amount)
• New 3.8% Medicare tax on investment income
• Medical care itemized deduction threshold increases to 10% of AGI
starting in 2013 but remains at 7.5% for those age 65 and older until
2016
• Notification to employees by October 1, 2013
2014
2015
• States will be required to provide federally approved insurance plans
or default to federal marketplace
• Premium assistance credit
• Excise tax on uninsured individuals on Form 1040
• Excise tax on applicable large employers
• Insurer reporting requirements
2017 • Increase in medical deduction threshold for taxpayers age 65 and over
2018 • Excise tax on high-cost employer plans
24. Individual Health Insurance Plans
The insurance price is determined by only
four criteria:
1. Age – Older people will not pay more than
three times the amount younger people
pay
2. Premium Rating Area – High cost areas will
have more expensive insurance
3. Number of family members covered
4. Tobacco Use Observation – Young adults
and men may see an increase in premiums
25. Essential Health Benefits
Generally, the following ten benefits must be
provided with no annual or lifetime limits:
1. Ambulatory services
2. Emergency services
3. Hospitalization
4. Maternity and Newborn care
5. Mental Health and substance abuse
6. Prescription drugs
7. Rehabilitative services
8. Laboratory services
9. Pediatric services including oral and vision care
10. Preventative and wellness services and chronic disease management
26. Individual Mandate
• The requirements
• The penalty
• Premium Assistance Credit
• Note: Not like a normal
credit. The money goes
directly to the insurance
company.
• Exceptions to the penalty
• Define Minimum Essential
Coverage
27. Individual Mandate (continued)
• Small Business Health Options Program
(SHOP) Marketplace for small
businesses with up to 100 employees
• Must purchase insurance through the
SHOP Marketplace to be eligible for
small business health care tax credit for
tax years 2014 and beyond
• Online SHOP Marketplace has been
delayed by one year requiring an agent,
broker or insurance company to get
coverage
28. Penalty For Remaining Uninsured
• Minimum essential coverage is
required to avoid the penalty
• Insurance bought through an
exchange will meet the minimum
essential requirements
• The penalty imposed on the
uninsured under 18 is one-half of that
imposed on adults
• A taxpayer is responsible for providing
coverage if they are able to claim a
personal exemption for the person
29. Penalty For Remaining Uninsured (continued)
• Exemptions from penalties
• The penalty is the greater of a Percentage of the Taxpayer’s Income
or a Flat Dollar Amount. The per adult annual penalty is phased in:
2014: Greater of 1% of applicable income* or $95
2015: Greater of 2% of applicable income or $325
2016: Greater of 2.5% of applicable income or $695
2017 and beyond: Indexed for inflation from $695
* Applicable Income is the excess of household income over the
threshold filing amount.
30. Penalty Cap
• The Flat Dollar amount is capped at 300%
of the adult penalty (without regard to
dependents)
• For 2016, the cap is 2.5% of household
income or $2,085 (3 x $695)
• The penalty cannot exceed the cost of a
bronze level plan
• The penalty applies to any period essential
coverage is not maintained (monthly)
• The penalty is to be assessed through the
IRC (no liens or levies allowed)
31. Premium Assistance Credit
• Tax credit available for those with incomes up to 400% of the federal
poverty level — currently: $46,680 (single), $95,400 (family of four)
• Not eligible for Medicaid or affordable employer insurance
• These people will have to obtain insurance through an exchange
32. Premium Assistance Credit
• Based on income level estimated before the
enrollment period
• Eligibility is determined month-by-month
• Cannot be eligible to be claimed as a
dependent
• The taxpayer is only eligible for the credit if
the employer coverage is unaffordable
• The employer plan is unaffordable if the
employee must pay (self-coverage only)
premiums that exceed 9.5% of household
income
33. Substantiation of Income in the Marketplace
• Include taxpayer, spouse, children who live with you, unmarried
partner, any dependent, and anyone else under 21 who you take care
of and lives with you
• Estimate your income for 2014 including wages, net income from self-employment
or business, unemployment, Social Security, alimony and
other items included in household income
• Household income is MAGI plus any tax-exempt Social Security, tax-exempt
interest and tax-exempt foreign income
• Any adjustment necessary based on actual income will be reflected on
tax return
34. Premium Assistance Credit Household Income
• Household Income is AGI plus:
– Tax exempt income, foreign
earned income and housing
excluded under Section 911,
and excluded social security
benefits
• Also include the AGI of
dependents who are required
to file a return
35. Premium Assistance Credit Household Income
• Taxpayer buys insurance at the exchange and the exchange makes advance
payments on behalf of taxpayer after the exchange determines eligibility.
At tax time, taxpayer reconciles the actual credit for the tax year computed
on his 1040 with the amount of advance payments made on his behalf. If
the credit exceeds the amount of advance payments, he gets a refund or
the excess amount is applied to other taxes owed. If the advance payments
exceed the credit, he owes but the amount owed is limited.
• Repayment of excess - The limitation is between $600 - $2,500 ($300 -
$1,250 single)
• The credit is the lesser of the premiums for the month or a calculation
based on your household income (Excess of “adjusted monthly premium”
for a “benchmark plan” (silver plan) over 1/12 of the product of household
income and the “applicable percentage”)
36. Premium Assistance Credit
Applicable Percentage
Household Income as % of Percentage of
Federal Poverty Level (FPL) Household Income
Less than 133% 2.0 – 2.0%
133% to 150% 3.0 – 4.0%
150% to 200% 4.0 – 6.3%
200% to 250% 6.3 – 8.05%
250% to 300% 8.05 – 9.50%
300% to 400% 9.50 – 9.50%
Over 400% N/A
Credit is benchmark plan premium over percentage.
37. Cost Sharing Reduction Subsidy
• The Cost Sharing Reduction Subsidy is available to those that
qualify with income not exceeding 250% of the FPL
• This subsidy allows for a reduction in the amount of out-of-pocket
expense they could incur
• Applies to deductibles and co-pays
• Must buy insurance through an Exchange to qualify
38. Exemption From Individual Mandate Penalty
1. Religious reasons
2. Member of health care sharing ministry
3. Indian tribes
4. No tax return filing requirement
5. Short coverage gap (went without coverage for less than three
consecutive months). The coverage gap only applies to the first gap.
6. Unaffordable coverage options – Minimum amount you must pay for
premiums is more than 8% of your adjusted household income.
7. Incarceration
8. Not a U.S. citizen, a U.S. national nor an alien lawfully present in the U.S.
39. Exemption From Penalty – 8% Rule
• If premiums exceed 8% of Adjusted
Household Income, the taxpayer is
exempted from penalties
• Adjusted Household Income is AGI plus:
– Tax exempt income, foreign earned
income and housing excluded under
Section 911
• Subtotal is called Household Income
• Add back premiums paid through a salary
reduction plan (e.g. Cafeteria plan)
• Total is Adjusted Household Income
40. Exemption From Penalty – 8% Rule (continued)
• Also include the AGI of dependents
who are required to file a return
• Do not add in non-taxed Social
Security benefits as we do with the
Premium Assistance Credit
• If an individual can only buy through
an Exchange the cost is based on
Bronze level premiums
41. Employer Mandate
• Effective Date - Effective January 1, 2015 for large
employers with 100 or more full-time equivalent
(FTE) employees and effective January 1, 2016 for
employers with 50 to 99 FTE employees
• Large Employer Play or Pay – A large employer is
one that had at least 50 FTE (average at least 30
hours per week or 130 hours per month) during
the previous calendar year
• Part-time workers – In determining whether a
company is a large employer the employer will
take the aggregate number of hours of part-time
employees ÷ 120 and add this to the number of
FTEs
42. Employer Mandate
• Large Employer (100+ FTE) – Business reporting and penalties delayed
until January 1, 2015. No penalties if offer insurance to 70 percent of
workers for 2015 and 95 percent of workers in 2016 and future years.
• Large Employer (50-99 FTE) – Shared-responsibility payments delayed
until January 1, 2016
• All Employers – Beginning in 2015, must report on workers and health
care insurance coverage.
• Transition Relief – Available only if employer doesn’t reduce the size of its
workforce or the overall hours of service of its employees unless the
reductions are for a bona fide business reason.
• Reimbursement of Individual Policies – Not available in 2014 unless part
of an integrated Health Reimbursement Arrangement (HRA)
43. Employer Mandate (continued)
• An exemption applies where the
workforce exceeds 50 FTE for no more
than 120 days, and the employees in
excess of 50 were seasonal
• Include all hours which the employee
is paid including holidays, vacation,
sick pay, etc.
• Coverage must begin within 90 days
of employment for full-time
employees
44. Employer Mandate Periods
• If an employee works at least 30 hours per week during the
measurement period, then they are treated as full-time during the
stability period regardless of how many hours they actually work.
• Standard Measurement Period - A three to six month period where an
employer can look back. The employer can choose the length of time.
The length of time needs to be consistent with employees in the
following categories: salaried and hourly employees, employees of
different entities, employees in different states, and collectively
bargained and non-collectively bargained employees.
45. Employer Mandate Periods
• Stability period - A period of time where
employees determined to be full-time in the
measurement period must be offered insurance.
• Must be for at least six consecutive calendar
months and no shorter than the measurement
period.
• Initial measurement period can be used by an
employer that is between three to twelve months.
• An administrative period is available for new
employees in addition to the initial measurement
period of up to 90 days before the stability period
starts.
46. Employer Mandate Potential Penalties
1. “No coverage penalty” - An employer does not offer minimum essential
insurance to at least 95% (70% for 2015) of its full-time employees (in
2015 this includes dependents) and at least one employee qualifies for the
Premium Assistance Credit or Cost Sharing Reduction. The penalty is
calculated on a monthly basis and there is a 30 FTE threshold before the
penalty is applied.
2. “Lacking Minimum Value or Unaffordable Penalty” - An employer does
offer minimum essential coverage to at least 95% (70% for 2015) of the
full-time, but at least one employee qualifies for the Premium Assistance
Credit or Cost Sharing Reduction. The penalty is assessed monthly with a
maximum of the above penalty.
47. Affordable Coverage
• Affordable coverage is determined to exist
if an employee’s share of the premium for
employer provided coverage would cost
the employee no more than 9.5% of that
employee’s annual household income
• If an employer offers multiple healthcare
coverage options, the affordability test
applies to the lowest-cost option available
to the employee that also meets the
minimum value requirement
48. Affordable Coverage
Employers can take advantage of one of the following safe harbors to
determine if the coverage is affordable:
a. Form W-2 Determination Method - Self-Only coverage does not exceed
9.5% of the W-2 as reported in Box 1. This is determined at the end of
the year on an employee-by-employee basis. The employee’s required
contribution must remain consistent throughout the year.
b. Federal Poverty Line Method - The cost does not exceed 9.5% of the
Federal Poverty Line.
c. Rate of Pay Method - The cost does not exceed 9.5% of 130 hours x
employee’s rate of pay as of the first day of the coverage period. Use
monthly salary for salaried employees.
49. Minimum Value
Methods for an employer to determine
whether the coverage it offers provides
minimum value:
a. A minimum value calculator will be made
available by the IRS and the Department
of Health and Human Services (HHS).
Employers can input information and
determine if the plan provides minimum
value by covering at least 60% of the
expected costs.
b. Ask the insurance agent or company.
50. Employer Mandate Issues
• Testing Periods - The employer can use any consecutive six month period
in the prior year to measure the number of employees for the applicable
year.
• Aggregation rules - Controlled and Affiliated group rules apply so you
can’t bypass with multiple companies.
• Benefits provided through an association - The determination of large
employer status is made at the employer level.
• The IRS will send a notice and demand for payment of the Employer
Shared Responsibility payment due and it is not deductible.
51. Employer Mandate Tax Planning
• Measurement Period
• Keep Employees Below 30
Hours Per Week
• Use Independent Contractors
• Health Insurance Coverages
• Thomson Reuters EBIA Health
Care Reform Tool for
independent information
52. Cadillac Plans Excise Tax
• 40% tax imposed on high cost employer-sponsored
and self-insured plans beginning
in 2018
• The tax is levied on insurance companies and
plan administrators
• It is applied to annual insurance premiums
for those under 55 that exceed $10,200 for
individuals/$27,500 for families
• For ages 55 and above, the threshold is
$11,850 for individuals/$30,950 for families
• There are age, gender and other
adjustments
53. Obamacare Strategy Steps
• Notice to Employees required on October 1, 2013
(http://www.dol.gov/ebsa/faqs/faq-noticeofcoverageoptions.html)
• Get an accurate head count to determine if the employer mandate is applicable
• Consider whether you will offer coverage
• Decide where to shop for health insurance (SHOP, Private, Marketplace, Direct,
or Agents)
• Explore a Self-Funded Plan (avoid community ratings)
• Consider Skinny Plan Strategy (doesn’t meet ACA minimum value test) to limit
the penalty to $3,000 per-employee only for employees who actually claims a
subsidy on exchange. The benefit to the employee is that they may qualify for
subsidy and avoid individual mandate penalty.
• Claim your Tax Credit if you have 25 or fewer FTEs and pay average wages
below $50,000 and pay at least half the cost of employee only health insurance
(SHOP and 2 year limitation for 2014 and future years).
54. American Tax Relief Act (ATRA)
• Agreement on legislation to address
the “fiscal cliff”
• 2012: Ordinary-income rates
permanent, ranging from 10% to 35%
• 2013: Taxable income exceeding the
following amounts are subject to the
top marginal tax rate of 39.6%:
– $400,000 (Single)
– $425,000 (Heads of Household)
– $450,000 (Married Filing Jointly)
56. American Tax Relief Act (ATRA)
• 2013: Return of limits on certain itemized
deductions. Thresholds at:
– $250,000 (Single)
– $275,000 (Heads of Household)
– $300,000 (Married Filing Jointly)
• Long-term capital gains
– 2012 rates of 0% and 15%
• Taxable income exceeding thresholds face
long-term gains rate of 20%. Thresholds at:
– $400,000 (Single)
– $425,000 (Heads of Household)
– $450,000 (Married Filing Jointly)
57. Return Of Phase-Outs – Exemptions
• Phase out of personal exemptions starting after 2012
• Reduced 2% for each $2,500 or part thereof Adjusted Gross
Income in excess of new thresholds:
Joint $300,000
Head of Household $275,000
Single $250,000
Married filing separate $150,000
• Can be completely phased out
• Adjusted for inflation after 2013
58. Return Of Phase-Outs – Itemized Deductions
• Limitation of itemized deductions starting after 2012
• 3% of excess of adjusted gross income in excess of new thresholds:
Joint $300,000
Head of Household $275,000
Single $250,000
Married filing separate $150,000
• Adjusted for inflation after 2013
• Reduction not to exceed 80% of Schedule A amount
• Medical, investment interest, casualty and gambling losses not
reduced by limitation
59. American Tax Relief Act (ATRA)
• Alternative Minimum Tax (AMT) relief
retroactive to January 1, 2012
• Tax break extensions:
– Deduction for state and local sales tax in
lieu of state and local income tax
– Child- and education-related credits and
deductions
– Taxpayers age 70 ½ or older can make
direct tax-free rollover from an IRA to
charity
– Certain home and energy-related breaks
60. American Tax Relief Act (ATRA) (cont.)
• Estate Taxes
– Top estate tax rate, 40%
– “Portability” election permanent
– Exemption annually inflated,
adjusted $5 million