ACA, SHOP, and Small Business Tax Credits

1. The Affordable Care Act
Information on SHOP, and
The Individual Marketplace
Presentation By:

2. What is the ACA?
• The Affordable Care Act (ACA) was enacted in March
2010.
– Biggest overhaul of the United States’ health care system
since Medicare and Medicaid in 1965
– Requires most individuals to obtain health care coverage
– Requires insurance companies and employers to provide
consumer protections related to health coverage, like covering
pre-existing conditions and not charging more for coverage
based on gender
– Employers of size groups now must offer coverage as well

3. What Are The Major Changes?
• Across-the-board changes to health insurance include:
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Eliminating annual and lifetime limits on essential health benefits
Prohibiting insurance companies from canceling coverage
Elimination of Pre-Existing Condition Limitation
Providing free preventive care
Requiring insurance companies to spend no more than 20 percent
of premiums on administrative, overhead and marketing costs and
requiring companies that exceed that number to issue refunds to
their customers
Waiting periods can no longer exceed 90 days
Most costs now accumulate towards out-of-pocket maximums
including copays (limits on deductibles and oop’s)
The individual mandate
Creation of Exchanges for both Individual Marketplace and
SHOP for small employers

4. Health Benefits Exchange
Public health insurance exchange required by
ACA
Primarily online marketplace for purchasing health
insurance (Qualified Health Plans)
Run by state or federal government with consumer
assistance from other entities
For individuals and small employers (generally up
to 50 employees)

5. Who Is Eligible For The Exchange?
Individuals
• Citizen or legal resident
• Not incarcerated
• Reside in state covered
by Exchange
Small Employers
(SHOP Exchanges)
• Qualify as a small
employer based on size
• Offer QHP coverage to
at least all FT employees
• Use SHOP in primary
office location or
employee’s primary
worksite location
Most individuals can shop for Exchange coverage
(even if eligible for employer coverage)

6. Individual Exchange Subsidy
Provide assistance to low-income individuals:
• 100%-400% of federal poverty level ($11,490-$45,960 individual
or $23,550-$94,200 for family of four)
• Not eligible for government programs that provide coverage
To help pay premiums or reduce cost-sharing
Not available to individuals who are:
• Eligible for affordable, minimum-value employer coverage or
• Enrolled in an employer plan
• Making less then $11,490 (Medicaid Eligible)

7. Shop Exchange
• Small Business Health Option Program (SHOP) – Exchange
for small employers
2014-15
• States can
limit size to
up to 50
employees
2016
• States must
increase size
to up to 100
employees
2017
• States can let
any size
employer
participate
Employers with over 50 FT employees not required
to offer health insurance until 2016

8. How To Count Full Time Employees?
• Full Time = 30 hours/week or 130 hours/month
• Part Time Counts in proportion to hours worked, so
two employees working 15 hours/week would count as
1 FT employee
• Counts are used to determine large employer vs small
and tax credit eligibility but you do not have to offer
insurance to the part-time employees
• Seasonal workers have their own sets of rules
(employers will need to use 6 month at minimum look
back)
• Other calculation is total hours of service for all
employees (no more then 2,080 for any 1 employee)
divided by 2,080 = total employees

9. Employer Responsibility
Small Employers
(fewer than 50
FT/FTE
employees)
Large
Employers (50+
FT/FTE
employees)
• No requirement to offer coverage
• Can get tax credits for providing
coverage
• Must offer coverage to FT employees and
dependents to avoid penalties
• Coverage must be affordable and provide
minimum value
• Penalties delayed until 2015
Employer penalties triggered if any full-time employee receives
subsidized coverage in an Exchange

10. Large Employer Plan Responsibility
Is
affordable
• Employee’s contribution for self-only
coverage does not exceed 9.5% of
income
• Safe harbors for what income and
premium amount to use
Provides
minimum
value
• Plan covers at least 60% of costs on
average
• MV calculator or design-based
checklists

11. Small Employer Requirements For Tax Credit
• Fewer the 25 FT Equivalent Employees
– Owners/partners, seasonal workers less then 120 days in
calendar year can be excluded
– Hours include PTO
• Average gross wages for employees needs to be less
then $50,000 per FTE
• Have to offer qualified plan through the SHOP which
covers all essential health benefits
• Employer must pay for at least 50% of the employee
only premium of the health insurance

12. Tax Credit Opportunity
• Credit is on a sliding scale based on wages and number
of employees
• Maximum amount is 50% of your employer
contribution
For Example:
If you have 9 employees and your employer contribution
of the total premium is $50,000 annually, you may be
eligible to get $25,000 back.
The smaller the business the bigger the credit. So if you
have more than 10 FTEs or if the average wage is more
than $25,000 (as adjusted for inflation beginning in
2014), the amount of the credit you receive will be less.

13. How To Apply
1. Talk with a licensed agent or broker about your
company to determine your options and eligibility
2. Purchase a qualified health plan from the SHOP
through a broker or agent
3. Fill out the SHOP Application
4. File Form 8941. http://www.irs.gov/uac/SmallBusiness-Health-Care-Tax-Credit-for-SmallEmployers

14. Contact Information and Questions?
Eric Stern
312-768-0634 (phone)
estern@sterninsgroup.com