The answer to that question can change from month to month, but here is some insight into what is happening with the Affordable Care Act (ACA) right now.
The individual “shared responsibility” mandate, requiring individuals to purchase health coverage or pay a tax penalty, was effectively eliminated when the penalty was reduced to $0 as of January 1, 2019. The impact of the reduction, however, remains to be seen; while some employees who sought insurance coverage when there was a penalty in place may now choose to drop enrollment, most employees still want the coverage and will remain enrolled in employer health plans.
The employer “shared responsibility” mandate is still in effect, along with ACA reporting requirements. The IRS has been actively enforcing the mandate by sending out proposed penalty assessments to employers. Employers do have the opportunity to contest the proposed assessment, and in our experience, most employers who explain their disagreement to the IRS in a timely manner have had the proposed penalty assessments reduced or eliminated. Timely and accurate reporting is still the best defense against a proposed penalty assessment. Access our archive of common reporting issues to make sure you’re in compliance with ACA reporting.
The ACA’s benefit mandates — e.g., coverage of adult children, elimination of lifetime/annual limits on in-network benefits, free preventive care, etc. — remain in effect. There has been a flurry of recent litigation and regulatory action about the contraceptive coverage mandate (which is part of the free preventive care mandate) with respect to employers with religious or moral objections. The legal status of the contraceptive coverage mandate as it applies to such employers is murky at best and may remain so for some time.
For self-funded plans, the annual fees that plans must pay to fund the Patient Centered Outcomes Research Institute (PCORI) are coming to an end. If your company’s last plan year ended on or between October 1, 2018 and December 31, 2018, your last PCORI fee is due July 31, 2019 (this would include calendar year plans).
However, if your company’s plan year ends on or between January 1, 2019 and September 30, 2019, you have two more PCORI fees: one due by July 31, 2019 for the plan year that ended between January 1, 2018 and September 30, 2018, and your last PCORI fee, due by July 31, 2020 for the plan year ending between January 1, 2019 and September 30, 2019.
If your plan is fully insured, your carrier pays these fees.
In the fall of 2018, the IRS issued proposed regulations that would, among other changes, allow more employers to offer “standalone” HRAs that can reimburse individual health insurance premiums. This is a change to prior ACA guidance that largely prohibited such arrangements. We expect that the final regulations will be published in spring or summer of 2019, so stay tuned!
As the Affordable Care Act continues to evolve, we strive to bring you the latest changes and the potential impact on your business. Please contact us with more questions.
Sarah provides employer-focused guidance on human resource matters. With an emphasis on employee benefits and the Affordable Care Act, she distils the complexity of employment laws into understandable action items that meet a client’s business goals.
Sarah provides employer-focused guidance on human resource matters. With an emphasis on employee benefits and the Affordable Care Act, she distils the complexity of employment laws into understandable action items that meet a client’s business goals. During previous private practice experience, Sarah handled numerous complex benefit matters, including the transition of benefit plans in large corporate acquisitions, de-risking solutions in pension plans, contested health plan claims, DOL and IRS audits and the implementation of ACA-compliant health plan solutions. Sarah graduated from University of Wisconsin Law School, with a Bachelor of Arts degree from Grinnell College.
Like Wrightstown Community School District Superintendent Carla Buboltz, many civic leaders — as well as business owners and executives — are seeing their job descriptions evolve. Healthcare reform, along with escalating health insurance costs, are demanding more of their attention than ever before. A survey by the U.S. Chamber of Commerce says the effects of the Affordable Care Act (ACA) are now the top concern for organizations, edging out general uncertainty about the U.S. economy.
When the public exchanges opened in October 2013, the technical glitches and low enrollment were well publicized. Since then, both public and private exchanges have evolved significantly. The private alternatives that have entered the scene often have more advantages than their public counterparts.
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