loophole

EMPLOYER REIMBURSEMENT OF INDIVIDUAL HEALTHPLAN PREMIUMS REMAINS A BANNED PRACTICE UNDER ACA

While this was more of a hot topic when the full monty of healthcare reform was implemented back in 2014, some employers perhaps unaware of the turmoil in the individual marketplace still ask about reimbursing employees for individual health insurance policies.

The IRS, the Department of Labor and Health and Human Services have all released several directives and guidelines that pretty clearly prohibit the practice. The most recent was issued in December 2015 (n-15-17).

“Who’s Exempt from the ACA Individual Mandate to Have Health Insurance?”

During several recent meetings this question was posed a number of times by curious employees and a few their employers. It seems many folks are still unclear about the exemptions. Many also were unclear on the amount of the penalties.

Below is a summary on exemptions and individual penatlies published recently in a Kaiser Health News article addressing these FAQs:

Who’s Exempt from the Requirement to Have Insurance?

 The list of possible exemptions is a long one. You may be eligible for an exemption if:
• Your income is below the federal income tax filing threshold.
• The lowest priced available plan costs more than 8.05 percent of your income.
• Your income is less than 138 percent of the federal poverty level (about $16,105 for 2015 coverage for an individual) and your state did not expand Medicaid coverage to adults at this income level as permitted under the health law.
• You experienced one of several hardships, including eviction, bankruptcy or domestic violence.
• You are a member of an Indian tribe, health care sharing ministry or a religious group that objects to insurance.
• You are in jail.
• You are an immigrant who is not in the country legally.

Many also asked about the penalties. More from the KHN article:

Penalties: How Much?

For 2016, the penalty will be the greater of $695 or 2.5 percent of income.
Although much of the discussion is often about the flat dollar penalty – $325 in 2015 — many people will be paying substantially more than that. A single person earning more than $26,550 would not qualify for the $325 penalty ($26,550 – $10,300 = $16,250 x 2 percent = $325.) So the 2 percent penalty is the standard that will apply in most cases, say experts. For example, for a single person whose modified adjusted gross income is $35,000, the penalty would be $494 ($35,000 – $10,300 = $24,700 x 2 percent = $494. That same individual would have paid $249 in penalties for 2014.

The penalty is capped at the national average price for a bronze plan, which the IRS announced was $2,484 for an individual and $12,240 for a family of five or more in 2015.

To read about other ObamaCare FAQ’s go to FAQ: What Are The Penalties For Not Getting Insurance?

Trick or Treat…which do you prefer in your healthcare?

For a little Halloween fun, I’ve compiled a few articles that have to do with healthcare tricks and treats. All related to Obamacare, or the Affordable Healthcare Act, of course…

Trick: Gov. Kasich’s four Obamacare tricks by Washington Examiner

Treat: Ebola: Obamacare’s ultimate pre-existing condition by The Fiscal Times

Trick: Government close to closing loophole that lets employers offer substandard insurance by The Washington Post

Stripped Down Plans without Any Hospital Benefits?  “Not so fast my friend!”

In last week’s Did You Know Series on Obamacare we pointed out a major glitch or loophole in the healthcare law that actually may allow large employers to avoid health-law penalties by offering stripped down plans that have no hospitalization coverage. Well, in the words of colorful former college football coach and current ESPN College Game Day host Lee Corso “Not so fast my friend!”

STOP

While there’s no official word yet, it sure sounds like this loophole was a screw up, is now on the administration’s radar screen and is likely to be fixed soon. We’ll continue to keep you posted on developments as they unfold. For more about this, here’s the link to a recent article on this topic from Kaiser health News that also appeared in The Washington Post.

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