Benefits, Cost-Sharing (Reductions), Employer Mandate, Health Care Reform, Individual Mandate, Taxes, Fees & Penalties

Current Status of Your Favorite ACA Provisions

There have been so many proposed bills, Executive Orders and rumors that you might be confused about what the current status is of various Affordable Care Act (ACA) provisions. Here is a handy chart.  It is current as of 1-17-18, but there are still changes on the horizon for some provisions.

Update January 22, 2018: Today the Senate passed (and the President is expected to sign) a Continuing  Resolution that  delays the effective date of the Cadillac Tax and the medical device tax for two years and delays the Health Insurer Tax (HIT) for one year.

ACA Provision
Current Status
Proposed Changes?
Individual mandate Congressional Tax reform bill (enacted and & signed by President Trump) includes a REPEAL of the individual mandate (reduces penalty to zero) effective as of Jan.1, 2019. NOTE that the individual mandate remains in effect for 2018, and also has been in effect since 1-1-2014.
Employer mandate Still in effect.   IRS began sending penalty assessment notices (226J letters) in November, for 2015 penalties. Letters for 2016 penalties are expected in 2018. Separate House bill proposed in December would put a moratorium on employer mandate penalties from 2015-2018. (Not enacted as of 1-17-18)
-Cost-sharing reductions (CSRs) to individuals; &

-Federal government reimbursements of CSRs to insurance companies

Still in effect:   CSRs to low-income individuals in Exchange health insurance.

 

NOT in effect:   CSR reimbursements to insurance companies. (Per 10-12-17 Announcements by White House & HHS.)

– CSRs for low-income individuals: No proposed changes.

– CSR payments to insurers: Possible (but unlikely) vote in January on bipartisan bill to restore them. (Was originally possible vote in December.)

Information Reporting (1094-C & 1095-Cs) Still required. 2018 due dates are: March 2 for 1095-Cs to employees; Feb. 28 for 1095-C paper filings with IRS; April 2 for 1095-C electronic filings with IRS. Due date to furnish 1095-C’s and –B’s to employees was January 31, but IRS delayed it 30 days to March 2 in Notice 2018-06. Still due to IRS by Feb. 28 for paper filings.
Taxes:
Health Insurance Tax (HIT tax) Was suspended for 2017 & was reinstated for 2018.

The Continuing Resolution enacted in the Senate 1-22-18 suspends the HIT tax for 2019.

The HIT tax IS still in effect for 2018.

Insurers generally add an additional 3-5% for this tax.

The Continuing Resolution was passed by House & Senate and is expected to be signed by the President.

PCORI fee Still in effect. Amount is $2.39 /enrollee for plan years ending after 9/30/17 & before 10/1/18. None.

Amount is indexed and has increased each year for inflation.

Transitional reinsurance fee No longer in effect.   Was effective 2014-2016; payments in 2017 were for 2016 year. None
Cadillac tax Not effective until 2022.  Was scheduled to go into effect in 2020, but the Continuing Resolution enacted in the Senate 1-22-18 delays the Cadillac tax 2 years until 2022. Employer advocacy groups are still working to get Congress to repeal the Cadillac tax before it becomes effective.  This tax will impose an annual 40% excise tax on plans with annual premiums exceeding $10,800 for individuals or $29,500 for a family.
Medical device tax Suspended for 2018 and 2019. Prior years: This was in effect from 2013-15.  It was suspended in 2016-17.  It was reinstated Jan. 1, 2018, but the Continuing Resolution enacted in the Senate 1-22-18 suspends this tax for 2018 & 2019.
ACA Provision
Current Status
Proposed Changes?
Insurance Market Reforms
No pre-existing conditions exclusions This prohibition still applies.
Small group & individual policies must cover “essential health benefits” (EHBs) Still in effect.
No annual or lifetime dollar limits on EHBs Still in effect.
Other
Association Plans 1-Employers cannot form an association for the purpose of offering insurance.

2-Employers in association plans must have a “commonality of interest” that includes industry and geography.

3-Sole proprietors are not employers.

DOL proposed regulations 1-5-2018 to expand use of Association plans:

1) CAN form association to buy insurance;

2) Employers’ commonality can be either industry or geography (e.g., same state);

3) Sole proprietors who are “working owners” will be considered employers and can enroll in Association plans.

Marketplace/Exchange Notice Still required. Employers are required to give this notice to employees within 14 days after hire. None. Most  current Notice expires 5-31-2020 and is at https://www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/model-notice-for-employers-who-do-not-offer-a-health-plan.pdf
Notice from Marketplace/exchange to employer, when an employee qualifies for a subsidy Marketplace should send these notices to employers. None. Note that this notice is not the same as the Marketplace/exchange notice the employer must provide to employees, nor is it the same as the 226J Letters the IRS sends to employers whom the IRS believes owe an Employer Shared Responsibility penalty.

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