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The fee for not having health insurance is increasing. If you don’t have health coverage
in 2016, you’ll risk having to pay 2% to 2.5% per person or more for the year.
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PPACA, ACA and Covered California
As licensed insurance agents we partner with Covered California to help reach and enroll the millions of Californians in need of health insurance coverage. With the upcoming changes in the health insurance market, individuals and small businesses need trusted advocates now more than ever.
Medicare and Medicare Advantage Plans
All plans offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare who enrol in the plan. Medicare health plans include all Medicare Advantage Plans, Medicare Cost Plans, Demonstration/Pilot Programs, and Programs..
Medicare Supplemental Plans
A Medicare supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn’t..
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How do I know if I am a small or large employer? Why does it matter?
An employer’s size is determined by the number of its employees. Employer benefits, opportunities and requirements are dependent upon the employer’s size and the applicable rules. Generally, an employer with 50 or more full-time employees or equivalents will be determined to be an applicable large employer.
- Two provisions of the Affordable Care Act apply only to applicable large employers (ALEs): ◦The employer shared responsibility provisions; and
- The employer information reporting provisions for offers of minimum essential coverage
- Whether an employer is an ALE is determined each calendar year, and generally depends on the average size of an employer’s workforce during the prior year. If an employer has fewer than 50 full-time employees, including full-time equivalent employees, on average during the prior year, the employer is not an ALE for the current calendar year. Therefore, the employer is not subject to the employer shared responsibility provisions or the employer information reporting provisions for the current year. Employers who are not ALEs may be eligible for the Small Business Health Care Tax Credit.
- If an employer has at least 50 full-time employees, including full-time equivalent employees, on average during the prior year, the employer is an ALE for the current calendar year, and is therefore subject to the employer shared responsibility provisions and the employer information reporting provisions.
- To determine its workforce size for a year an employer adds its total number of full-time employees for each month of the prior calendar year to the total number of full-time equivalent employees for each calendar month of the prior calendar year and divides that total number by 12.
Does my company qualify for the Small Business Tax Credit?
If you are a small employer, there is a tax credit that can put money in your pocket.
The small business health care tax credit benefits employers that:
- have fewer than 25 full-time equivalent employees
- pay an average wage of less than $50,000 a year
- pay at least half of employee health insurance premiums
To be eligible for this credit, you must have purchased coverage through the small business health options program, also known as the SHOP marketplace.
What are the Employer Shared Responsibility provisions?
For 2015 and after, employers employing at least a certain number of employees (generally 50 full-time employees or a combination of full-time and part-time employees that is equivalent to 50 full-time employees) will be subject to the Employer Shared Responsibility provisions under section 4980H of the Internal Revenue Code (added to the Code by the Affordable Care Act). As defined by the statute, a full-time employee is an individual employed on average at least 30 hours of service per week. An employer that meets the 50 full-time employee threshold is referred to as an applicable large employer.
Under the Employer Shared Responsibility provisions, if these employers do not offer affordable health coverage that provides a minimum level of coverage to their full-time employees (and their dependents), the employer may be subject to an Employer Shared Responsibility payment if at least one of its full-time employees receives a premium tax credit for purchasing individual coverage on one of the new Affordable Insurance Exchanges, also called a Health Insurance Marketplace (Marketplace).
When do the Employer Shared Responsibility provisions go into effect?
The Employer Shared Responsibility provisions generally are not effective until Jan. 1, 2015, meaning that no Employer Shared Responsibility payments will be assessed for 2014. See Notice 2013‑45. Employers will use information about the number of employees they employ and their hours of service during 2014 to determine whether they employ enough employees to be an applicable large employer for 2015.
Is more detailed information available about the Employer Shared Responsibility provisions?
Yes. Treasury and the IRS have issued final regulations on the Employer Shared Responsibility provisions. Treasury and the IRS also have issued proposed regulations on the related Information Reporting by Applicable Large Employers on Health Insurance Coverage Offered under Employer-Sponsored Plans.
Many of the services required when working with Covered California are similar to the traditional Agent role. The main differences are related to support for the affordability programs including premium assistance, cost-sharing reductions, and Medi-Cal. Certified Insurance Agents are expected to: