Tag Archive for: ACA

ACA is Here to Stay

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The Affordable Care Act, also known as Obamacare, was one of the biggest healthcare overhauls in recent history. It aimed to provide affordable health insurance coverage for all Americans. After several failed attempts to repeal the act, it seems that ACA is here to stay. 

In this blog post, we will take a closer look at what this means for American taxpayers and businesses.

What Is the Affordable Care Act (ACA)?

The Affordable Care Act was passed in 2010 and since then it has been under constant threat of repeal. The law required all Americans to have health insurance coverage or face a tax penalty. It also expanded Medicaid coverage and provided subsidies to help people afford private health insurance plans.

In 2017, Republican lawmakers attempted to repeal the Affordable Care Act but were unsuccessful. This led to a lot of uncertainty about the future of the law. However, it now seems that ACA is here to stay, at least for the time being.

What Does this Mean for American Taxpayers?

For starters, it means that the tax credits and subsidies that help people afford their health insurance coverage are still in place. It also means that the Medicaid expansion, which has provided coverage for millions of low-income Americans, is still in effect.

Taxpayers will continue to be responsible for funding the ACA. This includes the subsidies that help people pay for health insurance and the Medicaid expansion. The good news is that, because the ACA is no longer being repealed, there will be no need for major changes to the tax code.

What Does this Mean for Businesses?

The Affordable Care Act requires businesses with 50 or more employees to provide health insurance coverage for their workers. This requirement is still in place, so businesses will need to continue to comply with it.

There may be some changes to the way this is done in the future. For example, the government may provide more subsidies to help businesses cover the cost of health insurance. 

Overall, the news that ACA is here to stay is good news for American taxpayers and businesses. It provides stability and certainty in an uncertain time.

Final Thoughts

The Affordable Care Act has provided many benefits, including increased access to healthcare, lower costs for prescription drugs, and free preventive care services. These benefits are worth billions of dollars each year and help to improve the lives of millions of Americans.

There is still some uncertainty about the future of the Affordable Care Act, but for now, it seems that the law is here to stay. This is good news for American taxpayers and businesses who have benefited from the law’s many provisions.

If you’re interested in learning more about the ACA, read our articles on the advantages of the ACA and  what business owners should know about ACA benefits. 

Why SBMA is the Gold Standard of Customer Service

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At SBMA, we serve employers who want to offer their employees affordable benefits. We simplify the complexity of providing those benefits and ensure compliance with the Affordable Care Act. 

We’re in the business of providing health care to everyday people, ensuring peace of mind through trust and transparency. 

We pride ourselves on our personal service, speed of  implementation, and innovative approach to providing benefits coverage.


Today, we’d like to chat a bit more about the exceptional service we provide and why SBMA is, therefore, the gold standard of customer service for minimum essential coverage (MEC) insurance providers.

(Hint: Our one-stop-shop benefits portal plays a large role in our successful customer service efforts!)

Let’s dive in.

What Problem Do We Solve?

With us, you get peace of mind, security, and the insurance your employees want at a price everyone can afford. Providing affordable benefits to your employees not only ensures you employees remain motivated and excited about work, but they also ensure you remain in compliance with the ACA.

What Makes SBMA Benefits Different?

Our customer service is what sets us apart. We work when you work. Our carrier partners have given us exclusive offerings to complement our medical plans, giving you the best possible price. Our quick execution and advanced approach to benefit coverage is second to none.

How SBMA Supports the Onboarding and Offboarding Processes

At SBMA, we support businesses beyond providing affordable minimum essential coverage (MEC). We are proud to support the employee onboarding process so your human resources (HR) teams have more time to focus on the daily tasks that keep your business running.

This is why we offer a complete insurance solution that covers:

 

  • Implementation
  • Enrollment
  • Administration, and
  • Reporting

Our benefits professionals are fully equipped to support onboarding and offboarding procedures to eliminate the hassle for businesses.

How? Using our benefits portal.

Our Benefits Portal

Employee benefits administration can be a pain for any HR department. At SBMA, we aim to simplify the process by giving you access to everything you need in one place.

Our one-stop-shop portal is proprietary and unlike any other. Our portal grants you access to all of the tools necessary to support a new hire (from beginning to end).

We eliminate the headache of unnecessary paperwork with benefits management portal access. You can:

  • Make plan changes
  • Order ID cards
  • Check a claim status online
  • Track onboarding and offboarding
  • And more

Resources are only a click away.

Besides creating a seamless onboarding process with our all-in-one portal, we also provide video tutorials for our partners. These resources provide instructions that assist navigation through the portal.

Read on to view our enrollment portal walkthrough.

Which Industries are Most Susceptible to ACA Penalties from the IRS?

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While all organizations are susceptible to receiving IRS penalties, some industries are particularly vulnerable. These industries include home healthcare, staffing, restaurant, and construction industries. 

Why are these industries under fire from the IRS? Let’s take a look.

These Industries Typically Have a High Number of Hourly Workers

Home healthcare, staffing, restaurant, and construction industries have a high percentage of hourly workers with varying schedules. This can make it difficult for employers to determine which employees are ACA full-time and require an offer of health coverage.

HR is often a non-centralized function, making it challenging to gather the data necessary for compliance.

High Staff Turnover Rates

These industries are often associated with a high employee turnover rate. This can make it difficult for employers to track employees and their benefits. If an employer is unable to track the benefits in an efficient manner, that could be putting their company in a position to receive hefty fines.

SBMA identified this paint point among our clientele and decided to create a one-stop shop portal for all of your benefits needs; from onboarding to offboarding, we have you covered.

Workforces that Disproportionately Decline Health Coverage

Home healthcare, staffing, restaurant, and construction industries generally employ workforces that are more likely to decline offers of health coverage benefits. Employers may struggle to track declinations and face ACA penalties from the IRS. 

One way to encourage your employees to enroll in health coverage is to remind them of the importance of maintaining your health and how a simple annual doctor’s office visit can make a positive impact on their well-being. 

How Can Organizations Ensure They Are Complying with ACA Requirements?

Employers can ensure they are ACA compliant by determining the accurate full-time and part-time status of employees under ACA. Employers may experience significant ramifications for misclassifying employees. 

Additionally, employers should familiarize themselves with their requirements under the ACA’s Employer Mandate. For example, employers with 50 or more full-time employees, or ALEs, must:

  • “Offer Minimum Essential Coverage (MEC) to at least 95% of their full-time employees (and their dependents) whereby such coverage meets Minimum Value (MV); and 
  • Ensure that the coverage for the full-time employee is affordable based on one of the IRS-approved methods for calculating affordability.”

For more information, read on for the full article from the ACA Times.

Infographic for "Article Review Which Industries are Most Susceptible to ACA Penalties from the IRS?"

These Industries are Most at Risk for ACA Penalties From the IRS

The home healthcare, staffing, restaurant, and construction industries are under fire from the IRS for failing to comply with the ACA. Organizations within these industries have been shocked to receive ACA penalty notices from the IRS that are in the millions of dollars.

Of course, all types of organizations – hospitality, manufacturing municipal governments, non-profits, and other industries – are receiving IRS penalty notices too. However, the four industries mentioned above seem to be getting more than their fair share.

Here’s why these industries are so susceptible to receiving ACA penalties:

  • HR is often a non-centralized function, making it challenging to gather the data necessary for compliance
  • They have a high percentage of hourly workers with varying schedules, making it difficult to determine who is ACA full-time and requires an offer of health coverage
  • They employ workforces that disproportionately decline offers of health coverage benefits, creating a heavier employer burden in tracking declinations
  • Employees come and go during the year with high staff turnover rates, increasing the employer’s burden to track all such employees
  • Per diem piece work and multiple rates of pay complicate the determination of pay rates and affordability
  • Reliance on payroll systems (or other software programs) that collate data and submit Forms 1094-C and 1095-C often result in a failure to let you know when the data used is inaccurate, which will trigger ACA penalties

Determining the accurate full-time and part-time status of employees under the ACA is arguably the first, and most important, step for ACA compliance. There are real ramifications for inaccurately classifying employees. 

Under the ACA’s Employer Mandate, ALEs, or employers with 50 or more full-time employees and full-time equivalent employees to:

  • Offer Minimum Essential Coverage (MEC) to at least 95% of their full-time employees (and their dependents) whereby such coverage meets Minimum Value (MV); and 
  • Ensure that the coverage for the full-time employee is affordable based on one of the IRS-approved methods for calculating affordability

ALEs that fail to comply with these requirements can be subject to Internal Revenue Code (IRC) Section 4980H penalties.

For example, let’s look at an employer that improperly classifies an employee as not full-time and does not make an offer of insurance. That employee goes to a government marketplace exchange to purchase health insurance and receives a Premium Tax Credit (PTC) that helps subsidize the cost of the health insurance purchased on the exchange. This can trigger the issuance of an IRS Letter 226J penalty notice under IRC 4980H. 

The penalty assessment will be applied to every full-time employee working for that employer during the course of the tax year, not just the employee obtaining the PTC. For the 2022 tax year, that penalty could be as high as $275,000 for every 100 employees.

The first step in the full-time status evaluation is determining which measurement method is best for your organization.

For organizations made up primarily of variable-hour employees, you will want to implement the Look-Back Measurement Method. If your workforce has mostly full-time employees and non-varying schedules, the Monthly Measurement Method will be best.

The most expedient step for employers is to get your ACA Vitals score. This will help determine your risk of receiving IRS penalties by analyzing your unique workforce composition.

Such a review can reap dividends by helping employers avoid significant ACA penalties from the IRS, particularly if those organizations have not been filing ACA-required information annually with the IRS. These organizations should file this information as soon as possible to avoid receiving an IRS penalty notice and to minimize potential penalties. 

The IRS is currently issuing warning notices to employers identified as having failed to file and furnish Forms 1094-C and 1095-C for the 2019 tax year via Letter 5699. If you have received one, contact us to have the penalty reduced or eliminated. We’ve helped our clients prevent over $1 billion in ACA penalty assessments.

If you are part of the home healthcare, personnel staffing, restaurant and construction industries, or any industry that relies on a significant mix of full-time and part-time employees, you are at serious risk of being penalized for not complying with the ACA.

We see daily how the IRS is enhancing its methods for identifying employers that are not complying with the ACA and sending them penalty notices. 

We regularly see the surprise and shock expressed by organizations that receive these penalty notices, many of them containing significant penalty assessments. 

We also see how these organizations could have avoided these penalty assessments by receiving help from experts that understand ACA and IRS regulatory requirements and know how to successfully meet those regulatory requirements.

The Individual Mandate: What Employers Need to Know

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The California Individual Mandate, originally signed into law in 2019, was a response to the federal individual mandate being struck down by the Trump administration.

 

This state law requires all California residents obtain Minimum Essential Coverage (MEC) for a minimum of nine months, or they may face a tax penalty unless exempt.

 

Let’s discuss the individual mandate and what employers need to know, starting with a shorthand list of exemptions.

MEC Exemptions

According to the State of California Franchise Tax Board, some exemptions include:

 

  • An individual’s income is below the state tax filing threshold
  • A coverage gap consists of three consecutive months or less
  • Coverage is not affordable based on the income reporting in your state income tax return
  • If the cost of the lowest plan, whether marketplace or employer-sponsored, is more than 8.09% of income on an individual’s tax return
  • The cost of the lowest employer-sponsored family plan, including dependents, is more than 8.09% of the household income
  • Non-citizens who are not lawfully present in the state
  • Those who are living abroad or are residents of another state
  • Members of a health care sharing ministry
  • Enrolled in limited or restricted-scope Medi-Cal or other similar coverage
  • Those in federally recognized tribes are eligible for services through an Indian health care provider or the Indian Health Service
  • Those in jail, except for incarceration, pending the disposition of charges

 

These exemptions typically must be claimed on your state income tax return.

 

While the individual mandate went into effect “to reduce the number of uninsured individuals and families,” it also has implications for employers in California. Moreover, the law requires additional reporting from specific organizations.

Employer Reporting Required by the Individual Mandate

Employers must report insurance information to the Franchise Tax Board (FTB) of California by March 31. The data reported includes the enrollment participation of employees and their dependents.

 

Employers with an insurance provider who reports to the FTB are not required to report in addition to their provider.

What are the Penalties for Not Reporting Insurance Information to the FTB?

Employers who do not meet the filing deadlines of the FTB are subject to a $50 penalty for every employee receiving coverage.

 

Individually, there is a flat penalty per household member or 2.5% of the gross household income, whichever is higher. If an individual does not obtain coverage for the entire year, they would be subject to a minimum fine of $800. 

Why Are There ACA Reporting Requirements for Employers?

For applicable large employers (ALE), the FTB introduced these reporting requirements to help enforce the state’s healthcare mandate.

 

Employers who offer self-insured or employer-sponsored plans must report individual enrollment through Form 3895C unless their insurer reports via Form 1095-B. 

 

These reports allow the FTB to verify an individual’s coverage and identify who must pay an individual shared responsibility provision (ISRP).

 

This sounds like a lot, but don’t worry. At SBMA, we take care of all ACA reporting required for the ALEs we work with. We submit Forms 1095-B and 1095-C to ensure you comply with ACA requirements.

Individual Mandates in Other States

Individual mandates are becoming a more common practice in states other than California. The current states who have individual healthcare mandates include:

 

  • California
  • The District of Columbia
  • Massachusetts
  • New Jersey
  • Rhode Island, and
  • Vermont

 

Read our article “Understanding the Affordable Care Act Individual Mandate” for a more detailed look at each state’s requirements.

A Final Word

As an employer, it is essential to understand the individual mandate to ensure you remain compliant with reporting requirements and avoid hefty fines.

 

The best way to stay on top of these requirements is to partner with an insurance provider who handles your reporting. Look at our employer resources page for more information on how we assist employers with their health coverage needs.

Preventative Services Covered by MEC

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Minimum essential coverage is health insurance that meets the Affordable Care Act requirements. Employers have a requirement to offer at least Minimum Essential Coverage to any benefit-eligible employee. Non-compliance can result in a penalty of $214.17 PER eligible employee per month without coverage.

 

Take a look at our MEC calculator to discover how much you can save by investing in MEC for your employees.

 

At SBMA, we aim to offer affordable, flexible, and compliant coverage for all employers.

What Does Basic MEC Cover?

Our Basic MEC plans cover 100% of preventive services and wellness visits to the doctor. In addition, all members have access to 24/7/365 telehealth services and discounts on generic and brand prescriptions. 

 

These plans are the most affordable option under Minimum Essential Coverage. 

What Does Ultimate MEC Cover?

Ultimate MEC covers the preventative services and wellness visits mentioned above, as well as primary care and specialist visits with a $15 copay. As well as urgent care, labs, and X-rays with a $50 copay. 

 

24/7/365 telehealth services are included under this plan, along with access to behavioral health telehealth services

 

Prescriptions under the Ultimate MEC plan are covered based on your coverage tier.

 

*$50 fee max 3 per year

Preventative Services Covered Under MEC

Both plans cover preventative services and wellness visits. The services covered depend on age and gender. Here’s a look at the coverage offered under preventative services:

Covered Preventative Services for Adults

  • Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
  • Alcohol misuse screening and counseling
  • Aspirin used to prevent cardiovascular disease in men and women of certain ages
  • Blood pressure screening for all adults
  • Cholesterol screening for adults of certain ages or at higher risk
  • Colorectal cancer screening for adults over 50
  • Depression screening for adults
  • Diabetes (Type 2) screening for adults with high blood pressure
  • Diet counseling for adults at higher risk for chronic disease
  • Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over
  • Hepatitis B screening for people at higher risk
  • Hepatitis C screening for adults at increased risk, and one time for everyone born 1945 –1965
  • HIV screening for everyone ages 15 to 65, and other ages at increased risk
  • Immunization vaccines for adults — doses, recommended ages, and recommended populations vary: Hepatitis A, Hepatitis B, Herpes Zoster, Human Papillomavirus, Influenza (flu shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Tetanus, Diphtheria, Pertussis and Varicella
  • Lung cancer screening for adults 55 – 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
  • Obesity screening and counseling for all adults
  • Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
  • Statin preventive medication for adults 40 to 75 years at higher risk
  • Syphilis screening for all adults at higher risk
  • Tobacco use screening for all adults and cessation interventions for tobacco users
  • Tuberculosis screening for certain adults with symptoms at higher risk

Covered Preventative Services for Women

  • Anemia screening on a routine basis for pregnant women
  • Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer (counseling only; not testing)
  • Breast cancer mammography screenings every 1 to 2 years for women over 40
  • Breast cancer chemoprevention counseling for women at higher risk
  • Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
  • Cervical cancer screening
  • Chlamydia Infection screening for younger women and other women at higher risk
  • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
  • Diabetes screening for women with a history of gestational diabetes who aren’t currently pregnant and who haven’t been diagnosed with type 2 diabetes before
  • Domestic and interpersonal violence screening and counseling for all women
  • Folic acid supplements for women who may become pregnant
  • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
  • Gonorrhea screening for all women at higher risk
  • Hepatitis B screening for pregnant women at their first prenatal visit
  • HIV screening and counseling for sexually active women
  • Human Papillomavirus (HPV) DNA Test every 5 years for women with normal cytology results who are 30 or older
  • Osteoporosis screening for women over age 60 depending on risk factors
  • Preeclampsia prevention and screening for pregnant women and follow-up testing for women at higher risk
  • Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  • Sexually transmitted infections counseling for sexually active women
  • Syphilis screening for all pregnant women or other women at increased risk
  • Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users
  • Urinary tract or other infection screening, including urinary incontinence
  • Well-woman visits to get recommended services for women under 65

Covered Preventative Services for Children

  • Alcohol and drug use assessments for adolescents
  • Autism screening for children at 18 and 24 months
  • Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Bilirubin concentration screening for newborns
  • Blood pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
  • Blood screening for newborns
  • Cervical dysplasia screening for sexually active females
  • Depression screening for adolescents
  • Developmental screening for children under age 3
  • Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Fluoride chemoprevention supplements for children without fluoride in their water source
  • Fluoride varnish for all infants and children as soon as teeth are present
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screening for all newborns, and for children once between 11 and 14 years, once between 15 and 17 years, and once between 18 and 21 years
  • Height, weight, and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Hematocrit or hemoglobin screening for all children
  • Hemoglobinopathies or sickle cell screening for newborns
  • Hepatitis B screening for adolescents ages 11 to 17 years at high risk
  • HIV screening for adolescents at higher risk
  • Hypothyroidism screening for newborns
  • Immunization vaccines for children from birth to age 18 — doses, recommended ages and recommended populations vary: Diphtheria, Tetanus, Pertussis, Haemophilus influenza type B, Hepatitis A, Hepatitis B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), Measles, Meningococcal, Pneumococcal, Rotavirus and Varicella
  • Iron supplements for children ages 6 to 12 months at risk for anemia
  • Lead screening for children at risk of exposure
  • Maternal depression screening for mothers of infants at 1, 2, 4, and 6-month visits
  • Medical history for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Obesity screening and counseling
  • Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
  • Phenylketonuria (PKU) screening for this genetic disorder in newborns
  • Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
  • Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Vision screening for all children.

Read on for more information on MEC insurance plans and what they cover.

Understanding the Affordable Care Act Individual Mandate

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The Affordable Care Act (ACA) implemented the individual mandate, also known as the “individual shared responsibility provision” that requires that most Americans have a qualifying Minimum Essential Coverage (MEC).

Until 2018, those who did not prove themselves to have health insurance when filing taxes were penalized. The Tax Cuts and Jobs Act of 2017 then eliminated that requirement. This bill effectively eliminated the individual mandate penalty, as of 2019 on a federal level.

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Review: “Biden Bid to Expand Health Subsidies: ‘Family Glitch’ Explained“

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President Joe Biden continues seeking ways to make healthcare more affordable for Americans. His efforts include aiding over five million people who fall into the ‘family glitch’ of the Affordable Care Act (ACA).

The ‘family glitch’ is a section of the ACA that decreases the ability for families to qualify for health subsidies that make healthcare more affordable.

Read more

1094/1095 PCORI Compliance: What You Need to Know

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Businesses that provide health benefits for their employee workforce must submit the right forms proving that they offered the required benefits. Now that 1094/1095 filing is complete, it’s time to prepare for federally mandated annual PCORI fees. Are you prepared? Let’s discuss 1094, 1095, and PCORI compliance. 

How Can Applicable Large Employers Stay Compliant?

Applicable Large Employers (ALEs), employers with 50 or more full-time employees, must offer Affordable Care Act (ACA) compliant health benefits to at least 95% of their workforce. Failure to do so can result in hefty fines and penalties from the Internal Revenue Service (IRS). 

The IRS can issue ALEs Penalty A or Penalty B fines for ea

ch employee that is not offered correct or compliant benefit plans. Employers can avoid unnecessary fines and penalties by offering ACA Compliant Minimum Essential Coverage (MEC). MEC benefit plans allow employers to provide affordable benefits to their employees without compromising their bottom line. 

In order to verify employers are, in fact, offering ACA compliant benefits, the IRS requires employers to fill out form 1094 and 1095. 

Employers must complete Form 1094, which is used to determine their liability for payment under the employers’ shared responsibility provision. Form 1095, however, is used as a summary of healthcare information the ALE offers employees. 

What Can SBMA Do For You?

One of the many services we provide at SBMA Benefits is 1094 and 1095 Form processing. We simplify the complexity of providing employee benefits while simultaneously ensuring ACA compliance. 

What’s included in our 1094/1095 processing?

  • Electronic filing of 1094 and 1095 forms annually 
  • PDF soft copies of 1095 for employee distribution 
  • 1095 error corrections refiling (if applicable) 
  • Mail distribution

What Happens After I Submit Forms 1094 and 1095?

After submitting Forms 1094 and 1095 by their due date, March 31st, employers must pay fees to the Patient-Centered Research Institute (PCORI) by July 31st. This year, however, the due date has been extended to August 2nd since the previously mentioned due date lands on a Saturday. 

What is PCORI and Why Do I Have to Pay Their Fees?

PCORI was created to improve the quality, quantity, timeliness, and trustworthiness of health information for patients. 

According to the PCORI, its mission is to “help people make informed healthcare decisions, and improve healthcare delivery and outcomes, by producing and promoting high-integrity, evidence-based information that comes from research guided by patients, caregivers, and the broader healthcare community.”

Employers are responsible for paying PCORI trust fund fees annually. The amount employers owe depends on the number of people enrolled in their offered benefits program. 

The fee is calculated based on the average number of individuals covered in a benefits plan- including spouses, dependents, retirees, and COBRA participants. Currently, PCORI fees are $2.79 per enrollee. In 2021, PCORI fees cost $2.66 per enrollee. 

The fee was slated to end in 2019, but was extended via Trump’s Further Consolidated Appropriations Act of 2020. For now, PCORI fees are extended through 2029. 

For more information on Forms 1094 and 1095, read our article: What you need to know about 1094/1095 Filing. 

What Business Owners Should Know About ACA Benefits in 2022

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Applicable Large Employers (ALEs) are businesses that have at least 50 full-time, or full-time equivalent employees in one calendar year. Under federal law, they must provide at least 95% of their employees and their children up to age 26 with Affordable Care Act (ACA) compliant coverage.

Why? Because the ACA was designed to make healthcare services affordable to more people.

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Record Number of People Enroll in Health Insurance Coverage

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Open enrollment for health insurance in the United States begins annually on November 1st and ends on January 15th. Some states, like California, however, extend the enrollment date for residents to the end of January.

Over the past few years, enrollment rates dipped due to funding cuts from the previous administration for advertisements and navigators aiding sign-ups for coverage.

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