ACA Guide

Affordable Health Insurance: Insurance that costs less than 9.5% of family income.

Employer Mandate: Employers who exceed 50 full time or full time equivalent (FTE) employees during the preceding calendar year must offer affordable health insurance coverage that meets minimum essential coverage requirements.  Employers of 50+ FTE employees who do not offer health insurance that meets the ACA requirements will pay a penalty and those who do offer insurance but have subsidized employees on payroll might pay a penalty.

Employer Mandate Penalty:  There will be two basic calculations when determining employer penalties.

– If the business doesn’t provide health insurance and at least one employee is subsidized its annual penalty equals the total number of full time employees in the company (subsidized and unsubsidized) minus 30 x $2,000.

– If the business does provide health insurance and at least one employee is subsidized its annual penalty will equal the lesser of the previous (non-offered penalty) or the number of subsidized full time employees x $3,000.

– FTE / Part-time employees are only used to determine if a business is considered large or small.  Penalties are calculated based on full time employees only.

Full Time Employee: An employee who works 30 hours or more per week.

Full Time Equivalent (FTE):  Each 120 hours per month of part-time labor counts as a full time equivalent.

Individual Mandate: All non-exempted US citizens must carry ACA qualified insurance or pay a penalty.

Individual Mandate Penalty:

–          For 2016 and beyond, $695 per uninsured person or 2.5% of household income over the filing threshold.

Individual Premium Subsidy: There are three ways for citizens under age 65 to qualify for an individual premium subsidy.

–          The individual’s household income is less than 400% of Federal Poverty Level (FPL) adjusted for area and

–          The individual’s portion (cost) of their employer offered group health insurance exceeds 9.5% of the employee’s household income.

–          The employer’s health insurance plan does not meet the minimum essential coverage guideline.

 Metal Plans:

–          Bronze: Covers 60% actuarial value

–          Silver: Covers 70% actuarial value

–          Gold: Covers 80% actuarial value

–          Platinum: Covers 90% actuarial value

Minimum Essential Coverage: The type of coverage an individual needs to meet the individual responsibility requirement under the Affordable Care Act.  This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage.  The plan needs to meet a 60% minimum value test.  This coverage is needed to avoid the individual mandate penalty.

Qualified Individual Health Plans Available in 47374 Zip Code:

–   Through the Marketplace

  • CareSource
  • Ambetter

Subsidized Employees:  An employee that receives premium credits (government subsidies) to help purchase individual health insurance in the exchange.