The Affordable Care Act was passed
in 2010. It overhauls the U.S. healthcare system and affects nearly all
taxpayers, many employers and various elements of the healthcare industry. This
represents the most significant change to our healthcare laws since the passage
of Medicaid and Medicare in 1965.
The new law will be phased in over
multiple years spanning 2009 to 2018. As you’ll read in the article, the new
healthcare law uses the tax code and tax return in many respects to implement
its measures. The following article summarizes the important aspects of the law
and separates it out between the provisions impacting individuals and other
provisions impacting small businesses.
Higher Impact Provisions for Individuals
You need to carry insurance
beginning in 2014 unless you meet an exception
Exemptions will be granted for:
- Financial hardship
- Religious objections
- American Indians
- Individuals without coverage for less than 3 months
- Aliens not lawfully present in the United States
- Incarcerated individuals
- Individuals whose lowest cost plan option exceeds 8% of
household income
- Individuals with income below the tax filing threshold
($9,750 single; $19,500 married filing joint)
You have several options to get
health insurance:
- Job-based coverage:
If your employer offers health insurance coverage, you may be eligible to
receive it, including your spouse or dependents. Employers may decline or
restrict coverage for certain reasons (e.g., part-time worker), but not
for health reasons.
- Private policy: Beginning
in 2014, these plans will cost the same whether acquired directly or
through an insurance exchange. However, subsidies apply only if you’re
using an insurance exchange.
- Medicaid:
Each state offers this program for lower income people, the elderly and
people with disabilities.
- Health Insurance Marketplace (exchange): Beginning in 2014, this program helps you find health
insurance that fits your budget. When you use an exchange, which is run by
the state or federal government, it results in a private insurance policy.
If you can’t afford health
insurance, subsidies are provided
The centerpiece of the legislation
is to provide a subsidy or tax credit to low and middle income individuals so
they can better afford to buy health insurance. Beginning in 2014, people who
purchase insurance through an exchange may be eligible for the Premium Assistance
Credit.
The credit is refundable and payable
in advance directly to the insurer. The individual then pays the difference
between the total premium and the credit. For employed individuals, the
premiums can be made through payroll deductions. Direct subsidies are also
available.
To figure out if you’re eligible for
a subsidy, you need to determine your household size and household income and
see where it falls within the federal poverty line. Subsidies are available up
to 400% of the federal poverty line. Up to 133% of the federal poverty line, a
family needs to devote 2% of its income towards the premium, with the balance
subsidized by the government. The subsidy then decreases as income goes up.
Let’s say Mary is a school teacher
and is single with one child. She earns $45,000 per year, which is around 300%
of the federal poverty line. Under the healthcare law, Mary needs to devote
9.5% of her income, or $4,275, towards health insurance. If the average annual
premium is $5,160, the government would subsidize the balance of $885. In the
end, Mary would pay 83% of the premium and the government subsidy would cover
17%.
How to calculate the penalty for not
having insurance
Beginning in 2014, U.S. citizens and
legal residents must carry health insurance or be subject to a penalty.
The penalty is the greater of:
- $695 per year ($2,085 maximum per family), or
- 2.5% of household income
The penalty is phased in over time:
- Example 1: Family of 4 with household income of $50,000
in 2016, the penalty would be $2,085.
- Example 2: Family of 4 with household income of
$100,000 in 2016, the penalty would be $2,500.
What you can do prior to 2014
- Your 2012 tax return will help determine your
eligibility for an insurance subsidy from the government, which will help
you purchase health insurance under the healthcare law. There is nothing
special to do; your tax return determines your eligibility.
- Beginning in October 2013, uninsured Americans will be
able to enroll in a health plan through state exchanges.
- In 2014, everyone, except for a few, will be required
to purchase health insurance or face a tax penalty.
The exchanges are run by the
government, but insurance is still handled by private industry
Some people believe that the
exchange is where they can go to get enrolled into a new government run
insurance plan, which will be offered along with the private health care
insurance plans currently available in the market today. This is not the case.
There is no government run insurance
plan or single payer system established under the Affordable Care Act. The
government will only run the exchanges and the insurance industry will still be
run by private companies.
Public exchanges will be available
in all 50 states and four levels of health insurance will be offered (platinum,
gold, silver and bronze). Each insurance plan will offer “minimum essential
coverage”, which is needed to avoid paying a penalty. Private exchanges will be
available as an alternative to the public exchanges.
Increased Medicare taxes on
high-income taxpayers
- Wages. Currently,
wages are subject to a 2.9% Medicare payroll tax with the worker and
employer each paying 1.45%. There is no limit to the amount of wages that
are subject to the tax. Self-employed people pay both halves. Under
the new law beginning in 2013, there is an additional 0.9% (2.35% in
total) hospital insurance tax that applies to wages received in excess of
$250,000 for joint filers and $200,000 for single filers.
- Investment income. Currently,
the Medicare payroll tax only applies to wages. Under the new law
beginning in 2013, the tax will also to apply to investment income, such
as interest and dividends. The 3.8% surtax is levied on the lesser of net
investment income or the excess of modified adjusted gross income over
$250,000 for joint filers and $200,000 for single filers.
Higher Impact Provisions for Small Businesses
Only large employers will face
penalties for not providing insurance to employees
