What’s New with Obamacare?

It’s been awhile since I wrote anything about the Affordable Care Act, commonly known as Obamacare.  That’s mainly because the rules keep changing, especially for that provision of the law known as “play or pay”, which applies to employers and requires them to either provide “affordable” and  “minimum essential” insurance coverage to their employees or pay a penalty for not doing so.  What constitutes “affordable” and “minimum essential” insurance coverage has not changed, but whether an employer will be subject to a penalty for not offering such coverage in 2015 has changed.

Last year the “play or pay” penalty was delayed for all employers until January 1, 2015. This year the “play or pay” penalty has been delayed until January 1, 2016 for those employers who have 50-99 full-time employees or their equivalents, if they meet certain requirements, and has been watered down for those employers with 100 or more full-time employees or their equivalents.  As I explained in a earlier post, employers with 30 or fewer full-time employees (those who are normally expected to work an average of 30 or more hours a week), do not have to worry about the “play or pay” penalty in 2015 and beyond, because in calculating the amount of the penalty, the first 30 such employees are not counted.  For employers with 100 or more full-time employees or their equivalents, the exemption from the “play or pay” penalty for 2015 has been increased to the first 80 full-time employees.  So, if such an employer has 80 or fewer full-time employees during 2015, it will not pay a penalty if it does not offer insurance coverage at all or even if it offers such coverage that is not “affordable” and “minimum essential.”

For employers with 100 or more full-time employees or their equivalents who offer insurance coverage under non-calendar year plans, there are other ways they can escape the “play or pay penalty” without having to offer “affordable” and “minimum essential” coverage to 95% of their full-time employees, which is what Obamacare initially required. For an explanation of these other ways and the changes made in the “play or pay” penalty for 2015 in general, click here.

In order for employers with 50-99 full-time employees or their equivalents to escape the “play or pay” penalty for 2015, they must continue to do what they have been doing since February 9, 2014.  If they have not offered insurance coverage to their employees since that date, they do not have to offer such coverage during 2015.  If they have offered such coverage on or after that date, they must continue to offer the same coverage to the same employees and contribute the same amount toward the premium for employee only coverage during 2015, but that coverage does not have to be “affordable” or “minimum essential.”

The open enrollment period for 2015 individual insurance coverage runs from November 15, 2014 through February 15, 2015.  Insurance agents and brokers who want to be able to assist individuals in obtaining coverage through the federal insurance exchanges and the Small Business Health Options Program, more commonly known as SHOP, must register or re-register with Centers for Medicare and Medicaid Services (“CMS”).  For a copy of the slides from a recent seminar on that subject that explains the requirements for insurance agents to take part in those programs, click here.

One new benefit for registering with CMS is that an agent’s name and contact information will be accessible from the home page of the healthcare.gov website under “Find Local Help.”  For an article about this new benefit and how an agent can change their contact information, click here.

1 thought on “What’s New with Obamacare?”

  1. Mark,
    You offer one of the most concise and clear explanations that I’ve heard AND as an Insurance Professional I still find this information confusing.
    Wow, what a mess.

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