15 Key Health Care Act Provisions That Begin in 2014

(This story, originally on our sister site LifeHealthPro, was excerpted from Healthcare Reform Facts, which is available for purchase.)

The effective date of the Patient Protection and Affordable Care Act (PPACA) is March 23, 2010, although various provisions have their own effective dates from Jan. 1, 2010 (the small business income tax credit), through 2018. The start of 2013 saw the launch of a number of key provisions, among them Medicare tax increases, limits on Health FSA deferrals and the requirement that W-2 reporting note employer and employee payments for certain health care items in 2012.

But 2014 is the year when most core pieces of PPACA will be put into effect, like individuals must obtain minimum essential health coverage for themselves and their dependents, whether or not they have access to coverage through their employer. The mandate that employers with 50+ employees must provide health insurance was delayed till 2015.

Equally momentous, beginning Jan. 1, 2014, states are required to have opened a state-run health insurance exchange, or to have partnered with the federal government to open an exchange. Oct. 1 saw the rocky opening of enrollment into the exchanges. In theory, within these exchanges, insurance companies will compete for business on a transparent, level playing field, which should reduce costs and give individuals and small businesses the purchasing power enjoyed by big businesses.

However, health reform does many things to increase costs by covering those who are now uninsurable and by increasing mandated benefits. Many predict these factors will far outweigh any efficiencies created by the exchanges and that health insurance prices will increase. If exchanges succeed, they will create the first viable alternative to the group markets for the under-65 population.

In short, there’s a lot to track over these next six months. Read on for 15 provisions that will become effective on Jan. 1, 2014.

1. Health Insurance Nondiscrimination Requirements

Code Section 105(h) currently taxes the benefits received by highly compensated employees (HCEs) under discriminatory self-funded health plans. PPACA has extended these nondiscrimination rules to insured plans. It is unclear whether this change imposes tax penalties or is a substantive requirement. Employers with discriminatory insured arrangements, however, will need to consider changing them. Grandfathered plans are exempt from this rule.

This new requirement was originally intended to be effective for plan years beginning on or after September 23, 2010. The effective date was postponed in 2010 until IRS publishes a notice, which has not yet been issued. The provision may not be effective in 2014 but it likely will be. 

2. State Health Insurance Exchanges

Each state must establish a health insurance exchange (or HHS will do so) for use by the uninsured and small employers with 100 or fewer employees (although states may set the cap at 50 employees). The exchanges will offer fully insured insurance contracts that provide essential health benefits at different levels of coverage (bronze, silver, gold, and platinum). Employees of small employers who offer health insurance coverage through an exchange may pay their employee premiums for such coverage on a pre-tax basis through the employer’s cafeteria plan.

3. State Health Insurance Exchange Tax Subsidies

Individuals who do not have affordable minimum essential coverage from their employer will be eligible for tax credit subsidies for their health insurance purchase on a state exchange if their income is below 400% of the federal poverty level.

4. Employer Mandate (Pay or Play) Tax Penalties

(This has now been deplayed till 2015.) Employers with 50 or more full-time equivalent (FTE) employees will be required to offer their full-time employees (FTEs) minimum essential health coverage or pay a fine of up to $2,000 per year for each FTE in excess of thirty FTEs if any employee receives a premium tax credit on a state health insurance exchange.

If an employer provides minimum essential health coverage to its FTEs, but fails to pay at least 60% of its actuarial value or the coverage is considered unaffordable (costs more than 9.5% of household income), then the employer must pay a penalty of up to $3,000 per year for each FTE who receives the premium credit on an exchange, but not more than would be owed for the $2,000 per year penalty. An FTE is defined as an employee who is employed for 30 or more hours per week, calculated on a forty-hour work week. This provision also applies to grandfathered plans.

5. Individual Mandate Tax Penalty

Individuals are required to obtain minimum essential health coverage for themselves and their dependents or pay a monthly penalty tax for each month without coverage. The monthly penalty tax is one-twelfth of the greater of the dollar penalty or gross income penalty amounts. The dollar penalty is an amount per individual of:

• $95 for 2014 (capped at $285 per family),
• $325 for 2015 (capped at $975 per family), and
• $695 for 2016 (capped at $2085 per family).

These dollar penalties will be indexed for inflation starting in 2017.

The gross income penalty is a percentage of household income in excess of a specified filing threshold of:

• 1% for 2014,
• 2% for 2015, and
• 2.5% for 2016 and later years.

In no event will the maximum penalty amount exceed the national average premium for bronze-level exchange plans for families of the same size.

Minimum essential coverage includes Medicare, Medicaid, CHIP, TRICARE, individual insurance, grandfathered plans, and eligible employer-sponsored plans. Workers compensation and limited-scope dental or vision benefits are not considered minimum essential health coverage.

6. Automatic Enrollment