Five Facts about the Small Business Health Care Tax Credit

The IRS wants you to know that, if you are a small employer, there is a tax credit that can put money in your pocket. The small business health care tax credit is available through the small business health options program, also known as the SHOP marketplace. Employers must have fewer than 25 full-time equivalent employees, pay an average wage of less than $50,000 a year, and pay at least half of employee health insurance premiums. The IRS offers these five facts about this credit:

  1. The maximum credit is 50% of premiums paid for small business employers and 35% for small tax-exempt employers.
  2. To be eligible, you must pay premiums on behalf of employees enrolled in a qualified health plan offered through a Small Business Health Options Program Marketplace or qualify for an exception to this requirement.
  3. The credit is for eligible employers for two consecutive taxable years beginning in 2014 or later. You may be able to amend prior year tax returns to claim the credit for tax years 2010 through 2013 in addition to claiming this credit for those two consecutive years.
  4. You can carry the credit back or forward to other tax years if you don’t owe tax during the year.
  5. You may get a credit and a deduction for employee premium payments. Since the amount of your health insurance premium payments will be more than the total credit, if you are eligible, you can still claim a business expense deduction for the premiums in excess of the credit.

The Benefit Gap for Small Businesses

Health insurance is offered to 96% of employees at large and small companies and 89% of employees at small-businesses, in particular. But the study by Lincoln Financial reveals a much larger gap when it comes to other benefits:

Benefits offered Small Business Employees Employees of businesses of all sizes
Dental Insurance 74% 91%
A retirement plan 72% 89%
Vision insurance 66% 84%
Life insurance 62% 81%
Disability insurance 52% 74%

Employees at small businesses say that it’s important for their employers to offer these benefits:

  • 90% a retirement plan.
  • 87% dental coverage.
  • 83% vision insurance.
  • 76% life insurance.

Almost 70% of employees at small businesses say that benefits have influenced their employment decisions. Business-continuation strategies are critical since more than 50% of small-business owners are 50 to 85. Life insurance can help ensure that the business continues in the event of the death of an owner, co-owner, or key employee.

How Health Coverage Differs Between Small Firms and Large Firms

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Small and large employers vary substantially in health insurance offer rates and costs, according to a study by the Kaiser Family Foundation. Small employers are less likely to offer coverage. Also, workers at small firms have higher cost sharing. (The study defines small employers as those with three to 199 workers and large employers as those with 200 or more.)

The smallest employers (three to nine workers) are less than half as likely as are large employers to offer health coverage. While family premiums are less expensive at small firms, covered workers face higher premium contributions and higher higher deductibles. The study reveals the following:

Offer Rates
  • 56% of small employers offer health insurance to at least some employees, compared to 98% of large employers.
  • 47% of very small employers (three to nine workers) offer health insurance.
  • 41% of small employers did not offer coverage because of the cost of health insurance.
  • 18% of small employers offer health benefits to part-time workers compared to 35% of  large employers.
  • 3% of small employers offer health benefits to temporary workers compared to 11% of large employers.
Waiting Periods
  • 81% of covered workers at small firms have a waiting period to get benefits compared to 71% of workers at large firms. The average waiting period is 2.2 months at small firms and 1.8 months at large firms.
Premiums
  • In the West, average premiums for single and family coverage are lower for workers at small firms than at large firms.
  • Workers for small firms have average annual premiums for family coverage of $17,938 compared to $16,625 for workers at large firms.
  • Since 2010, average family premiums have grown 25% for small employers and 28% for large employers. Dating back to 2000, family premiums have grown 155% for small employers and 180% for large employers.
Premium Contributions
  • Workers for small firms contribute an average of $899 to their premiums for single coverage compared to $1,146 for workers at large firms.
  • Workers at small firms contribute an average of $5,904 for family coverage compared to an average of $4,549 for workers at large firms.
  • Thirty-two percent of workers at small firms contribute more than half of the premium for family coverage compared to just 8% of workers at large firms.
  • Workers’ contributions to family premiums at small employers have increased 27% since 2010 and 204% since 2000.
  • 34% of small employers contribute more for workers enrolled in family coverage than in single coverage compared to 67% of large employers.
Plan Types
  • 19% of workers in small firms enroll in a point-of-service (POS) plan compared to 6% of workers at large firms.
  • 41% of workers in small firms are in a PPO compared to 56% of workers in large firms.
Deductibles
  • 63% of workers for small firms with single coverage have a deductible of $1,000 or more compared to 39% of workers at large firms.
  • 36% of workers at small firms with single coverage have a deductible of $2,000 or more compared to 12% of workers in large firms.
  • Workers with single coverage at small firms have annual deductibles averaging $700 more than those in large firms. The average difference between small and large employers is more than $1,400 for those with family coverage.
  • The average general annual deductible for single coverage for all covered workers at small firms is $1,507 (up 51% from 2010) and $890 for all covered workers at large firms (up 95% from 2010).
PEOs
  • Many small employers outsource the administrative functions of their health programs. Some employers provide health benefits by entering into a co-employment relationship with a professional-employer organization (PEO). The employer manages the employees, but the PEO hires employees and acts as the employer for insurance, benefits, and other administrative purposes. Five percent of employers with three to 499 workers with health benefits offer coverage with a PEO.
  • 6% of covered workers with health benefits at firms with three to 499 workers are enrolled in a plan offered through a PEO.
Self-Funded Plans
  • 83% of covered workers at large firms are  in a self-funded plan compared to 17% at small firms. The percentage of covered workers at small employers enrolled in a self-funded health plan is unchanged from 1999.

Major Health Insurance Changes for the New Year

Covered CA 2016 ChangesCovered California is reminding consumers and small businesses about important changes in 2016. Starting January 1, Covered California increased access to plans and providers and offered more health plans, and increased the number of benefits that are not subject to a deductible. Here is a run-down of the changes:

Most California Consumers Get New Forms for the 2015 Tax Year
This year, consumers who are insured through their employer or a government program, like Medi-Cal, will get Form 1095-B or Form 1095-C. The forms show who maintained minimum essential coverage and is not liable for the tax penalty. Consumers under Covered California will continue to get a Form 1095-A. For more information, visithttps://www.irs.gov/Affordable-Care-Act/Questions-and-Answers-about-Health-Care-Information-Forms-for-Individuals.

The Penalty for Not Buying Affordable Insurance Is Going Up — A Lot
The IRS penalty applies to people who go without insurance when they can afford to buy it. It will increase for 2016 to at least $695 per adult and $347.50 per child under 18 or 2.5% of household income, whichever is greater. A recent study by the Henry J. Kaiser Family Foundation estimates that the average household penalty in 2016 will be $969, which is a 47% increase from 2015. For more information, visit www.taxpayeradvocate.irs.gov/estimator/isrp.

New Requirements and New Options for Many of California’s Small Businesses
Employers with more than 50 full-time-equivalent (FTE) employees must offer health insurance to employees or pay a penalty. Through 2015, this requirement applied only to businesses with more than 100 employees. Any of these employers with an employee who does not take their offer of coverage will have to pay a penalty if the employee goes on to get financial assistance to purchase coverage through Covered California. For more information, visit https://www.irs.gov/Affordable-Care-Act/Employers/ACA-Information-Center-for-Applicable-Large-Employers-ALEs.

Covered California for Small Business will expand beyond the ceiling of 50 employees to serve companies employing 100 or fewer FTE employees. For more information, visit www.CoveredCA.com/ForSmallBusiness.

Major Improvements in Choice, Access and Benefits
Covered California used its power as an active purchaser to hold down rate changes for a second year. Before the Affordable Care Act, consumers regularly experienced double-digit premium increases. For 2016, Covered California negotiated a weighted average change of 4%, which is lower than last year’s change of 4.2%. In addition, nearly 90% of Covered California enrollees get some financial assistance to help pay premiums. On average, those subsidies resulted in more than $5,200 for each household in 2014.

Benefit Changes for the 2016 coverage year:

  • The majority of Bronze plan consumers now get three office visits a year to a primary care provider or specialist with no deductible. Other needed services, such as lab tests and rehabilitation, will not be subject to a deductible.
  • Covered California’s Silver plan will combine copay and coinsurance into a single product. Every doctor visit, lab test, and prescription will not be subject to a deductible in this single product. Consumers with chronic conditions will be protected by a cap on specialty drugs. The vast majority of consumers will see their specialty drugs capped at $250 per month, per prescription. Plus, because of Covered California’s standard benefit design, the caps must be offered by every health insurance plan in the individual market and by all plans offered by the exchange. For more information, visit http://news.CoveredCA.com/2015/05/covered-california-board-protects.html.
  • Adult dental coverage is now offered as an add-on.
  • 6% of Covered California consumers will be able to choose from at least three health insurance companies thanks to the addition of two new health insurance companies — UnitedHealthcare Benefits Plan of California and Oscar Health Plan of California as well as the expansion of Blue Shield of California and Health Net.
  • More than 90% of hospitals (general acute centers as designated by the California Office of Statewide Health Planning and Development) in California will be available through at least one health insurance company, and 74% will be available through three or more companies.

 Medi-Cal Coverage for Undocumented Children

  • Medi-Cal will be expanded to all children regardless of their immigration status. The new law goes into effect in May 2016.

Health Care Improvements for All Californians
Starting July 1, health plans must publish and maintain printed and online provider directories. Health plans must maintain accurate provider directories, including routine updates. For more information, visithttp://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB137.

A new state law will require health plans and insurers to implement formula-tier requirements and cost-sharing caps similar to products offered through Covered California. Assembly Bill 339 requires plans and insurers to have formularies that do not discourage the enrollment of people with certain health conditions. It also sets requirements regarding access to in-network retail pharmacies, standardized formularies, and coverage for certain single-tablet HIV and AIDS treatments. For more information, visithttp://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB339.

Employers Shift Health Care Burden to Employees

moneyburdenEmployer-based healthcare plans are in a state of flux following this year’s implementation of the Affordable Care Act (ACA). Since health care costs in retirement have long been considered a major source of financial stress, changes to coverage are affecting how Americans tackle retirement planning, according to an analysis by Mike Flower and Brad Bofford, managing partners of Financial Principles, LLC in Fairfield, NJ. Until recently, most of the focus of the ACA has been on coverage for the previously uninsured or of those covered through individual health plans. But the conversation is shifting toward how insurance exchanges are affecting employer-based group plans. While information on enrollment and coverage changes will not be available for some time. Principles, LLC has worked with several small businesses that have switched their healthcare coverage this year from group pricing to individual pricing. Traditionally, employees would choose from price-fixed categories such as, married with children, married couple, single parent with children, and single person. By moving to individual pricing, coverage is based on the age of the employee, spouse, and each child — maxing out at three children. What is surprising is the time and effort that are now going into collecting the data needed to administer these plans before and after enrollment since every employee is paying a different price.

Some insurance companies are increasing their premiums in order to move employees out of the top-of-the-line Cadillac plans. It forces employers to accept lesser service plans for the same price as what was paid for the Cadillac just two years ago. Increased deductibles, higher co-pays, and more restricted pharmacy benefits are just a few examples of how these changes to employer-base plans are shifting more and more costs to employees. Employees are forced to allocate more of their own money on health and less on retirement vehicles. The authors says that the market trend is moving toward more consumer responsibility and less employer control. The analysis advises employees to ask their employers following:

1. Will there be bigger paycheck deductions for employee and/or dependent coverage?
2. Are there plans to move employees into a private insurance exchange? If so, will it be within a defined contribution framework?
3. Will part-time workers continue to receive coverage?

Employees are also advised to do the following:

1. Consider a high deductible health plan with an HSA, and research the federal or state exchanges.
2. While it’s tempting to reallocate money otherwise put into retirement accounts to pay for increasing healthcare costs, don’t do it. Look for other ways to cut back on spending and keep saving to ensure you have enough money to last through your entire retirement years.
3. Work with an independent financial advisor.

For more information, visit www.financialprinciples.com.

Small Business Owners Are Not Faring Better Under the ACA

Fifty one percent of business owners say their employees are not getting better healthcare or more affordable healthcare under the Affordable Care Act  (ACA). Fifty-five percent are unsatisfied with or unsure about their current healthcare solution. Only 19% say their employees received healthcare that is more affordable and better under the Affordable Care Act, while over 80% were unsure or said they did not get more affordable care. Barry Sloane of The Small Business Authority said, “In the near term, the promise of more affordable care from the Affordable Care Act has not yet materialized. Hopefully the government and the health insurance providers will take the necessary steps to decrease healthcare costs, increase choice, and improve services to independent business owners and their employees.” For more information, visit http://www.thesba.com.

How Small Business Can Get the Best Health Coverage at Most Affordable Price

Frank Saltzburg, a partner with Healthcare Solutions Team, LLC (www.ushcre.com) outlines his strategies for businesses to lower their health care premiums while providing the most comprehensive health plans:
•  Always use a professional, state-licensed broker or agent who is certified as a health care reform specialist. They are trained and educated to be aware of the best plans in the ever-changing current market, both in the private and public exchanges. It does not cost you any more to use a broker since major medical rates are already approved by your State Insurance Commissioner.
•  Don’t use a public online quote engine as your final answer. It is only a starting point and is susceptible to data breaches leading to identity theft.
•  Be aware of the limitations of public exchange call center navigators who don’t hold a state-issued health insurance license. In many cases, navigators are not state-licensed to represent major medical coverage and are not even government-certified as health care reform specialists in the Affordable Care Act.
•  Use the bundle concept to give you better coverage at a more affordable price with less out-of-pocket financial exposure.

Saltzburg says there has been an influx of online insurance quote engines through the public insurance exchanges. “The problem here is these public exchange quote engines will list  ‘bargain health plans’ that typically have the smallest network of doctors and hospitals. Many people are shocked to learn their plan’s network is limited to one county within their state and their doctors are not part of these networks. A recent Associated Press survey found that most cancer hospitals don’t accept Obamacare,” he stated.

“One big, ongoing concern is that the average deductible is estimated at $5,000. However, what everyone should really be looking at is the out-of-pocket maximum per calendar year. This is the true financial exposure we all experience. We design our plans so that the deductible and the maximum out-of-pocket exposure are no longer a major issue…We bundle our plans to include accidental coverage to pay up to the deductible amount and cover out-of-pocket expenses. Plus, we offer critical illness coverage to also offset the deductible and any out-of-pocket expenses. The critical illness coverage offers the ability to have a lump sum payout allowing the insured to have an extra $5,000 to $200,000 of living expense money. While people are recuperating from their critical illness, they won’t worry about paying daily living bills. Bundling allows the insured to have a more comprehensive plan with true peace of mind,” he said. For more information, visit http://www.ushcre.com.

California’s Small Business Health Insurance Exchange Off to Slow Start

Kaiser Health News reports that California’s insurance marketplace for small businesses has attracted just a fraction of eligible companies, with most being deterred by technology glitches, paperwork delays, and customer service problems. The SHOP program has kind of taken a backseat, said John Kabateck, the California executive director of the National Federation of Independent Businesses. California began offering online enrollment in November. But in February, the exchange suspended Internet sign-ups after applicants ran into such glitches as error messages or delays in loading pages and some applications came in incomplete. The exchange instructed businesses and their brokers to use  traditional paper applications, for now. The online  version is expected to be up again in the fall with more efficient service and a better way to determine eligibility.

Orange County insurance broker Kathy Hope, told Kaiser Health News that the SHOP is just a mess and insurers are offering comparable products outside of the marketplace, so there is little reason to enroll. “The tax credit is a relief for some small businesses, but getting it requires red tape, time and expense. We are encouraging our members to look both in and out of the market,” said Kabateck of the National Federation of Independent Businesses.

Small businesses wait for congressional action on tax breaks

Small businesses are waiting to see whether Congress will extend bonus depreciation and increase the size of the Section 179 deduction. Bonus depreciation has expired, while the Section 179 deduction has decreased to a maximum value of $25,000, down from $500,000. “If you talk to the typical small business out there, there’s a very high level of frustration,” certified public accountant Doug Bekker says. ABC News/The Associated Press (4/9)

Small Business Report Plan Cost Hikes

Ninety-one percent of small businesses surveyed by the National Small Business Assn. (NSBA) were hit with cost increases during their most recent health insurance renewal. Twenty-five percent were hit with increases exceeding 20%. NSBA President Todd McCracken said, “These costs have real-world implications: one-third of small businesses held off on hiring a new employee and more than half say they held off on salary increases for employees.”

While the majority of employers say that offering health insurance is very important to recruiting good employees, just 51% of the smallest firms offer health benefits. Among the 70% of small firms that offer health insurance, the majority pay for more than half of the cost of their employees’ plans.

The average monthly per-employee cost of health insurance premiums for a small firm is $1,121 compared to just $590 in 2009. Small businesses spend an average of 13 hours and $1,274a month on the administrative side of understanding the Affordable Care Act. For more information, visitwww.nsba.biz

Last Updated 01/13/2021

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