Group Health Insurance Experts

The Affordable Care Act

For more questions on Healthcare Reform and/or the Affordable Care Act, please contact us at (502) 339-7980 or email us.


What is the Affordable Care Act? It is an extensive new law that is being implemented to insure all U.S. Citizens and legal residents have access to affordable healthcare insurance.  In fact, the new law mandates that individuals and employers face hefty penalties for non-compliance. Following are just a few highlights of the implications of the ACA that employers, employees and individuals under 65 should be aware of: 


Essential Benefits: To be in compliance with the new healthcare reform laws and avoid costly penalties, you must purchase insurance coverage that pays at least 60% of the costs of the following "essential benefits".   






-Prescription drugs

-Rehabilitative and habilitative services and devices

-Preventive and wellness services and chronic disease management

-Pediatric services, including oral and vision care  

-Ambulatory patient services

-Emergency services


-Maternity and newborn care

-Mental health and Substance use disorder services

Tax Penalties:  Beginning in 2014, individuals must obtain qualifying coverage either through an individual policy or through their employer.  Beginning in 2015, both small and large employers will also be impacted by the new law as well and could be penalized for not “directly” providing qualifying benefits to their employees. 

Penalties for Individuals and Families (the Individual Mandate)

In 2014, the penalty for individuals (for each family member) will be $95 for adults ($47.50 for a child) or 1% of household income, whichever is greater.

In 2015, penalty rises to $325 per adult and $162.50 per child (up to $975 for a family) or 2% of family income, whichever is greater.  

In 2016 it jumps to the greater of $695 for adults ($347.50 for a child) or 2.5% of income.  

Currently, the maximum family penalty in 2016 is the greater of 2.5% of income or three times the per-adult penalty ($2,085).    


The Employer Mandate

Beginning in 2015, if you have 50 or more full-time equivalent employees, and do not offer health coverage to them,  and at least one employee receives a premium tax credit/cost sharing subsidy in the exchange, your tax penalty is $2,000 annually multiplied by the number of full-time employees (excluding the first 30 employees).   The penalty is increased each year by the growth in insurance premiums.


NOTE:  The above is just a few highlights of the implications of the ACA.  We highly recommend you call our office for more information.