IRS Guidelines – Indexed for 2025
FICA Social Security Tax is 6.2% on income up to $176,100 Medicare Tax unlimited 1.45% to Unlimited ACA Affordability — The ACA benchmark for determining the affordability of employer-sponsored health coverage will drop significantly to 9.02% of an employee’s household income for the 2025 plan year. High Deductible Health Plans Minimum Annual Deductible (Individual/Family) $1,650 / $3,300 […]
IRS Guidelines – Indexed for 2024
FICA Social Security Tax is 6.2% on income up to $168,600 Medicare Tax unlimited 1.45% to Unlimited ACA Affordability — The ACA benchmark for determining the affordability of employer-sponsored health coverage will drop significantly to 8.39% of an employee’s household income for the 2024 plan year. High Deductible Health Plans Minimum Annual Deductible (Individual/Family) $1,600 / $3,200 […]
Florida PBM Reform is Here
Effective July 1, 2023 the Florida legislation reshapes the PBM landscape, requiring that PBMs pass through 100% of all manufacturer rebates to plan sponsors, while prohibiting spread pricing, clawbacks, mail order mandates, affiliate-only networks, and other practices that have long been status quo for many in the pharmacy industry. Florida SB 1550 requires that entities […]
CAA 2023 Allows for Telehealth Relief
The Consolidated Appropriations Act, 2023 (CAA23) was signed into law on December 23, 2022. One of the health provisions contained in the law was the relief on telehealth coverage offered through HSA Qualified High Deductible Health Plans (HDHPs). Typically, HSA-qualified HDHPs cannot pay for covered services, except for specified preventive care, until the individual satisfies […]
IRS Guidelines – Indexed for 2023
FICA Social Security Tax is 6.2% on income up to $160,200 Medicare Tax unlimited 1.45% to Unlimited Individual Mandate’s Affordability Exemption — required contribution percentage is 8.17%. High Deductible Health Plans Minimum Annual Deductible (Individual/Family) $1,500 / $3,000 Maximum Out-of-Pocket Limit (Individual/Family) $7,500 / $15,000 Health Savings Accounts Individual / Family $3,850 / $7,750 Catch-up Contribution […]
Significant Change in ACA Affordability
The Affordable Care Act (ACA) benchmark for determining the affordability of employer-sponsored health coverage will significantly decrease to 9.12% of an employee’s household income for the 2023 plan year. This is a significant decrease from the 2022 level of 9.61%. This affordability percentage affects an individual’s eligibility for federally subsidized coverage from a marketplace exchange. It also […]
Medicare Secondary Payer Penalty
The U.S. Department of Health and Human Services (HHS) has increased the following penalty affecting group health plans: Medicare Secondary Payer (MSP): Violating the prohibition of offering Medicare beneficiaries financial or other benefits as incentives not to enroll in or to terminate enrollment in a group health plan that would otherwise be primary to Medicare will now […]
Employers’ premium surcharges for unvaccinated employees could result in ACA penalties
Employers are considering vaccine incentives and potential penalties for workers who remain unvaccinated against COVID-19. Before adding a premium surcharge, employers will want to consider how they may impact the affordability of an employer’s health plans. While there is an exception for tobacco, there’s nothing currently in the ACA rules that similarly applies to a […]
CMS warning Hospitals on price transparency failure
(Read EBA’s Health Care Transparency December 8, 2020 blog for background.) Centers for Medicare & Medicaid Services has started issuing warning letters to hospitals not in compliance with the hospital price disclosure rule. The purpose of the rule, effective Jan 1., is to make hospital pricing information readily available to patients to compare costs and […]
COBRA and The American Rescue Plan Act
The American Rescue Plan Act of 2021 (“ARPA”) includes major changes to COBRA administration in 2021. The Act creates an opportunity for free COBRA coverage during a six-month period from April through September 2021 for employees (and their family members) who experience a loss of group health coverage due to involuntary termination or reduced hours […]