On August 16, 2022, the IRS updated its FAQs on the Affordable Care Act’s (ACA) employer shared a responsibility (pay or play) rules to include updated penalty amounts for 2023. The adjusted $2,000 penalty amount is $2,880 and the adjusted $3,000 penalty amount is $4,320.
Pay or Play Penalty Calculations
An applicable large employer (ALE) is only liable for a penalty if at least one full-time employee receives a subsidy for Exchange coverage. Employees who are offered affordable, minimum value coverage are generally not eligible for these subsidies.
Depending on the circumstances, one of two pay or play penalties may apply – the 4980H(a) penalty or the 4980H(b) penalty.
Under Section 4980H(a), an ALE will be subject to a penalty if it does not offer coverage to “substantially all” (generally, at least 95%) of its full-time employees (and dependents) and any full-time employee receives a subsidy toward their Exchange plan. The monthly penalty assessed under Section 4980H(a) is equal to the ALE’s number of full-time employees (minus 30) multiplied by one-twelfth of $2,000 (as adjusted) for any applicable month.
Under Section 4980H(b), ALEs offering coverage to substantially all full-time employees (and dependents) may still be subject to a penalty if at least one full-time employee obtains and Exchange subsidy because the ALE did not offer coverage to all full-time employees, or the ALE’s coverage is unaffordable or does not provide minimum value. The monthly penalty assessed under Section 4980H(b) for each full-time employee who receives a subsidy is one-twelfth of $3,000 (as adjusted) for any applicable month. However, the total penalty is limited to the 4980H(a) penalty amount.
On August 16, 2022, President Joe Biden signed the Inflation Reduction Act into law. While this law is primarily aimed at fighting inflation and reducing carbon emissions, it also contains a number of reforms that will impact health coverage. These reforms have staggered effective dates and will be implemented over the next several years.
Overview of the New Health Reforms
The health reforms primarily impact those with Medicare coverage. Specifically the law implements the following measures:
Insurance services provided by CoverEase Insurance Services, LLC and its licensed agents and affiliates. The information contained within these materials are confidential and not to be distributed. Descriptions are general in nature only. Please refer to the terms and conditions of policies offered or purchased. Insurance products are subject to application and underwriting requirements. Pricing depends on a variety of factors including policyholder location. Not all discounts available in all states. Not all products available in all states. Use of and access to this information, site or any of the links contained within this site does not create a relationship between the user and CoverEase. © 2022 CoverEase, Inc. All Rights Reserved.