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Does the ACA Require My Employer to Offer Me Health Insurance?

By Nate Herpich


We addressed whether all Americans have to buy health insurance under the Affordable Care Act (ACA) -- in short, the answer is "yes they do." But what does the new law say about your employer's responsibility to offer you a plan directly?

Here's what the law says, in basic terms -- employers who have more than 50 full-time employees must offer health insurance that meets ACA minimum coverage criteria, or face a tax penalty from the federal government.

The minimum criteria is defined this way:

The coverage must be affordable, meaning an employee's share of the premium costs (for employee-only plans) cannot exceed 9.5 percent of their yearly household income.

The coverage must also provide "minimum value", meaning that the plan's share of its total covered service is at least 60 percent. (Check out this article from Health Affairs blog to learn more about how this is calculated).

Those employers with 50+ full-time employees who fail to offer insurance will be penalized through a tax payment called an Employer Shared Responsibility Payment (ESRP). ESRPs are $2000 per full-time employee if a large company fails to offer insurance at all (excluding the first 30 workers). If they do offer coverage to their employees, but it doesn't provide "minimum value," the company will be penalized $3000 per employee who qualifies for premium assistance through Health Insurance Marketplaces.

Of course, if your company isn't compelled to offer you insurance, and doesn't, what's really important is to sign up through the ACA's Health Insurance Marketplaces. This blog explains how to best prepare for that process.

An important note regarding signing up for Marketplace-based insurance: Due to the much publicized problems with ACA websites, the deadline for signing up for plans with coverage beginning on January 1, 2014 has been extended from December 15, 2013, to December 23.

Source: HealthCare.gov

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The Reeve Foundation Paralysis Resource Center Information Specialists are reachable business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9:00 am to 5:00 pm Eastern U.S. Time. International callers use 973-467-8270. You may also schedule a call or send a message online.

The information provided in the Paralysis Resource Center was supported by Cooperative Agreement number 1U59DD000838-01 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the Reeve Foundation and do not necessarily represent the official views of the CDC.