As an employer, are you feeling overwhelmed trying to keep up with the ever-evolving Affordable Care Act (ACA) regulations? You’re not alone. Managing compliance, staying ahead of deadlines, and avoiding penalties can feel like a full-time job, especially when ensuring your employees have proper health coverage.
ACA rules are complex and constantly changing, leaving many business owners wondering how to stay compliant without drowning in administrative tasks. The stakes are high: non-compliance can lead to steep financial penalties and even reputational harm.
At Lift HCM, we’ve helped countless businesses like yours tackle ACA compliance with confidence. With years of experience in payroll, human capital management, and benefits, we know the ins and outs of ACA regulations. In this guide, we’ll demystify the key requirements and provide actionable steps to help you navigate ACA compliance smoothly—saving you time, money, and stress.
Table of Contents
- What is the Affordable Care Act (ACA)?
- Who Needs to Be ACA Compliant?
- Key Employer Responsibilities Under the ACA
- ACA Safe Harbor Methods
- ACA Notification Requirements
- Common ACA Compliance Mistakes to Avoid
- Staying Ahead of ACA Compliance with Lift HCM
What is the Affordable Care Act (ACA)?
The Affordable Care Act, or ACA, is a comprehensive healthcare reform law enacted in 2010. Its goal is to expand healthcare access, improve quality, and reduce costs. For employers, the ACA includes mandates to offer affordable health insurance that provides minimum essential coverage to employees—or face penalties.
Who Needs to be ACA Compliant?
ACA compliance primarily applies to Applicable Large Employers (ALEs), defined as businesses with 50 or more full-time equivalent employees. ALEs must:
- Offer health insurance meeting ACA standards.
- Report their compliance to the IRS annually.
Even smaller businesses should pay attention if they plan to grow or already offer voluntary health benefits. Knowing the rules in advance helps avoid future compliance headaches.
📌 Pro Tip: Use the FTE Employee Calculator on HealthCare.gov to determine if your business qualifies as an ALE.
Key Employer Responsibilities Under the ACA
Here are the essential compliance requirements every employer needs to understand:
1. Offering Affordable, Minimum Essential Coverage
Under the ACA:
- Minimum Essential Coverage: ALEs must offer health insurance that covers at least 95% of their full-time employees and their dependents.
- Affordability: An employee’s share of premiums cannot exceed 8.39% (2024) of their household income.
- Minimum Value: Plans must cover at least 60% of the total cost of medical services.
2. Reporting to the IRS
To ensure compliance, employers must file two important forms with the IRS annually:
- Form 1094-C:This is the transmittal form for your ACA reporting.
- Form 1095-C:This form provides detailed information about the health coverage offered to each eligible employee.
These forms must be submitted to the IRS and distributed to employees by specific deadlines each year.
3. Avoiding Penalties
Failing to offer qualifying coverage or missing reporting deadlines can result in the Employer Shared Responsibility Payment (ESRP). There are two types of penalties under Section 4980H:
1. 4980H(a) Penalty: Applies if the employer does not offer coverage to at least 95% of full-time employees and their dependents. For 2024, the annual penalty is $2,970 per full-time employee, excluding the first 30 employees.
2. 4980H(b) Penalty: Applies if the employer offers coverage, but it is either unaffordable or does not provide minimum value. The penalty is calculated monthly and, for 2024, amounts to $4,460 annually per full-time employee receiving the premium tax credit.
Quick Tip: To avoid penalties, employers must track their employees' hours diligently and ensure health coverage is both affordable and meets minimum essential coverage requirements.
ACA Safe Harbor Methods
One of the challenges of the ACA is determining whether the health coverage you offer to employees is considered affordable. The affordability of your plan is a critical compliance factor. Thankfully, the ACA includes several Safe Harbor options that allow employers to measure the affordability of their health plans without needing to know the actual household income of their employees.
The three main ACA Safe Harbor methods are:
1. W-2 Safe Harbor
Under the W-2 Safe Harbor, employers can determine affordability by looking at each employee's W-2 wages. To qualify, the employee's share of the premium for the lowest-cost self-only coverage must not exceed 9.83% (2021) or 8.39% (2024) of their W-2 wages for the calendar year.
Example: If an employee earns $40,000 annually, their contribution to the health insurance premium must be less than $3,356 in 2024 to meet the affordability threshold.
2. Rate of Pay Safe Harbor
This method allows employers to calculate affordability based on an employee's hourly wage rate multiplied by 130 hours per month (representing full-time employment). The employee's monthly premium contribution must be less than or equal to 8.39% of this monthly wage calculation for the health plan to be considered affordable.
Example: For an employee earning $15 per hour, the affordability threshold is $15 x 130 hours = $1,950 per month. Therefore, the employee’s monthly premium contribution must be less than $163.51 to satisfy the ACA’s affordability requirement in 2024.
3. Federal Poverty Line Safe Harbor
The third Safe Harbor is based on the federal poverty line (FPL) for a single individual. If the employee’s contribution for self-only coverage does not exceed 8.39% of the federal poverty line, the coverage is deemed affordable. This Safe Harbor is advantageous for employers with lower-wage employees, as it sets a clear, low-cost premium contribution threshold.
For 2024, the FPL for a single individual is estimated to be around $14,580. Therefore, the maximum monthly contribution under this Safe Harbor would be approximately $101.98.
ACA Notification Requirements
In addition to offering affordable coverage and meeting reporting requirements, employers must also comply with certain ACA notification requirements to ensure employees are properly informed about their healthcare options.
1. Marketplace Notice
Employers must notify all new employees about the Health Insurance Marketplace (or Exchange). This notice explains:
- The existence of the Marketplace.
- How employees can access it.
- Their potential eligibility for premium tax credits if the employer’s health plan is unaffordable or doesn’t meet minimum essential coverage requirements.
When: Within 14 days of an employee’s start date.
How: Notices can be delivered via mail, electronically, or included in the onboarding process.
2. Summary of Benefits and Coverage (SBC)
Employers are required to provide employees with a Summary of Benefits and Coverage (SBC), which:
- Offers clear, concise details about the health plan’s coverage and costs.
- Helps employees make informed choices during open enrollment or when selecting a plan.
When: At open enrollment, plan renewal, or upon employee request.
How: Can be delivered electronically or in print.
3. Notice for Employees Who Decline Coverage
If employees choose not to enroll in the employer-sponsored health plan, employers must inform them about other coverage options, particularly their ability to seek insurance through the Marketplace.
These notification requirements are crucial for compliance and for ensuring employees understand their options.
Common ACA Compliance Mistakes to Avoid
Even well-meaning employers can make mistakes when it comes to ACA compliance. Here are some common pitfalls and how to avoid them:
- Missing Reporting Deadlines: Filing late or failing to distribute forms to employees on time can result in significant penalties.
- Offering Inadequate Coverage: If your health plan doesn’t meet ACA standards, you may face penalties—even if you offer coverage.
- Misclassifying Employees: Misclassifying full-time employees as part-time or contractors can lead to underreporting and noncompliance issues.
- Not Keeping Proper Documentation: Accurate record-keeping is essential for proving compliance if you’re audited by the IRS.
Staying Ahead of ACA Compliance with Lift HCM
Navigating ACA compliance has never been more manageable. With the right tools and expert support, you can transform a stressful process into a streamlined, manageable task. At Lift HCM, we specialize in helping businesses meet their ACA obligations, from reporting to employee tracking.
Confused about ACA compliance? Don’t navigate it alone. Contact Lift HCM today for expert guidance on reporting, employee tracking, and health plan selection. Let us help you stay compliant while saving time and avoiding penalties. Schedule Your Free Consultation.
