Navigating ACA: Unraveling Requirements, Eligibility, and Impacts on Healthcare
Discover how Liferaft's strategic role and HRA offerings align with ACA stipulations to enhance employee well-being while ensuring compliance.
August 24, 2023
The abbreviation ACA stands for the Affordable Care Act, a pivotal legislation that extends health insurance coverage to the uninsured population while introducing crucial reforms to the health insurance market. The ACA encompasses two critical components for businesses mandated to provide health insurance:
1. Minimum Essential Coverage (MEC): These plans are accessible through state or federal exchanges.
2. Affordability: The Internal Revenue Service (IRS) has established an affordability threshold for businesses to avoid the "Schedule B Penalty."
Liferaft plays a significant role in tailoring your company's Individual Coverage Health Reimbursement Arrangement (ICHRA) to guarantee that the reimbursement levels align with the affordability metric outlined by the IRS. This strategic alignment ensures that your business meets the essential criteria and avoids penalties, all while optimizing the benefits of your ICHRA offering.
The ACA marketplace, also known as the health insurance exchange, is a platform where individuals and families can shop for and purchase health insurance plans. To be eligible to buy insurance through the marketplace, you generally need to meet the following criteria:
It's important to note that the specific eligibility criteria and rules can vary by state, and changes to these criteria can occur due to legislation or policy updates.
The ACA has significantly increased the number of Americans with health insurance coverage. Firstly, it brought about a notable increase in coverage rates by introducing the health insurance marketplace and expanding Medicaid. Millions who previously lacked coverage gained access to affordable plans through these channels.
Secondly, the ACA's impact on healthcare costs is multifaceted. While it initiated efforts to control healthcare expenses by promoting efficient care delivery and electronic health records, debates persist about its complete cost-containment efficacy. The mandate for preventive services and essential health benefits without cost-sharing has spurred improved health management.
A Health Reimbursement Arrangement (HRA) satisfies businesses' requirements to offer affordable health insurance. By incorporating an HRA, you fulfill regulatory requirements and establish a comprehensive healthcare strategy that aligns employee well-being with your financial goals.
Within the framework of an HRA, careful attention is needed to establish a reimbursement budget that adheres to specific requirements, namely Minimum Essential Coverage (MEC) and affordability. MEC ensures that the health plans offered encompass essential benefits, while affordability ensures a harmonious balance between insurance offerings and employees' financial capacities.
The Liferaft platform verifies employees are enrolled in individual healthcare plans and consistently pay their premiums. Our team of licensed health insurance agents is available to assist your employees with the enrollment process. Depending on your state, Liferaft has a network of licensed agents to help with employee enrollment, making the process smoother and tailored to local regulations.
The "Schedule B Penalty" is related to the affordability requirement set by the IRS for businesses offering health insurance. Companies might face penalties if the insurance offered is not affordable according to IRS criteria. Liferaft's role in tailoring Individual Coverage Health Reimbursement Arrangements (ICHRA) helps ensure that reimbursement levels align with affordability metrics, assisting businesses to avoid these penalties.
Minimum Essential Coverage (MEC) health plans offered through exchanges include various essential benefits such as preventive services, emergency services, prescription drugs, maternity and newborn care, mental health services, and more. These benefits ensure comprehensive coverage for individuals.
In the Liferaft platform, employees submit documentation every month showing proof of payment for their insurance premium charges, ensuring that the plan is still active.
Government programs like Medicaid, Medicare, and CHIP (Children's Health Insurance Program) could render an individual ineligible to purchase insurance through the ACA marketplace. Additionally, being incarcerated, not a U.S. citizen, or a lawfully present immigrant could impact eligibility.
The ACA's mandate for preventive services and essential health benefits without cost-sharing has improved health management. Individuals have better access to preventive care, leading to earlier detection and management of health issues, ultimately contributing to healthier populations.
Our team knows the ins and outs of the health insurance marketplace and will guide you towards the solution that make the most sense for your business and your team. Come with questions! Our experts are happy to dig into the details to get you the clarity you need.
During the call, Liferaft will run a cost-benefit analysis on your company's current healthcare spending and show you different ways you can save—without sacrificing plan quality. After your consult, Liferaft will design a unique plan for your employee's health insurance, including suggested plans and accounts, plan policy documents, and the annual budget.
