Through The End of 2015
These provisions affect businesses with 50 or fewer workers and were classified as a “small group” market. Starting Jan. 1, 2016, that “small group” classification expands to companies with 2-100 employees, and companies with 50 or more employees must provide health insurance for their workers.
Businesses that previously had access to “large group” benefits must move to ACA-compliant plans in 2016.
About 64 percent of businesses in groups with 51-100 employees will see premiums rise in 2016, according to an analysis by
Blue Cross Blue Shield Foundation.
On Average,
Small businesses pay about 18 percent more than large firms for the same health insurance policy, according to the National Conference of State Legislatures.
Starting in 2016, small business with up to 100 employees can use the
SHOP marketplace — Small Business Health Options Program — to get lower costs on group plans and claim tax credits. The program gives small businesses the buying power that only large businesses had in the past.
There is no restricted enrollment period when businesses can start offering a SHOP plan to employees.
Massachusetts has its own SHOP website to help small businesses find employee coverage and apply for tax credits.
What It Means For Small BusinessesThe change will mean leaner health plan benefits as costs will likely increase — up to 30-40 percent for some, according to
OrgOrg.co. Rate structures will become age-banded and community rated.
One way small businesses can deal with this change is pooling together with other small groups for “big company” leverage and savings.
Another Option
For a company with less than 100 employees move to a self-insured or partially self-insured model. However, such plans can have cost volatility and increased risk.
If moving to an ACA-compliant plan, small businesses should be aware of high risk factors, OrgOrg points out, such as if they employ a lot of older workers with serious ongoing medical conditions. In those cases, a community rating could benefit the company.
Changes For Individuals
Open enrollment for for individuals in 2016 starts Nov. 1, 2015, according to
Healthcare.gov, with coverage starting Jan. 1, 2016. Open enrollment ends Jan. 31, 2016.
People who don’t enroll in a 2016 plan by Jan. 31, 2016 can’t enroll in a health insurance plan for 2016 unless they qualify for a special enrollment period. Certain life events such as marriage, birth of a child or loss of other health coverage can open a 60-day window for enrollment.
People without healthcare coverage in 2016 may have to pay a fee, which is higher in 2016 than it was in 2015.
Without Coverage in 2016, the Fee is The Higher of These Two Amounts:
• 2.5 percent of your yearly household income
• $695 per person ($347.50 per child under 18)
The fee is adjusted for inflation in future years. The fee is paid on the federal income tax return filed for the year you don’t have coverage.
