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ACA Affordability Percentage Takes a Dip in 2020

Jul 22, 2019 blog featured image

Today, the Internal Revenue Service issued Rev. Proc. 2019-29 which contains the 2020 contribution percentage for purposes of determining whether an employer-sponsored group health plan is considered affordable to an employee. This determination has two implications:

  • Employees who have access to affordable health coverage generally are not eligible for a premium tax credit through Affordable Care Act’s public marketplace exchange.
  • Large employers who are subject to the employer shared responsibility rule (aka the employer mandate or the “pay or play” mandate) must offer affordable coverage to their full-time employees or may be subject to a penalty.

For plan years beginning in 2020, a group health plan will be considered affordable if the employee’s contribution for self-only coverage does not exceed 9.78% of the employee’s household income. This is down from 9.86% of household income in 2019.

Because employers do not generally have access to an employee’s household income, the IRS developed three safe harbors employers can use to measure the affordability of their coverage. The three safe harbors an employer can use are: Form W-2 wages, the federal poverty level for a single individual, or the employee’s rate of pay.

The affordability test applies only to the portion of the annual premiums for self-only coverage and does not include any additional cost for family coverage. Also, if an employer offers multiple health coverage options, the affordability test applies to the lowest-cost option that also satisfies the minimum value requirement.

Employers should take this affordability threshold into consideration as they develop their 2020 contribution strategies. Reach out to your Hylant representative with any questions you have.

Author Holly Wahl, Hylant Vice President, Employee Benefits Compliance Leader