Pennsylvannia PA Health Care Information

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Information For Sole Proprietors and Small Businesses (50 employees or less)

  • Affordable Care Act (ACA) requires healthcare coverage through individual mandates and employer shared responsibility.
  • Small businesses with fewer than 50 employees are exempt. Other Exemptions: Individuals who cannot afford coverage (insurance premium is more than 8% of their annual income); Taxpayers with income below the filing threshold; Members of Indian tribes; Hardship and more. See
  • Individuals must obtain health insurance by January 1, 2014 and are eligible for Premium Assistance Subsidies (tax credits for individuals). Failure to purchase insurance may result in penalties. Note that employees who are offered coverage by an employer are not eligible for premium credits unless: the employer plan does not have an actuarial value of at least 60% or if employee share of the premium exceeds 9.5%.
  • Shared Responsibility Provision: calls for each individual (including self-employed) to have minimum essential coverage, qualify for an exemption, or make a shared responsibility payment (penalty) when filing a federal income tax return.
  • Full Time Equivalent Employee (FTE). FTE is defined as an employee who works on average 30 hours per week or more. A combination of employees, each of whom individually is not a full time employee because they are not employed at least 30 hours per week, but who, in combination are counted as the equivalent of a full time employee. Please consult a professional on determining FTE.
  • Options on purchasing insurance: Conduct a census on employees and determine current coverage; obtain quotes from current private insurance; contact chambers, business associations and insurance brokers for quotes; research insurance available to employees (and owners) through the federal marketplace. Determine how employees are currently covered there may be spousal coverage, Medicaid or Medicare eligible employees
  • Obtain insurance through the Small Business Health Options Program (SHOP)
  • Employees may obtain insurance through federal marketplace (exchange)
  • Maintain your current private insurance
  • Contact chambers, business associations, insurance brokers

This information is intended as an overview of the PPACA for small businesses with less than 50 employees. It is for educational purposes only and not intended as a legal, tax, or insurance advice. Readers should consult their legal, tax, or healthcare advisors to discuss how these matters relate to their individual business circumstances. Note that this information is subject to change. Please subscribe for updates.

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