The Internal Revenue Service (IRS) recently issued Revenue Procedure 2020-36 which indexes the contribution percentages for 2021 for purposes of determining affordability of an employer’s plan under the Affordable Care Act (ACA). For plan years beginning on or after January 1, 2021, employer-sponsored coverage will be considered affordable if the employee’s required contribution for self-only coverage does not exceed 9.83 percent of the employee’s household income for the year for purposes of the employer shared responsibility rules. This is an increase from the 2020 affordability threshold percentage of 9.78%. The 2021 increase in the affordability percentage for employer shared responsibility purposes means that employers can charge employees a slightly higher price for their health benefits to meet the “affordability” test.
Since an employer would not know an employee’s household income, IRS Notice 2015-87 confirmed that ALEs using an affordability safe harbor may rely on the adjusted affordability contribution percentages if they use one of three affordability safe harbor methods. The three safe harbors to measure affordability are Form W-2 wages from that employer, the employee’s Rate of Pay or the Federal Poverty Line (FPL) for a single individual. 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.
Below is an example of how the percentage change impacts an employer’s monthly affordable amount using the three safe harbor tests. The example assumes an employee earns $11/hour.
*Based on Jan. 2019 FPL of $12,490 for 2020 and Jan. 2020 FPL of $12,760 for 2021
Under the ACA, employees (and their family members) who are eligible for coverage under an affordable employer-sponsored plan are generally not eligible for the premium tax credit from the Exchange. This is significant because the ACA’s employer shared responsibility penalty for applicable large employers (ALEs) is triggered when a full-time employee receives a premium tax credit for coverage under an Exchange.