How Does the Affordable Care Act (Obamacare) Affect My Business?


How the Affordable Care Act will affect your business depends, in part, on the size of your business. If you are a business that has 50+ employees then you have certain requirements regarding proving health insurance or paying a penalty. If you are an employer who has less than 50 employees, there are some tax credit opportunities available to you if you do provide health insurance to your employees.

© 2014 Parsonage Vandenack Williams LLC

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IRS Releases Guidance RE: ACA’s Effect on HRAs and HSAs

The Affordable Care Act creates rules that could affect special employer healthcare plans like HRAs and HSAs. It requires that health plans provide certain preventive services without imposing cost-sharing. It also prevents health plans from setting annual limits on certain benefits. However, HRAs and HSAs typically cap benefits and may not provide preventive care. Thus, it was not clear whether such HRAs and HSAs would be allowed under the Act.

The IRS has recently announced rules that resolve this issue in some cases. Specifically, the guidance provides rules on when an HRA or HSA will be “integrated” with a group health plan. If the HRA or HSA is integrated with a group health plan, it will not violate the ACA. The rules create safe harbors under which employer HRAs or HSAs will satisfy the Act. Employers offering HRAs or HSAs need to review these rules to decide whether their plans satisfy the new safe harbors. Because of the nature of most HRAs and HSAs, many employers may need to revise these plans.

© 2013 Parsonage Vandenack Williams LLC

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New IRS Guidance Clarifies Tax Treatment of HSAs

Health savings accounts (HSAs) are a useful tool for employees and employers because of their tax-favored status. The IRS has recently clarified that certain Affordable Care Act rules will not affect the tax treatment of HSAs.

An HSA must be paired with a high-deductible health plan (HDHP) to receive tax-favored treatment. The Affordable Care Act requires health plans to provide certain preventive services with no deductible or cost-sharing. There was some concern that this rule would result in loss of HDHP status with the effect of HSAs losing tax favorable treatment. The IRS, however, has indicated that HDHPs will not lose their status as HDHPs solely because they offer the preventive services required by the Affordable Care Act. Thus, HSAs will still be a strong, tax-favored tool for dealing with medical expenses.

© 2013 Parsonage Vandenack Williams LLC

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Employers with group health plans need to provide Medicare Part D notices of creditable or non-creditable coverage to Medicare-eligible individuals by November 15, 2009.  Employers can satisfy this requirement by including the notice in enrollment materials or in separate mailing during the fall. When preparing materials for distribution this fall, employers should be aware of revised model notices provided by the Centers for Medicare & Medicaid Services (“CMS)”.


The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 requires group health plans that provide prescription drug coverage to disclose to individuals eligible for Medicare Part D whether their coverage is “creditable.”  Basically, prescription drug coverage is considered “creditable” if it is at least actuarially equivalent to (i.e., at least as good as) the Medicare Part D coverage. This disclosure is very important because individuals who do not enroll in Medicare Part D when first eligible and who have gone more than 63 days without creditable coverage generally will have to pay higher premiums permanently when they finally enroll. Thus, individuals need to know the status of their group health plan coverage in order to make an informed decision about enrolling in Part D.

Notices regarding whether prescription drug coverage is creditable or non-creditable must be provided –

  • prior to the start of the annual Part D enrollment period (November 15 through December 31 of each year);
  • prior to an individual’s initial enrollment period for Part D;
  • prior to the effective date of coverage for a Part D-eligible individual who joins an employer plan;
  • when an employer’s prescription drug coverage ends or changes status as creditable coverage; and
  • upon a beneficiary’s request.

The deadline for providing annual creditable coverage notices this year is November 15.

Revised Notices Posted

Earlier this year, CMS posted revised model notices and updated guidance regarding creditable coverage disclosures. The changes to the model notices and guidance are minimal.  CMS recommends, but does not require, that personalized notices be provided upon request to enable individuals to show proof of prior creditable coverage when enrolling in a Part D plan.

What Information is Required in the Creditable Coverage Notification?

The information must explain whether the plan sponsor’s prescription drug coverage is creditable. If the coverage is not creditable, this information must also explain that there are limitations on the periods during the year in which the individual may enroll in a Medicare drug plan and that the individual may be subject to a late enrollment penalty.

What Should Employers Do to Comply with the CMS Rules?

It is important for employers to review their current notices and determine whether any changes or updates need to be made so that they are in compliance with the CMS requirements.  If you have any questions in regard to determining whether your group health plan is creditable or non-credible, or in regard to the notice process in general, you should consult your attorney.

© 2009 Parsonage Vandenack Williams LLC

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MGMA Releases Proposed 2010 Medicare Physician Fee Schedule Analysis –

The Centers for Medicare & Medicaid Services (“CMS”) recently released the 2010 Medicare proposed physician fee schedule along with a related press release and fact sheet. The regulation includes provisions that confirm a 21.5 percent reduction in 2010 Medicare physician payments unless Congress enacts legislation to reverse this cut.  The regulation also proposes to “remove physician-administered drugs from the definition of “physician services” for purposes of computing the physician update formula in anticipation of enactment of legislation to provide fundamental reforms to Medicare physician payments,” a move that has been advocated by the Medical Group Management Association (“MGMA”) for a long time.

MGMA analyzed the regulation’s impact on medical group practices and is making its analysis available only to members at The proposed fee schedule includes provisions that would affect physician practices as follows:

  • Start implementation of the congressionally-mandated requirement that suppliers of advanced diagnostic imaging services become accredited
  • Notably change the practice expense relative value units for many covered services
  • Increase the equipment usage assumption for equipment costing greater than $1 million
  • Transfer responsibility from the patient to the Medicare program for co-payments for covered outpatient mental health services
  • Add a group practice reporting option to both the Physician Quality Reporting Initiative and the E-Prescribing Incentive Program

 The member-only analysis can be accessed here:

© 2009 Parsonage Vandenack Williams LLC

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