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Figure 10:
Considerations by Business Size
Employer Size
≤
25 FTEs
May be eligible for Small Employer Tax Credits
1-50
• Considered small employer
• Eligible to participate in SHOP
• No shared responsibility payment if less than 50 FTEs
• Benefit plans must comply with Essential Health Benefits requirements
and Actuarial Value/Metal level requirements
51-100
• Considered small employer beginning 1/1/2016 (or earlier at state option)
• Eligible to participate in SHOP beginning 1/1/2016 (or earlier at state option)
• Benefit plans must comply with Essential Health Benefits requirements and Actuarial
Value/Metal level requirements beginning 1/1/2016 (or earlier at state option)
• Beginning Jan 1, 2016, the shared responsibility payment applies if the size is at least
50 FTEs
100+
• May be eligible to participate in SHOP beginning 1/1/2017
• Beginning in 2015, the shared responsibility payment applies if the size is at least
100 FTEs
For the first time, employees who do not have access to employer-sponsored coverage will
have available health insurance options in the new market, regardless of their health status or
pre-existing conditions.
Small Business Tax Credits
Small employers purchasing employee benefits through the SHOP Marketplace may receive
tax credits for up to 50 percent of the cost of providing employer-sponsored health coverage
These tax credits may offer a cost-effective way to boost total workforce compensation.
Advance Premium Tax Credits (APTC)
Employees with household incomes between 100 percent and 400 percent of the federal
poverty level (FPL) may be eligible for tax credits through the Health Insurance Marketplace,
making coverage cheaper through the Health Insurance Marketplace rather than their
employer. However, employer-sponsored insurance (ESI) affects employee eligibility for
available tax credits, and could determine whether employees will receive credits, as well as
whether their employer is penalized. The table below shows employees’ eligibility for subsidies
based on the available ESI coverage.
4
Federal
Premium Tax
Credits
3
Guaranteed
Issue in the
Individual Market
