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Medical equipment in a doctors office, file photo. REUTERS Lucas Jackson

Employer health insurance coverage may turn on employee income

2/22/2013 COMMENTS (0)

By Terry Baynes

Feb 22 (Reuters) - Under the Affordable Care Act, employers only have to provide health insurance to some of their employees, said lawyer Charles Wachsstock in a webcast sponsored by the Practising Law Institute on Thursday.

Many employers may think that they will have to offer insurance to all of their employees or face penalties under the new healthcare law, but that's not the case, according to Wachsstock, who discussed the issue in a continuing legal education seminar, "Health Care Reform: An Employer's Essential Guide."

During the online talk, Wachsstock, an employee benefits lawyer at Debevoise & Plimpton, presented some innovative approaches that employers and their legal advisors are considering for complying with healthcare reform and controlling costs.

One option for employers who do not currently provide health insurance to their employees is to analyze their obligations based on employee income, according to the presentation.

Under the new law, the employer penalty is only triggered if an employee receives a tax credit for buying insurance on a government-run exchange. But only people who earn four times the federal poverty level or less qualify for that tax credit. As a result, employers only have to provide coverage for employees who earn up to that amount to avoid penalties, said Wachsstock.

For a single employee without a family, that cutoff would be an annual income of $45,960, according to one slide in the presentation. Employers can refuse to cover single workers who earn more than that amount without incurring the penalty.

Wachsstock also noted what he called a "mind-boggling" dynamic in the law. Under the employer mandate, employers can charge employees up to 9.5 percent of their household income for health insurance coverage. Under the individual mandate, however, employees don't have to buy health insurance through their employer if it costs more than 8 percent of their household income.

Instead, the employee may try to buy insurance on a government-run exchange. However, the employee won't be eligible for the tax credit for buying insurance on the exchange because employer coverage is an option.

The employee and his or her family may get a better deal on health insurance through an exchange if they are not offered coverage through an employer.

(The original version of this story misspelled Charles Wachsstock's name.)

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