The 5th U.S. Circuit Court of Appeals recently  ruled  that a key component of the Affordable Care Act’s (ACA) preventive care mandate is unconstitutional. However, in a decision it referred to as a “mixed bag,” the 5th Circuit limited its ruling to the plaintiffs in the case, a small group of individuals and businesses from Texas.  The ACA requires non-grandfathered health plans and issuers to cover a set of recommended preventive services without imposing cost-sharing requirements, such as deductibles, copayments or coinsurance, when the services are provided by in-network providers.  5th U.S. Circuit Court of Appeals decisions  In March 2023, the U.S. District Court for the Northern District of Texas struck down a key component of the ACA’s preventive care mandate as unconstitutional and issued a nationwide injunction against its enforcement. This decision involved a wide range of preventive care services, such as cancer screenings and medications for chronic diseases.  The 5th Circ

The Affordable Care Act created reporting requirements under Internal Revenue Code Sections 6055 and 6056. Under these rules, certain employers must provide information to the IRS about their employees' health plan coverage (or that the organization does not offer health plan coverage). However, things are set to change in the new 2024 ACA reporting requirements. In the original rules, any reporting entity that was required to file at least 250 individual statements under Sections 6055 or 6056 had to file electronically. However, on Feb. 23, 2023, the IRS released a final rule implementing a law change in the Taxpayer First Act of 2019, which lowers the 250-return threshold for mandatory electronic reporting to 10 returns. This means most reporting entities will be required to complete their ACA reporting electronically starting in 2024. This ACA blog describes the process for reporting electronically under Sections 6055 and 6056. Action steps Employers that are subject to the AC

  Since the Affordable Care Act was enacted in 2010, many reforms have been made to group health plan coverage. To make reviewing ACA group health plan requirements easier, download this ACA 2024 compliance checklist . If you have additional questions, TruePlan’s team of experts is here to assist. Contact us today to get the answers you need or to review your current employee benefits plan .

Approaching ACA reporting deadlines for 2024   Employers subject to Affordable Care Act reporting under Internal Revenue Code Sections 6055 or 6056 should prepare to comply with the upcoming ACA 2024 reporting deadlines. For the 2023 calendar year, covered employers must: furnish paper statements to individuals by March 1, 2024; and file paper returns with the IRS by Feb. 28, or April 1 if filing electronically. Beginning in 2024, employers who file at least 10 returns during the calendar year must file electronically. Penalties may apply if employers are subject to ACA reporting and fail to file returns and furnish statements by the applicable deadlines. The following employers are subject to ACA reporting under Sections 6055 and 6056: employers with self-insured health plans (Section 6055 reporting); and applicable large employers with either fully insured or self-insured health plans (Section 6056 reporting). ALEs are employers with 50 or more full-time employees (including full-ti

Group health plans must expand price comparison tool for 2024 Beginning this year, group health plans and health insurance issuers must expand the online price comparison tool they make available to participants, beneficiaries and enrollees so that it includes all covered items, services and drugs. This tool provides consumers with real-time estimates of their cost-sharing liability from different providers for covered items and services, so they can shop and compare prices before receiving care. For plan years beginning on or after Jan. 1, 2023, health plans and issuers were required to make price comparison information available for 500 shoppable items, services and drugs. For plan years beginning on or after Jan. 1, 2024, price comparison information must be available for all covered items, services and drugs. Most employers rely on their issuers or third-party administrators to develop and maintain the price comparison tool. Employers should confirm that their issuers and TPAs wil

  The IRS has updated penalty amounts for 2024 related to the employer shared responsibility (pay or play) rules under the Affordable Care Act. For calendar year 2024, the adjusted ACA pay or play penalty amounts increased as follows: $2,000 penalty amount is now $2,970; and $3,000 penalty amount is now $4,460. Pay or play penalty calculations Under ACA pay or play rules, an applicable large employer is only liable for a penalty if at least one full-time employee receives a subsidy for exchange coverage. Employees who are offered affordable, minimum value coverage are generally not eligible for these exchange subsidies. Depending on the circumstances, one of two penalties may apply under the pay or play rules: the  4980H(a) penalty  or the  4980H(b) penalty . Under Section 4980H(a), an applicable large employer will be subject to a penalty if it does not offer coverage to “substantially all” (generally, at least 95%) of its full-time employees (and dependents) and any one of its full-t

The 5th U.S. Circuit Court of Appeals has issued a stay of enforcement of a lower court’s ruling in  Braidwood Management Inc. v. Beccara . In  Braidwood , the lower court vacated a key portion of the Affordable Care Act’s preventive care coverage requirement.  In this issue, let’s get into what the court’s reinstatement of the ACA’s preventive care mandate means. We’ll also look at another ACA insurance-related topic: Patient-Centered Outcomes Research Institute fees. The ACA Preventive Care Mandate Explained  The ACA requires most health plans and health insurance issuers to cover a set of preventive services without imposing cost-sharing requirements when the services are provided by in-network providers. Among these are evidence-based items or services that have a rating of A or B in the current recommendations of the U.S. Preventive Services Task Force. In  Braidwood , the lower court ruled that preventive care coverage requirements based on an A or B rating by the USPSTF on or af