Annually, the IRS releases the Affordable Care Act (ACA) affordability percentage, which impacts contributions required for medical coverage to avoid potential penalties for certain employers. For 2023, the affordability percentage is 9.12% for plan years beginning in 2023, as described in our prior blog, 2023 ACA Affordability Decreases to 9.12%.
As a reminder, the ACA requires applicable large employers (ALEs) – that is, employers with 50 or more full-time and full-time equivalent employees, on average, in the prior calendar year – to offer affordable minimum value coverage to their full-time employees and dependents, or face a potential penalty. For plan years starting in 2023, ALEs must offer at least one plan that costs employees less than 9.12% of their household income. Applicable Large Employers can utilize one of the three safe harbors: Federal Poverty Level (FPL), W-2, and Rate of Pay, to determine whether they meet the 2023 affordability requirement.
For more on the affordability safe harbors, see the IRS Q&A on Affordability.
FPL Affordability Safe Harbor & Non-Calendar Year Plans
Under the FPL safe harbor, coverage will be affordable if the cost to employees for self-only coverage on the lowest-cost plan offered is less than 9.12% of the federal poverty level (which is determined annually). The FPL safe harbor amount is calculated based on the following formula:
Monthly Safe Harbor Amount = [9.12% x Federal Poverty Level (FPL)] / 12
- 9.12% x $14,580 (2023 FPL) = $1,329.70
- $1,329.70/12 = $110.81
Importantly, employers are permitted to use the federal poverty guidelines in effect six months prior to the beginning of the plan year to calculate affordability under the FPL safe harbor. This is because the annual federal poverty amount is generally not released until after the calendar year begins, so calendar year plans generally rely on the prior year’s federal poverty level. This flexibility provides employers with adequate time to establish premium amounts in advance of a calendar year plan’s open enrollment period.
- 9.12% x $13,590 (2022 FPL) = $1,239.41
- $1,239.41/12 = $103.28 (monthly amount)
As a result, the FPL safe harbor is calculated differently for calendar year plans than for non-calendar year plans:
- Employers with plan years beginning January 2023 will meet the FPL safe harbor if they offer their full-time employees at least one plan that costs less than $103.28 ($129.12 for Alaska, and $118.79 for Hawaii) for self-only coverage.
- Employers with plan years beginning February through June 2023 have the option of using either the 2022 or 2023 FPL to calculate the FPL safe harbor (and set contributions accordingly). Practically speaking, plan years beginning earlier in the year (e.g., February and March) generally rely on 2022 FPL to establish premiums in advance of open enrollment.
- Employers with plan years beginning July through December 2023 will meet the FPL safe harbor if they offer their full-time employees at least one plan that costs less than $110.81 ($138.39 for Alaska, and $127.45 for Hawaii) for self-only coverage.
While the 2022 FPL can be used to determine the FPL safe harbor for plan years that begin before July 1, 2023, the 2023 FPL must be used for plans that begin on or after July 1, 2023. Note that Rate of Pay and W-2 safe harbors are calculated the same regardless of plan year start.
With the flexibility to use the FPL in place six months prior to the start of the plan year, the FPL safe harbor amount will depend on plan year start, as described above. As such, ALE employers who rely on the FPL safe harbor to meet the ACA affordability requirements should keep this in mind when developing their contribution strategy.
- IRS Rev. Proc. 2022-34
- HHS Federal Poverty Level
- Sequoia Foreword: 2023 ACA Affordability Decreases to 9.12%
Disclaimer: This content is intended for informational purposes only and should not be construed as legal, medical or tax advice. It provides general information and is not intended to encompass all compliance and legal obligations that may be applicable. This information and any questions as to your specific circumstances should be reviewed with your respective legal counsel and/or tax advisor as we do not provide legal or tax advice. Please note that this information may be subject to change based on legislative changes. © 2023 Sequoia Benefits & Insurance Services, LLC. All Rights Reserved