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The Affordable Care Act Changes in Healthcare for 2016
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The Affordable Care Act Changes in Healthcare for 2016


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The Affordable Care Act (ACA) was met by everyone with varying degrees of enthusiasm or criticism, and managed to get most of the citizens covered under it. To get up to speed with what happened so far on ACA and what it entails, it’s best to start directly with the governmental page about the Affordable Care Act. Whether you’re a supporter of ACA or not, you should be informed of the changes in healthcare scheduled to take place in 2016. Step 2 of this health policy is being enacted, bringing some revising to the initial plan; these soon to be materialized 2016 ACA changes have seen a lot of debate light recently, so it’s time to fill you in on the key points.

Changes in Healthcare
Source: Transgender Law Center

Upcoming 2016 ACA Changes in Healthcare

The main ACA changes in 2016 will target employers, especially those with at least 50 to 100 employees, since they will now be defined as ‘small employers’ as well. Up to the end of 2015, small employers as defined by the current text of the Affordable Care Act were only those employers with 1 to 50 employees, so you can see that the category is about to be enlarged starting January 1st. This means these employers will be considered small for insurance purposes, making it easier for them to offer their employees better health care coverage and plans.

Changes in Healthcare Employer Penalties

On the other hand, the same employers (with a number of employees ranging from 50 to 100) won’t be so protected by ACA from another point of view. If for insurance purposes they will be considered small employers, on the other hand they will be considered large group employers as far as penalties will go. The Affordable Care Act penalty for these employers will be applied if they fail to provide the minimum health care coverage to their employees and dependants (provided that these dependants aren’t older than 26). The Employer Mandate penalties were until now only applied to employers of over 100 people; so this is a pretty important point in the upcoming 2016 ACA changes.

Also, up until now, employers were required to offer this minimal essential insurance to at least 70% of their employees in order to avoid the penalty, but the threshold has increased, in order to make sure as many employees as possible are covered. The new essential minimum required in order to avoid the Affordable Care Act penalty is for 95% of all employees to be insured with the minimum health coverage plan, starting January 1st, 2016.

Another potential penalty to be avoided by employees will be applied in cases of misreporting the actual size of the company. The penalty caps, as well as the IRS penalties for failing to meet the reporting requirements for employers, will go up in 2016 under the new Affordable Care Act. The same penalties will apply to failing to provide individual statements for full-time employees. The reports which employers are supposed to fill in for 2015, and which are subject to these penalties should the data be reported incorrectly, are due in 2016.

Changes in Healthcare Maximum Out-of-pocket Costs for Employees

The maximum rates which employers can require their employees to provide as out-of-pocket costs (co-pays) to insurance will go up a little in 2016, amounting to $6,850 per employee (or family member of that employee, scheduled to benefit from health coverage as well) and $13,700 per family of people covered. In case the employer covers their employees and dependants of employees through grandfathered (or transitional) plans, these maximum amounts of out-of-pocket costs won’t apply. Also, the maximum required amount which an employee or covered department can be asked to pay before family coverage can start is also $6,850 per year.

Even if this may seem as bad news regarding the changes in health care prescribed by the 2016 updated ACA, this isn’t actually a set-back. More healthcare will be provided for a larger number of employees (if employers want to avoid the penalties, and by way of the extended ‘small employee’ stature, and at more affordable rates.

Self Plus One Enrollment for Federal Employees

Federal employees will have the opportunity to sign up for a Self Plus One Enrollment which will mean transferable health coverage benefits to another person in your family. This is meant to be added as an extension to the pre-existing forms of individual and family health coverage. The first enrollments for the Self Plus One program for federal employees took place starting November 2015, but they are expected to go into full scale in 2016. This is one of the upcoming 2016 ACA changes meant to offer more flexibility to insured employees, and it’s definitely a welcome new feature, even if it isn’t available at this time for non-federal employees.

In order to enroll in this program (to benefit from it starting January 2015), you need to contact your Human Resources office and talk to them about it. Until the end of December 2015, you can also change your options regarding the Self Plus One program as well, by contacting the representatives of the same office at your work place. You can read more about the Self Plus One Enrollment here, in case you have any extra concerns.

Changes in Healthcare Affordability

The new measures of the Affordable Care Act have been designed to theoretically allow everyone better access to healthcare, and to help employers offer this access easier. This ease of access will also mean some greater steps taken towards a centralization of health care plans and rates, so that the user can truly choose the best option for them. In order to access the 2016 healthcare plans and prices personalized for your zip code, feel free to use the federal search engine.

Also, this centralization means it will be easier for internet users looking to shop for insures directly on the government-backed Marketplace. After finding an insurance plan that works for you, the next steps are uploading some documents and finally signing up for the plan. Once the enrollment is done, the user will be asked if they would also like to shop for dental health coverage. That will be the only time the user can answer yes or no, because once the health coverage actually starts, they will not be able to go back to this step and choose to have a dental plan later on.

If you’d like to review the government’s answers to a list of Frequently Asked Questions about the Affordable Care Act, take a look here. As for the changes in the actual rates of all healthcare premiums, here is an estimate calculation. A 40 year-old employee making about $30,000 per year will be expected to pay about 0.2% less per year after the tax credits will also come in. Since premium rates vary by city and area of residence, this would mean that the 40 year-old employee making $30,000 per year will have the following benchmark silver rates: $183 per month in Albuquerque, NM and $719 per month in Anchorage, Alaska. These rates are valid before the person benefiting from them would be accountable for the tax credit and will change a bit afterwards. For a more detailed view of projections and calculations for the new rates coming up with the 2016 ACA changes, feel free to consult the table here.


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