On January 29, 2026, the U.S. Department of Health and Human Services (HHS) officially released the maximum cost-sharing limits for the 2027 plan year. These figures represent a significant 13.2% increase over the 2026 limits, marking a substantial shift in potential out-of-pocket expenses for plan participants. 2027 Maximum Out-of-Pocket Limits For 2027, the maximum annual … Continued
Employers must prepare for Affordable Care Act (ACA) reporting covering the 2025 calendar year. Staying ahead of these deadlines is critical for Applicable Large Employers (ALEs) and providers of self-insured health plans. Who is Required to Report? Reporting obligations under Internal Revenue Code Sections 6055 and 6056 fall into two main categories: Note for Self-Insured … Continued
How to position yourself as a trusted ACA compliance advisor For brokers and benefits advisors, Q4 planning doesn’t start in October. It starts now. September marks a critical moment in the annual ACA compliance cycle, when employers begin thinking about year-end strategies, benefits renewals, and how to avoid last-minute reporting panic. That makes now the perfect … Continued
Big changes are coming to women’s preventive care coverage! Starting with plan years on or after December 31, 2025, group health plans and health insurance issuers must expand their no-cost coverage for women’s preventive care. This expansion includes additional breast cancer imaging or testing needed to complete an initial mammogram, as well as patient navigation … Continued
ACA REPORTING Affordable Care Act (ACA) reporting for applicable large employers (those with 50 or more employees) was due for the 2024 plan year in March. Reporting to Employees – due March 3, 2025 Form 1095-C: For Applicable Large Employers (ALEs) to report health coverage offered to full-time employees. Form 1095-B: For employers with self-funded … Continued
At the close of 2024, Congress passed two new pieces of legislation: the Paperwork Burden Reduction Act and the Employer Reporting Improvement Act. These laws simplify the Affordable Care Act (ACA) reporting requirements for employers and introduce new limits on the IRS’s authority to enforce “pay-or-play” penalties, among other changes. Under the ACA, applicable large … Continued
For employers subject to the Affordable Care Act (ACA), staying compliant with reporting requirements is non-negotiable. With 2025 due dates just around the corner, now is the time to prepare for distributing Forms 1095-C to employees and filing with the IRS. These forms provide essential information about health coverage offered to employees and are critical … Continued
The Affordable Care Act (ACA) requires large employers to offer affordable health insurance coverage to their full-time employees or face a penalty known as the “Pay or Play” tax. This tax is based on the employer’s average monthly wage (AMW) and the number of full-time employees. The affordability rate for employer-sponsored health coverage will increase from 8.39% to … Continued
The Affordable Care Act (ACA) introduced the Medical Loss Ratio (MLR) to ensure that health insurance companies spend a significant portion of premiums on medical care and quality improvement activities rather than administrative costs and profits. When insurers fail to meet the MLR threshold, they are required to issue rebates to plan sponsors. Understanding MLR … Continued
On September 30, 2021, the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury (collectively, the Departments), along with the Office of Personnel Management (OPM), released an interim final rule (IFR) under the No Surprises Act (Act) to help protect health care consumers from surprise billing and excessive … Continued
