Summary Definition: A provision in the Affordable Care Act (ACA) that requires employers with 50 or more full-time employees to provide minimum essential health coverage at a defined affordable rate.
The Affordable Care Act (ACA) employer mandate requires Applicable Large Employers (ALEs) to provide full-time employees and their dependents with affordable minimum essential health coverage.
Those who don’t must pay a penalty to the Internal Revenue Service (IRS) in the form of an Employer Shared Responsibility Payment (ESRP).
Also known as the “pay or play provision,” the purpose of the mandate is to ensure employers with larger workforces provide adequate healthcare coverage to their workers, or contribute to public healthcare subsidies via their ESRP payment.
An ALE is an employer who on average has at least 50 full-time employees, full-time equivalent employees, or a mix of the two during the prior calendar year. The IRS determines an organization’s status each year, and that determination is based on the average size of the employer’s workforce from the prior year. ALEs are also subject to additional IRS reporting requirements regarding the coverage they provide.
To avoid paying the IRS, ALEs must provide minimum essential coverage that’s deemed affordable.
Minimum essential coverage must provide a minimum value to employees by covering at least 60% of the total cost of the plan’s benefits (e.g., copays, deductibles, etc.) while giving substantial coverage of inpatient hospital and physician services.
For coverage to be affordable in 2024, its employee-only option can’t exceed 8.39% of an employee's total household income.
Since it’s impossible for an employer to know the total household income for every employee, the IRS allows the use of safe harbors when calculating affordability:
PTCs are refundable tax credits that eligible individuals can use to afford health insurance purchased through the ACA’s Health Insurance Marketplace. The amount of a single credit varies based on the economic status of the individual receiving it.
If an ALE has employees receiving PTCs, they could still owe a payment to the IRS under the Employer Mandate even if they’re already providing affordable minimum value coverage to 95% of their employees and the employees’ dependents (i.e., Payment Type 1).
There are two types of ESRPs an ALE can owe the IRS. Note that employers can’t be subject to both payments simultaneously, regardless of their decisions towards providing affordable coverage.
|Payment Type||Applies To||Calculation|
|4980H(a): Failing to Offer Affordable Minimum Essential Coverage||ALEs who don’t offer minimum essential coverage to at least 95% of their full-time employees, and the employees’ dependents, and if at least one full-time employee receives a PTC.||
$2,000 annually (as adjusted) for each employee without coverage (minus the first 30 full-time employees without coverage.
2024 Annual Penalty: $2,970
|4980H(b): Failing to Offer Affordable Minimum Essential Coverage with Minimum Value||
ALEs with employees receiving a PTC, even if the employer offers affordable minimum essential coverage to at least 95% of their full-time employees, and the employees’ dependents.
The payment is computed separately for each month. The amount of the payment for the month equals the number of full-time employees who receive a premium tax credit for that month multiplied by 1/12 of the annual 49980H(b) penalty.
$3,000 annually (as adjusted) for each employee receiving a PTC.
2024 Annual Penalty: $4,460
Reference the IRS' Shared Responsibility Provisions for complete details. This material is for informational purposes only and shouldn't be solely relied on for tax, accounting, or legal advice.
Stand out from the competition with a benefits experience that makes it simple for employees to choose and manage. Our tools make enrollment and day-to-day tasks quicker for you and understanding and select the best plans easier for them. Find out how modern tools empower employees, ensure accuracy and compliance, and pull data to keep costs where you want them.