Healthcare
5 min read

ACA Affordability Threshold Increases to 9.02% for 2025

Published on
Sep 17, 2024
ACA Affordability Threshold Increases to 9.02% for 2025
Blog
Author
Stacy Edgar

For 2025, an employee’s health insurance cannot exceed 9.02% of their household income. This is up slightly from 2024's ACA Affordability threshold of 8.39%.

How does the 2025 ACA affordability requirements impact employers?

If your business employees 50 or more full-time equivalent (FTE) employees, you are required by the Affordable Care Act to provide "Minimum Essential Coverage." This coverage cannot cost more than 9.02% of an employees' household income. The IRS offers multiple methodologies for an employers to prove they've met ACA Affordability requirements (aka, "Safe Harbors"). Every year, employers file a 1094/1095-C to the IRS to confirm they've met these requirements.

How does the 2025 ACA affordability requirements impact employees?

ACA Affordability establishes the maximum amount that individuals must pay for their health insurance premiums. If you find yourself paying more than 9.02% of your household income on health insurance premiums, you may have the option of declining your employers plan, purchasing a plan on Healthcare.gov (or your state's health insurance exchange), and qualifying for Advanced Premium Tax Credits (aka, "Obama Care subsidies). APTCs lower your monthly premium costs to as little as $1 per month.

ACA Affordability and ICHRA

The ACA Affordability Requirements determine the minimum amount of funding an employer must provide their employees under an ICHRA. Curious how this new requirement impacts you? Our team can walk you through the regulation and make sure your ICHRA funding strategy is ACA-compliant.

FAQs

You got questions, we got answers!

We're here to help you make informed decisions on health insurance for you and your family. Check out our FAQs or contact us if you have any additional questions.

How does an ICHRA work?

ICHRA stands for Individual Coverage Health Reimbursement Arrangement (ICHRA). This health arrangement allows you to pick your own health insurance plan using your employer’s monthly tax-free allowance. These funds can be used to cover insurance premiums, including dental and vision, as well as qualified medical expenses.

What are the benefits of an ICHRA?

  • Your health plan belongs to you, and you can keep your health insurance if you leave your company. 
  • You get to choose from any qualified health plan on the market. Venteur can help you select a plan where your preferred doctors, providers, and prescriptions are covered.
  • If you choose a health plan that costs less than your employer contribution, the extra funds are added to Venteur’s Health Wallet, an account used to pay for qualified medical expenses.

What's the difference between an ICHRA and a Group Plan?

Group health insurance plans are purchased by companies and offered to their employees. Traditional group plans take a one-size-fits-all approach to healthcare, giving employees limited choice when it comes to their coverage options. Employer-sponsored ICHRAs give employees a tax-free allowance to pick any plan on the public exchange that meets their unique needs.

What expenses are reimbursable through my Health Wallet?

You can use money in your Health Wallet to pay for qualified medical expenses, as the IRS defines in Publication 502. The full list is available here: https://www.venteur.com/post/213-d-reimbursements-or-health-wallet.

Please note that some expenses, like gym memberships or vitamins, are only reimbursable if you obtain a doctor's note confirming medical necessity. 

What is the Health Wallet and how can I use it?

1. What Your Health Wallet Balance Represents:

Your Health Wallet balance could be thought of as a measure of the medical expense reimbursements you're entitled to under your health insurance plan. It's essential to note that it isn't quite like a bank account with a set amount of accessible cash. Rather, consider it as a marker of what you're eligible to get reimbursed for as part of your ICHRA plan.

When you shop for insurance through the app, you will see a dollar amount that is available for out-of-pocket expenses. This amount is what gets contributed to your Health Wallet account for your use in reimbursements. However, depending on how your employer has setup the account, it may be available immediately or it may be available after every monthly invoice.

2. Your Health Wallet Account:

When your account is setup, there is a predetermined way on how your Health Wallet functions for your reimbursement funds. The first scenario is that there is money that has been set aside at the start of the period which can be used for your reimbursements. You may see the entire amount entitled to you is immediately available for medical expense reimbursements. It's like having a store of health benefits ready to be used when you need them.

3. Simplifying the Health Wallet Experience:

We're always striving to enhance your experience and are currently working on making the Health Wallet balance operate more like a pre-paid debit card. This shift aims to streamline the funding process further and allow you quicker and more direct access to your health reimbursements, leading to an even smoother journey for you.

Remember, whether your account shows the funds immediately or after every invoice, it doesn't affect the overall sum you're entitled to under your ICHRA plan; it merely affects the timing of when you will receive the reimbursements.

Your trust is important to us, and we're continually striving to make our services better for you. If you ever have questions about your Health Wallet or anything that would help make for a more understandable benefits experience with us, don't hesitate to reach out to our customer service team.

What criteria does Venteur use to make plan recommendations?

We’ve built an AI model that uses something called a 'composite patient'. We use over 30 years of historical claims data and your age, gender, and zip code to predict your total healthcare spending under each plan. As you add additional information to your profile--specific doctors, prescriptions, risk profile, etc.--your list of recommendations becomes more personalized.

Do ICHRAs meet the Affordable Care Act's employer mandate?

The Affordable Care Act (ACA) requires that employers with more than 50 full-time equivalent employees provide health insurance to their employees. This is known as the 'employer mandate'.

ICHRAs can meet the mandate as long as they are considered 'affordable.' According to IRS, 'an ICHRA is affordable if the remaining amount an employee has to pay for a self-only silver plan on the exchange is less than 8.39% of the employee’s household income.'

To simplify, this means that the ICHRA contribution an employee receives cannot be less than the lowest-cost silver plan available to the employee - (9.02% of the employee's household income).

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