If your business has around 50 or more employees, the Affordable Care Act may require you to offer health coverage — and the penalties for not complying can be steep. This tool walks you through the key tests: Are you actually required to offer coverage? Does your plan meet the minimum requirements? Is it considered affordable for your employees?
Answer a few straightforward questions below and you will see exactly where you stand. If there are any gaps in your compliance, the tool will flag them and estimate what the penalties could be so you can address issues before the IRS does.
Determine your ALE status, check affordability requirements, and estimate potential penalties under the Affordable Care Act
FTE Calculation: Full-time employees (30+ hrs/week) count as 1 FTE each. Part-time employee FTEs are calculated by dividing total monthly part-time hours by 120. Formula: FTEs = Full-Time Count + (Part-Time Count x Avg Weekly Hours x 4.33) / 120.
ALE Determination: An employer is an ALE if it had an average of 50+ FTEs during the prior calendar year. The seasonal worker exception applies if you exceed 50 FTEs for 120 days or fewer and the excess is from seasonal workers.
Affordability Test: Using the W-2 Box 1 safe harbor method, employee self-only coverage is affordable if the required monthly contribution does not exceed 9.02% of the employee's W-2 Box 1 wages divided by 12. The 9.02% threshold is indexed annually (IRS Notice 2024-35 / Rev. Proc. 2024-35).
Minimum Value: A plan provides minimum value if it covers at least 60% of the total allowed cost of benefits expected to be incurred. Verified using the HHS MV Calculator or plan design safe harbors.
Penalty A — 4980H(a): $2,970 per year per full-time employee (minus the first 30) if the employer fails to offer MEC to at least 95% of full-time employees. Triggered only when at least one full-time employee receives a premium tax credit.
Penalty B — 4980H(b): $4,460 per year for each full-time employee who receives a premium tax credit because the coverage offered was not affordable or did not meet minimum value. Capped at the Penalty A amount.
Sources: ACA Section 4980H, IRS Notice 2024-35, IRS Rev. Proc. 2024-35, IRS Final Regulations (79 FR 8544), DOL ACA FAQ, HHS MV Calculator methodology.
A benefits advisor can review your specific situation and help you avoid costly ACA penalties.