What are the long-term changes in the healthcare legislation?

Christopher Axene | October 20th, 2010

Looking into the Future: A Summary of Healthcare Law Changes for 2013 and Beyond

The Patient Protection and Affordable Care Act and the related Health Care and Education Reconciliation Act (which are collectively referred to as the healthcare legislation) were signed into law in March. The new laws contain a large number of tax changes. Some have nothing to do with healthcare, some won’t kick in for several years, some are effective right now, and some are even retroactively effective.

In our last blog post, we listed changes that became effective prior to 2010 as well as those becoming effective in 2010, 2011 and 2012. This chart briefly summarizes those changes that will take effect in 2013 and later. (Of course, there will be some clarifications, technical corrections, and IRS guidance to follow.)


IN 2013
0.9 percent
Medicare Tax
on Salaries
Earned by
Higher Income




Right now, the Medicare tax on salary and/or self-employment (SE) income is 2.9 percent (1.45 percent is withheld from employee paychecks, and the other half is paid by the employer. Self-employed people pay the whole 2.9 percent).
Starting in 2013, an extra .9 percent Medicare tax will be charged on:

  • Salary and/or SE income above $200,000 for an unmarried individual;
  • Combined salary and/or SE income above $250,000 for a married joint-filing couple; and
  • Salary and/or SE income above $125,000 for those who use married filing separate status.

These thresholds will not be adjusted for inflation. For self-employed people, the additional .9 percent Medicare tax hit will come in the form of a higher SE tax bill. However, the additional .9 percent will not qualify for the above-the-line deduction for 50 percent of SE tax. (The additional .9 percent Medicare tax must be taken into account for estimated tax purposes.)

Tax years beginning after 2012.IRC Sections 164(f), 1401(b), 3101(b), 3102, and 6654
3.8 percent
Medicare Tax
on Net
by High
Income Folks
and Trusts
 Right now, the maximum federal tax rate on long-term capital gains and dividends is 15 percent. In 2011, the top rate is scheduled to go up as the “Bush tax cuts” expire. Starting in 2013, all or part of the net investment income, including long-term capital gains and dividends, collected by high-income folks can get hit with a 3.8 percent “Medicare contribution tax.” Therefore, the top federal rate on long-term gains and dividends for 2013 and beyond will be 23.8 percent.
The additional 3.8 percent Medicare tax won’t apply unless modified adjusted gross income (MAGI) exceeds: $200,000 for an unmarried individual; $250,000 for married joint-filers; or $125,000 for married filing separately. These thresholds won’t be adjusted for inflation.
The additional 3.8 percent Medicare tax will apply to the lesser of: net investment income or the amount of MAGI in excess of the applicable threshold.
Net investment income includes interest, dividends, royalties, annuities, rents, gross income from passive business activities, gross income from trading in financial instruments or commodities, and net gain from property held for investment (but not for business purposes) reduced by deductions allocable to such income.
The additional Medicare tax must be taken into account for estimated tax payment purposes.
For a trust, the extra 3.8 percent Medicare tax will apply to the lesser of: undistributed net investment income or the AGI in excess of the threshold for the top trust federal tax bracket.
Tax years beginning after 2012.IRC Sections 1411 and 6654
New $2,500 Cap on Healthcare FSA Contributions Right now, there’s no tax-law limit on salary-reduction contributions to an employer healthcare FSA (although many plans impose their own annual limits). Starting in 2013, the maximum annual FSA contribution by an employee will be capped at $2,500. After that, the cap will be indexed for inflation. Tax years beginning after 2012.IRC Section 125(i)
Higher Threshold
for Itemized
You can now claim an itemized deduction for medical expenses paid for you, your spouse, and dependents, to the extent the expenses exceed 7.5 percent of AGI. Starting in 2013, the hurdle is raised to 10 percent of AGI. But if you or your spouse is age 65 or older at year end, the new 10 percent-of-AGI threshold will not take effect until 2017. The medical deduction threshold for AMT purposes remains at 10 percent of AGI. Tax years after 2012 (2016 if taxpayer or spouse is 65 or older at year end).IRC Section 213(a) and (f)
No More
for Retiree
Drug Plan
Employers that sponsor qualified retiree prescription drug plans are entitled to collect tax-free federal subsidies for a portion of the cost. Employers are currently allowed to deduct the full cost of retiree drug plans without any reduction for the tax-free federal subsidies. In effect, deductions are allowed for amounts that are actually paid by the government. The healthcare law reduces deductions by the amount of tax-free federal subsidies. Tax years beginning after 2012.IRC Section 139A
New Excise
Tax on
Device Manufacturers
Manufacturers have to pay a 2.3 percent excise tax on taxable sales of medical devices for humans. However, devices retailed to the general public will be exempt. The tax will not apply to eyeglasses, contact lenses, hearing aids, etc. Sales after 2012.IRC Section 4191
New Deductible Compensation
Limit for
Health Insurers
Affected health insurance providers face a $500,000 per-person deduction limit on compensation paid to “applicable individuals,” which can include officers, employees, directors, and certain other service providers such as consultants. Tax years beginning after 2012.IRC Section 162(m)(6)(A)
IN 2014
“Adequate” Coverage
In general, U.S. citizens and legal residents will be required to pay penalties if they don’t obtain “adequate” health insurance coverage.
The tentative penalty will equal the greater of: the applicable percentage of household income above the threshold that requires filing a federal income tax return; or the applicable dollar amount times the number of uninsured individuals in the household. The applicable income percentage is 1 percent for 2014, 2 percent for 2015, and 2.5 percent for 2016 and beyond.
The applicable dollar amount is $95 for 2014, $325 for 2015, and $695 for 2016. After that, the $695 amount will be adjusted for inflation. For under-age-18 household members, the applicable dollar amounts will be 50 percent of the aforementioned amounts.
The final penalty amount for each household will be limited to 300 percent of the applicable dollar amount. For example, the maximum 2016 penalty will be $2,085 (3 times $695). However, if the national average cost of “bronze coverage” (a new term of art) for the household is less, the maximum penalty will be limited to the cost of bronze coverage.
If an affected individual is uninsured for only part of the year, the penalty will be calculated monthly using pro-rated annual figures.
in 2014.IRC Section 5000A



    Employers with at least 50 full-time employees that do not provide them with affordable health coverage that meets certain minimum standards will be charged a penalty if even one full-time employee purchases his own government-subsidized coverage through a state-run exchange.
Government-subsidized coverage means coverage for which a federal cost-sharing subsidy (explained below) is available.
The penalty will be $167 per month ($2,000 per year) for each employee who is not provided with “adequate” coverage for that month (even if a particular employee purchases subsidized coverage from a state-run exchange). However, no penalty is charged for the first 30 employees.
An employer can still owe penalties even when employees are offered the opportunity to enroll in a plan that provides minimum essential coverage, but one or more employees choose to instead buy subsidized coverage through a state-run exchange. In this case, the penalty is $250 per month for each applicable employee, but the total penalty cannot exceed the penalty that would be charged for outright failure to offer “adequate” coverage.
Employers cannot deduct these penalties as a business expense.
in 2014.IRC Section 4980H
“Cost-Sharing Subsidies”
Government paid “cost-sharing subsidies” will be provided to help individuals ineligible for Medicaid, employer-provided coverage, or other “adequate” coverage. This has been explained as a low-income benefit, but you can be eligible with income up to 400 percent of the federal poverty level. (For 2009, this was $43,320 for one person or $88,200 for a family of four.)
The cost-sharing subsidy is sometimes called a “premium assistance tax credit,” because the enabling language is found in the tax code. In most cases, however, the subsidy will be paid directly to the insurer. If that doesn’t happen, the subsidy amount can be claimed as a refundable tax credit on the eligible individual’s federal tax return.
in 2014.IRC Section 36B
Tax Credit
for Small
As explained in the 2010 changes, qualifying small employers can claim a new tax credit to help cover the cost of providing employee health coverage. For 2010-2013, the maximum credit percentage is 35 or 25 percent for tax-exempt employers. Starting in 2014, the maximum credit percentage increases to 50 or 35 percent for tax-exempt employers. However, employers must purchase qualifying health coverage from state-run insurance exchanges to be eligible for the higher credit percentages. Also, the FTE wage caps for credit qualification and calculation purchases are indexed for inflation, starting in 2014. Tax years beginning in 2014.IRC Section 45R and Section 1421 of the healthcare legislation.
Must Give Employees
“Free Choice
An affected employer must give a “free choice voucher” to any eligible employee who chooses to buy his or her own coverage instead of participating in the company plan. The voucher amount equals what the employer would have contributed on behalf of the employee if he or she participated. As long as the employee spends at least the amount of the voucher on qualified health coverage, the voucher is tax-free to the employee. However, an employee who takes advantage of the voucher is ineligible to receive any cost-sharing subsidy for buying coverage from a state-run exchange. Calendar year 2014.Section 10108 of the healthcare legislation.
on Health Insurance Providers
A new fee is imposed on health insurance providers. Each targeted company must pay an allocable portion of the total annual fee, which is $8 billion for 2014. The fee is apportioned among targeted companies based on each company’s share of applicable net premiums. Calendar year 2014.Section 9010 of the Patient Protection Act.
IN 2018
on “Cadillac
Health insurance companies that service the group market and administrators of employer-sponsored health plans will get socked with a 40 percent excise tax on premiums that exceed the applicable threshold of $10,200 for self-only coverage or $27,500 for family coverage. For retired individuals and plans that cover employees in high-risk professions, the thresholds will be $11,850 and $30,950, respectively. These thresholds may be increased to reflect higher-than-expected inflation in health premiums. Plans sold in the individual market will be exempt, except for coverage that is eligible for the above-the-line deduction for self-employed health premiums. Tax years beginning
in 2018.IRC Section 4980I
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