The IRS has announced an increase in the ACA affordability percentage to 9.02% for 2025, as per Revenue Procedure 2024-35 issued on September 9, 2024. This adjustment, up from 8.39% in 2024, impacts the affordability of health insurance plans starting on or after January 1, 2025.
Defining Affordable Coverage Under ACA
The Affordable Care Act (ACA), enacted in 2010, requires applicable large employers (ALEs) with 50 or more full-time equivalent employees to offer affordable health insurance to their full-time employees.
In 2025, affordable coverage means the employee’s share of the premium for the minimum value plan can’t exceed 9.02% of their household income. For employees, coverage is affordable if the cost for the minimum value plan for employee-only coverage doesn’t exceed this percentage. For spouses and dependents, coverage is affordable if the cost for the minimum value family coverage plan meets the same percentage criteria.
Employers must ensure their health plans comply with the new ACA affordability rates to avoid penalties under IRC Section 4980H(b). They are not required to offer affordable coverage to spouses and dependents and can require employees to pay the full cost of premiums for their family members’ coverage. If the employer’s health insurance is deemed not affordable, employees and their family members may qualify for subsidies to help pay for health insurance through the Health Insurance Marketplace.
Safe Harbors for Employers
Safe harbors are provisions that help employers determine if their health plans meet the ACA affordability criteria, providing clear guidelines to avoid penalties. Because employers may not have access to an employee’s total household income, coverage is deemed “affordable” if the required employee contribution satisfies at least one of the three available safe harbors:
Partnering with Pierce Group Benefits
The new ACA affordability rates for 2025 are crucial for both employers and employees, as staying informed ensures better health insurance decisions and compliance with the ACA. For more information on the impact of this change, contact your PGB Account Executive or email a PGB Representative at partnership@piercegroupbenefits.com.