What are ACA excepted benefits?
Asked by: Prof. Adela Ernser | Last update: December 17, 2025Score: 4.8/5 (18 votes)
What are excepted benefits under ACA?
These “excepted benefit” plans include the following insurance coverage: accident-only; disability income; liability supplement; general liability; automobile liability; workers' compensation; automobile medical payment; credit-only; on-site medical clinics; dental or vision; long-term care; nursing home care; ...
What is excepted benefit in HRA?
An excepted benefit HRA allows employers to finance additional medical care, like vision or dental coverage, coinsurance and copayments for individual health insurance coverage, short-term limited-duration insurance, or other health care costs not covered by their primary group plan.
What does it mean to be ACA exempt?
You can get an exemption so that you won't have to pay a penalty for not having qualifying health insurance. Some exemptions require an exemption application through Covered California. Other exemptions do not require an application: Instead, you can claim them when you file your state tax return.
What are 5 mandated benefits under the ACA?
The 10 categories of benefits in an EHB package are: 1) ambulatory patient services, 2) emergency services, 3) hospitalization, 4) maternity and newborn care, 5) mental health and substance use disorder services, 6) prescription drugs, 7) rehabilitative and habilitative services and devices, 8) lab services, 9) ...
ACA vs EXCEPTED BENEFIT?!
What are ACA compliant benefits?
A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.
What are the ACA 10 essential benefits?
The Affordable Care Act requires non-grandfathered health insurance coverage in the individual and small group markets to cover essential health benefits (EHB), which include items and services in at least the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization ...
What is an ACA exemption?
Exemptions from the requirement to have health insurance
This means you no longer pay a tax penalty for not having health coverage. If you don't have health coverage, you don't need an exemption to avoid paying a tax penalty.
What is the 30 hour rule for ACA?
If an employee is credited with an average of 30 hours per week or more during the Standard Measurement Period, the employee would be eligible for benefits for the upcoming plan year. The Stability Period is the period of time that the employee cannot lose eligibility regardless of the hours he works.
What is the maximum employer contribution for excepted benefits?
2025 excepted-benefit HRA maximum new-contribution amount:
The 2025 excepted-benefit HRA maximum new-contribution amount is $2,150 (up from $2,100 in 2024). Plan sponsors offering HDHP plans will find the updated figures useful in plan design for the 2025 plan year.
Is there a downside to HRA?
You are not taxed on the money your employer puts in your HRA, but you cannot invest the money, can only withdraw it for eligible medical services, and will lose it if you leave your job unless you choose COBRA continuing coverage.
How do I get an HRA exemption?
You can claim HRA exemptions by submitting your monthly rent receipts. However, keep in mind that it is mandatory to report the PAN card details of your property owner if you pay more than Rs 1 lakh annually. How does the new tax regime impact HRA? You can continue claiming HRA only if you opt for the old tax regime.
Is an hra an excepted benefit?
An EBHRA stands for Excepted Benefit HRA. It is a tax-advantaged health reimbursement arrangement that pays premiums and qualified medical expenses for excepted benefits like dental and vision coverage.
How do you qualify for ACA benefits?
- Must live in the United States.
- Must be a U.S. citizen or national (or be lawfully present). Learn about eligible immigration statuses.
- Cannot be incarcerated in prison or jail.
Is dental an excepted benefit?
Common examples of excepted benefits include dental coverage, accident coverage, vision coverage, disability income plans, travel insurance, hospital indemnity plans, long-term care insurance, and workers compensation insurance.
What happens if I underestimate my income for Obamacare in 2024?
For the 2024 tax year, if you underestimated your income and received a larger tax credit than you were eligible for, you must repay the difference between the amount of premium tax credit you received and the amount you were eligible for.
How much is Obamacare a month for a single person?
Monthly premiums for Affordable Care Act (ACA) Marketplace plans vary by state and can be reduced by premium tax credits. The average national monthly health insurance cost for one person on an Affordable Care Act (ACA) plan without premium tax credits in 2024 is $477.
Can I refuse health insurance from my employer and get Obamacare?
Obamacare is available to everyone, whether or not their employers offer insurance. From a practical standpoint, though, there are financial consequences to doing this. Often, an employer subsidizes part or all of their employees' coverage.
What are excepted benefits under the ACA?
This type of coverage has no coordination with benefits under a group health plan. Examples of this category of excepted benefits include: Coverage for a specific disease or illness (e.g., cancer insurance) Hospital indemnity (insurance that pays the holder if they are hospitalized)
What disqualifies you from ACA?
Can you be denied Obamacare? As long as you are eligible for Obamacare, you can't be denied. That means that as long as you are living in the U.S. lawfully and are not incarcerated or covered by Medicare, you can enroll in an ACA insurance plan.
Who is exempt from ACA?
Hardship exemptions are available for those who cannot afford to pay for health insurance or for whom health insurance would exceed 8.16 percent of their gross household income.
Does Obamacare cover surgery?
All plans offered in the Marketplace cover these 10 essential health benefits: Ambulatory patient services (outpatient care you get without being admitted to a hospital) Emergency services. Hospitalization (like surgery and overnight stays)
What counts as a pre-existing condition?
A “pre-existing condition” is a health condition that exists before someone applies for or enrolls in a new health insurance policy. Insurers generally define what constitutes a pre-existing condition. Some are obvious, like currently having heart disease or cancer.
What are the pros and cons of the Affordable Care Act?
The pros of the ACA include prohibiting insurance companies from denying coverage based on health history and providing subsidies to reduce premiums and out-of-pocket costs. The cons of the ACA include small business challenges and limited provider options in some regions.