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What are the penalties for me, as an employer, if I don’t provide health benefits to my seasonal workers?

If you are a large employer, you will face a penalty if you do not offer affordable coverage that meets minimum value to all of your full-time employees and their dependent children. If, as an employer, you’re unsure whether or not your seasonal workers are full-time employees, you can use a special measurement period (a three- to twelve-month look back, at your discretion) to decide if your employees are in fact seasonal or full-time. During this measurement period, you don’t have to offer coverage, but if it turns out an employee did work full-time during that measurement period, you must treat that employee as full time during a subsequent “stability” period (which must be the longer of six months or the length of the measurement period that you chose) and offer that worker health benefits regardless of their actual hours worked during the stability period. Full-time means the employee worked on average 30 hours a week over the measurement period.

My workers are seasonal employees. Do I count them in determining whether I am a large employer?

In general, an employer is considered a “large” employer for the purposes of the Affordable Care Act if the employer has more than 50 full-time-equivalent workers per year. Seasonal workers do count among your full-time employees unless your business qualifies for the seasonal worker exemption. The seasonal worker exemption applies if: a) you had more than 50 employees for fewer than 120 days, and b) during the 120 period you would have had fewer than 50 employees if you excluded your seasonal workers. The 120 days (or 4 months) do not need to be consecutive. For example, Farm A has 30 full-time, year round employees, and hires 25 workers to work 50 hours per week during a 2-month planting season in the winter, and then invites the same crew back for a 3-month harvest season in the fall. Farm A is a “large” employer because the Farm employs more than 50 full-time workers for more than 120 days.

Farm B has 30 full-time, year round employees, and hires 25 workers to work 50 hours per week during a 3 month harvest only. This employer is a “small” employer because the number of full-time employees exceeded 50 during a period that is less than 120 days, and during that time the seasonal worker exemption applies, because after excluding the seasonal employees you had fewer than 50 full-time workers.

I’m an employer with agricultural workers. Am I required to provide health benefits to all of my workers?

If you are a large employer (you have more than 50 full-time equivalent employees), you may owe a penalty if you do not provide affordable and minimum essential coverage to all of your full-time employees. A full-time employee is one that averages more than 30 hours per week of work, although there are special rules for employees with variable hours.

I’m a migrant seasonal worker. Can I buy health insurance in the Marketplace where I live now? If I move to another state during the year, can I keep the plan I bought here or will I have to buy different coverage?

Eligibility to buy coverage in the Marketplace is based on where you establish your permanent residence. Some health insurers will offer larger networks than other plans and may offer regional or national provider networks. Once Open Enrollment begins, check the plans available in your Marketplace to see if there is a plan with provider coverage in the areas you work.  If your move during the year is a permanent move, not just a temporary one, you may qualify for a special enrollment period following the permanent move.

Am I required to have health insurance?

Congress eliminated the federal tax penalty for not having health insurance, effective January 1, 2019.

For 2018, most people are required to have health insurance or else pay a tax penalty, unless they qualify for an exemption.  This is called the individual responsibility requirement, or the individual mandate.

While the federal tax penalty continues to apply for 2018, recent changes will make it easier for people to claim a hardship exemption, and so owe no penalty, when they file their 2018 federal income tax return.  If you experienced a hardship that prevented you from getting coverage in 2018, just check the box on the front of Form 1040, indicating that you qualify for a hardship exemption.  You will not be required to submit proof of the hardship with your tax return, though you should retain any documentation for your own records.

Several states have adopted individual mandates with state tax penalties for not having health insurance.  These include Massachusetts, New Jersey, and the District of Columbia, effective for the 2019 calendar year.  Vermont will impose a tax penalty for not having health insurance starting in 2020.  Other states are considering state individual mandates.  Check with your tax adviser for more information.

Regardless of the penalty, it is important to have health coverage if you can.  Health insurance continues to be offered during annual Open Enrollment periods.  If you don’t sign up during Open Enrollment you might have to wait up to one year until your next opportunity to enroll.

I entered the U.S. lawfully and I’m over 65, but I don’t qualify for Medicare. Can I apply for coverage and subsidies in the Marketplace? I hear premiums can be higher based on age. How much higher can my premium be if I’m over age 65?

Yes, you can purchase Marketplace coverage and qualify for subsidies based on your income. Premiums for Marketplace plans can vary by age unless States decide otherwise. In most states, your premium (before taking into account tax credits) could be up to three times that charged for somebody in their early 20s. Several states prohibit age adjustments to premiums or require lower age adjustments.

Where can immigrants get health care or health coverage when they cannot enroll in Medicaid or CHIP or get coverage through the Marketplaces?

Hospitals are required to provide emergency care and treatment to all individuals regardless of immigration or insurance status, though afterwards they can bill for their services. In addition, individuals may get low-cost care at community health centers.

Individuals may purchase health coverage through an employer or a spouse’s employer or the individual insurance market outside of the Marketplace. Some states and counties also offer health programs for immigrants.