Employee Benefit News for School, City and County Employers

2025 Pay-or-Pay Affordability Percentage Increased

Written by Rick Labian | Sep 12, 2024 12:09:59 PM

1 minute read

On September 6, 2024, the IRS unveiled Revenue Procedure 2024-35, which updates the contribution percentage for 2025 to determine the affordability of an employer’s health plan under the Affordable Care Act (ACA). Starting in 2025, employer-sponsored health coverage will be deemed affordable under the ACA’s "pay-or-play" mandate if the employee’s share for self-only coverage does not exceed 9.02% of their household income for the year.

 

Affordability Test

The ACA’s pay-or-play rules mandate that large employers offer affordable, minimum-value health coverage to full-time employees and their dependents. If the employee’s contribution does not exceed 9.5% of their household income, adjusted annually, the coverage is deemed affordable. Failure to meet this requirement may result in penalties.

In recent years, the affordability percentage has been updated to:

  • 9.12% for 2023;
  • 8.39% for 2024; and
  • 9.02% for 2025.

The affordability test applies only to self-only coverage premiums and excludes family coverage costs. For multiple health coverage options, it applies to the lowest-cost option meeting minimum value. Because employers may not know an employee’s household income, the IRS offers three affordability safe harbors: Form W-2, rate of pay, and federal poverty level.

 

Affordability Percentage for 2025

For 2025, the affordability percentage rises to 9.02%, allowing more flexibility for employers in setting contributions, as coverage is deemed affordable if an employee's self-only contribution does not exceed 9.02% of their income. Download the bulletin for more details.