The Small-business Health Care Tax Credit Begin Planning Now to Maximize This Benefit

If your medical or dental practice is considered to be a small business, and you pay at least half of the cost of single health insurance coverage for your employees in 2010, you may qualify for a new tax credit. In 2010, the tax credit can be as much as 35{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the premiums you pay on your employees’ behalf.

There are different provisions for small tax-exempt employers, but since most doctors’ practices are not tax-exempt, this article won’t cover those provisions.

The tax credit is included in the Patient Protection and Affordable Care Act, which became law March 23, 2010 and is effective Jan. 1, 2011. The new law is intended to encourage small employers to offer health insurance coverage for low- and moderate-income workers by subsidizing premiums paid with a tax credit. Section 45R of the Internal Revenue Code was added to provide for this credit. IRS Notice 2010-44 was written to provide guidance in determining eligibility and to assist in calculating the tax credit.

Amount of the Tax Credit

The maximum amount of the credit is 35{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of a small-business employer’s premium costs in 2010. This rate increases to 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2014. To obtain the maximum credit, an employer must have no more than 10 full-time-equivalent employees (FTEs), and the average annual wages of its employees must be no more than $25,000.

For employers with more than 10 but less than 25 FTEs or with average annual wages of more than $25,000 but less than $50,000, the credit gradually phases out according to a formula.

Who is Eligible for the Tax Credit?

A qualifying employer must have fewer than the equivalent of 25 FTEs as defined in the act, the average annual wages of its employees must be less than $50,000 per FTE, and the employer must maintain a ‘qualifying arrangement’ under which the employer pays premiums for each employee enrolled in the health-insurance plan in an amount equal to a uniform percentage (not less than 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}) of the cost of coverage. For 2010, under transitional rules, paying 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the cost of single insurance coverage will satisfy this requirement.

Do Owners of the Business Count as Employees?

A sole proprietor, a partner in a partnership, a shareholder owning more than 2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of an S corporation, and any owner of more than 5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of any other corporation or business and their family members or members of their household are not considered employees for purposes of the credit. Their wages, hours worked, and premiums paid on their behalf are excluded from any calculations in determining the amount of the credit. This is significant because, in many cases, including owners would disqualify the related employer for the credit.

What is an FTE?

For purposes of this credit, an FTE is an employee that is paid for at least 2,080 hours of service, including vacations and other paid time off. So if an employee works part time and is paid for 1,040 hours, the employee is considered a half FTE. The law allows three different methods for determining hours of service. To calculate the number of employee FTEs, divide the total hours of service by 2,080 and round down to the next-lowest whole number. Therefore, an employer with 25 or more employees may qualify for the credit if some of the employees work part-time.

Seasonal or temporary workers may be disregarded in determining FTEs and average annual wages unless each works for the employer more than 120 days during the taxable year; however, premiums paid on their behalf may be counted in determining the amount of the tax credit.

Determining the Average Annual Wages

To determine the average annual wages, divide the total wages (as defined for FICA purposes) paid by the employer during the year to the employees that were taken into account in determining FTEs by the FTEs for the same year, and round the result down to the nearest $1,000.

Qualified Insurance Premiums

For years prior to 2014, only premiums paid by the employer to health-insurance issuers, such as an insurance company or HMO licensed to engage in the business of insurance, are counted for purposes of the credit. Qualified health-insurance coverage plans include major medical, dental, long-term care, nursing-home care, home health care, community-based care, or any combination of the above. Also included are specific disease or illness plans, indemnity insurance plans, Medicare, and other supplemental plans.

Each type of plan must separately satisfy the qualifying arrangement requirement first before aggregating the premiums paid by the employer to calculate the allowable tax credit; i.e., at least 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of premiums must be paid by the employer.

Finally, for taxable years beginning before 2014, the amount of the credit is limited to a percentage of the lesser of 1) the amount of non-elective contributions (premiums) paid by the eligible small employer on behalf of employees under the arrangement during the taxable year, and 2) the amount of non-elective contributions the employer would have paid under the arrangement if each such employee were enrolled in a plan that had a premium equal to the average premium for the small-group market in the state (or in an area of the state) in which the employer is offering health-insurance coverage. The secretary of Health and Human Services (HHS) determines whether separate average premiums will apply for areas within a state (‘sub-state areas’) and also determines the average premium for a state or sub-state area. Revenue Ruling 2010-13 sets forth the average premium for the small-group market in each state for the 2010 tax year. This table can be accessed through www.irs.gov.

Claiming the Credit

The credit is claimed on the practice’s annual income tax return. Small employers whose credit exceeds their current-year income tax can carry the excess credit back one year (except for 2010) and forward 20 years.

Devil in the Details

As with most tax benefits, there are exceptions, conditions, and other complications that can limit the amount of the credit and tax savings:

  • Members of a controlled group or an affiliated service group, as defined in the tax regulations, are treated as a single employer for purposes of the credit. Therefore, all employees and all related wages of the control group must be aggregated to determine eligibility.
  • The amount of the employer’s deduction for health insurance premiums must be reduced by the amount of the credit claimed in that year.
  • There are specific rules as to the effect that state tax credits and subsidies for health insurance may have on the amount of tax credit allowable to the employer.

Although the rules and calculations involved are somewhat complex, the tax credits can save a small employer tens of thousands of dollars in cash flow each year, so it behooves you to do the math.

Start Planning Now

You should engage your CPA or tax advisor now to ascertain whether you might likely qualify for this in 2010. The following steps must be followed to determine whether you are eligible for the tax credit under IRS Code Section 45R:

  • Determine the employees who are taken into account for purposes of the credit.
  • Determine the number of hours of service performed by those employees.
  • Calculate the number of the employer’s FTEs.
  • Determine the average annual wages paid per FTE.
  • Determine the premiums paid by the employer that are taken into account for purposes of the credit. Specifically, the premiums must be paid by an employer under a qualifying arrangement and must be paid for health insurance that meets the requirements of Section 45R.
  • Determine if there are any state tax credits or premium subsidies related to the employer’s health-insurance program.

Running a pro-forma calculation now not only gives you an indication of your eligibility, but also identifies an action plan to take over the remainder of the year to maximize the tax credit, such as timing of premium payments and changing the policy relative to employer-paid premiums.

The accompanying examples of small-employer tax credits published by the IRS (see box) shows the potential savings to small employers.


The small-business health care tax credit could represent the largest federal tax credit ever made available to small employers. Go to www.irs.gov and search for ‘small-business health care tax credit’ to learn more about this credit, including a fact sheet, a worksheet to determine eligibility, frequently asked questions, examples of applying the rules, Notice 2210-44, and Notice 2010-13.

James B. Calnan, CPA, is a partner with Meyers Brothers Kalicka, P.C. in Holyoke, certified public accountants and business strategists; (413) 536-8510;www.mbkhealthcare.com