Excise Tax on High-Cost Employer-Sponsored
Health Coverage: In Brief
Annie L. Mach
Analyst in Health Care Financing
August 14, 2015
Congressional Research Service
7-5700
www.crs.gov
R44147
Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief
Summary
The Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) includes a 40%
excise tax on employer-sponsored health coverage. This tax, often called the Cadillac tax, is to be
implemented beginning in 2018.
The excise tax was included in the ACA to raise revenue to offset the cost of other ACA
provisions. According to the Congressional Budget Office and the Joint Committee on Taxation,
the excise tax is expected to increase federal revenues by $87 billion between 2016 and 2025.
The excise tax applies to the aggregate cost of an employee’s applicable coverage that exceeds a
dollar limit. Applicable coverage includes, but is not limited to, the employer’s and the
employee’s contribution to health insurance premiums and certain contributions to tax-
advantaged health accounts (e.g., health care flexible spending accounts, or FSAs).
In 2018, the dollar limits are $10,200 for single coverage and $27,500 for non-single (e.g.,
family) coverage. The dollar limits may be adjusted based on growth in health insurance
premiums and characteristics of an employer’s workforce. Additionally, the dollar limits are to be
adjusted for inflation in subsequent years.
The entity providing the coverage, the coverage provider, is responsible for paying its share of the
excise tax. A coverage provider may be an employer, a health insurer, or another entity that
sponsors the coverage. The employer is responsible for calculating the amount of tax owed by
each coverage provider (if any).
All of this information is covered in more detail in this report, which provides an overview of
how the excise tax is to be implemented. The information in the report is based on statute and
guidance issued by the Department of the Treasury and the Internal Revenue Service.
Congressional Research Service
Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief
Contents
The Excise Tax on High-Cost Employer-Sponsored Health Coverage ........................................... 1
Applicable Coverage ................................................................................................................. 2
Definition of Applicable Coverage ..................................................................................... 2
Determining the Cost of Applicable Coverage ................................................................... 4
Dollar Limits ............................................................................................................................. 5
Demographic Adjustment ................................................................................................... 6
Retiree and High-Risk Profession Adjustment ................................................................... 6
Coverage Providers ................................................................................................................... 6
Cost Estimate ................................................................................................................................... 7
Relationship to the Tax Exclusion for Employer-Sponsored Insurance .......................................... 8
Tables
Table 1. Applicable Coverage .......................................................................................................... 3
Table 2. Not Considered Applicable Coverage ............................................................................... 3
Table 3. Coverage Provider by Type of Coverage ........................................................................... 7
Contacts
Author Contact Information ............................................................................................................ 8
Congressional Research Service
Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief
he Patient Protection and Affordable Care Act (ACA;P.L. 111-148, as amended) includes a
40% excise tax on high-cost employer-sponsored health insurance coverage, often referred
T to as the Cadillac tax.1 The 40% excise tax is assessed on the aggregate cost of employer-
sponsored health coverage that exceeds a dollar limit. If a tax is owed, it is levied on the entity
providing the coverage (e.g., the health insurance issuer or the employer). The excise tax goes
into effect in 2018.
The excise tax is included in the ACA to raise revenue to offset the cost of other ACA provisions
(e.g., the financial subsidies available through the health insurance exchanges), and it is expected
to increase federal revenues by $87 billion between 2016 and 2025.2 The excise tax also is
expected to limit the tax advantages for employer-sponsored health coverage. Many economists
contend that the tax advantages lead to an overconsumption of coverage and health care services.
This report provides an overview of the excise tax. The report includes cost estimates for the
excise tax and explores the excise tax’s relationship with the tax advantages for employer-
sponsored health coverage. The information in this report is based on statute and two notices
issued by the Department of the Treasury (Treasury) and the Internal Revenue Service (IRS).
Notice 2015-16 was issued February 17, 2015, and the comment period for the notice closed May
15, 2015. 3 Notice 2015-52 was issued July 30, 2015. The comment period for the notice closes
October 1, 2015.4 As of the date of this report, regulations related to the excise tax have not been
promulgated.
The Excise Tax on High-Cost Employer-Sponsored
Health Coverage
Many employers offer health insurance plans and other health-related benefits (e.g., health care
flexible spending accounts, or FSAs). These benefits are one part of an employee’s total
compensation. Often employers pay for part or all of these benefits. To illustrate, 55% of
employers offered health insurance plans to their employees in 2014, and on average employers
covered 82% of the premiums for single coverage and 71% of the premiums for family coverage.5
Beginning in 2018, a 40% excise tax is to be assessed
Definition of Employee
on the aggregate cost of an employee’s applicable
coverage that exceeds a dollar limit during a taxable
Under Section 4980I(d)(3) of the Internal
Revenue Code (IRC), “the term employee
period.6 Unlike some other ACA provisions,
includes any former employee, surviving spouse,
assessment of the excise tax is not dependent on an
or other primary insured individual.” The same
employer’s characteristics (e.g., number of workers);7
definition is used in this report unless otherwise
noted.
1 26 U.S.C. §4890I.
2 Congressional Budget Office, Insurance Coverage Provisions of the Affordable Care Act – CBO’s March 2015
Baseline, March 9, 2015.
3 Department of the Treasury (Treasury) and the Internal Revenue Service (IRS), Notice 2015-16, February 17, 2015.
4 Treasury and IRS, Notice 2015-52, July 30, 2015.
5 The Kaiser Family Foundation and Health Research & Educational Trust, Employer Health Benefits, 2014 Annual
Survey, September 10, 2014.
6 In statute, taxable period is defined as “the calendar year or such shorter period as the Secretary may prescribe. The
Secretary may have different taxable periods for employers of varying sizes” (26 U.S.C. §4980I(f)(8)). In Notice 2015-
52, Treasury and IRS say that they anticipate the taxable period will be a calendar year for all taxpayers.
7 For instance, the Patient Protection and Affordable Care Act (ACA; 111-148, as amended) employer shared
(continued...)
Congressional Research Service
1
Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief
assessment is dependent on whether the aggregate cost of an employee’s applicable coverage
exceeds a dollar limit. The entity responsible for paying the excise tax to the IRS is the coverage
provider. The terms applicable coverage, dollar limit, and coverage provider are defined and
described in more detail below.
Applicable Coverage
The excise tax is assessed on the amount by which the aggregate cost of an employee’s applicable
coverage exceeds a dollar limit.8 The amount is called the excess benefit. Determining the excess
benefit requires knowing which types of coverage are considered applicable coverage and how
the cost of such coverage is calculated. For example, consider an employee who has an employer-
sponsored health plan, a separate vision-only plan, and a health care flexible spending account
(FSA). To determine the excess benefit, if any, of the employee’s coverage, it is necessary to
know whether any of the coverage is considered applicable coverage and the methods for
determining the cost of such coverage.
Definition of Applicable Coverage
Applicable coverage is defined as
coverage under any group health plan made available to the employee by an employer
which is excludable from the employee’s gross income under section 106 [of the IRC], or
would be so excludable if it were employer-provided coverage (within the meaning of
such section 106).9
Coverage that is excluded from an employee’s gross income under Section 106 of the IRC
includes, but is not limited to, employers’ contributions to health insurance premiums, Archer
Medical Savings Accounts (MSAs), and health savings accounts (HSAs).
Additionally, three arrangements are identified in the statute as applicable coverage:10 (1) the
employee-paid portion of health insurance coverage (i.e., an employee’s contribution to
premiums); (2) a self-employed individual’s health insurance coverage for which a deduction is
allowable under Section 162(l) of the IRC;11 and (3) coverage under a group health plan for
civilian employees of federal, state, or local governments. See Table 1 for a list of what is
considered applicable coverage based on the statute and Notice 2015-16.
(...continued)
responsibility requirement (the employer mandate) only applies to large employers as measured by the size of the
employer’s workforce.
8 In Notice 2015-16, Treasury and IRS indicate that the aggregate cost of applicable coverage is based on the coverage
in which the employee enrolls, not the coverage that is made available to the employee.
9 26 U.S.C. §4980I(d)(1)(A).
10 26 U.S.C. §4980I(d)(1).
11 IRC §162(l) allows self-employed individuals to deduct certain medical expenses, including premiums.
Congressional Research Service
2
Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief
Table 1. Applicable Coverage
(for purposes of the excise tax on high-cost employer-sponsored health coverage)
Employer’s and employee’s contributions to the premium for a group health plan
Retiree coverage
Health care flexible spending account (FSA)
Archer medical savings account (MSA)a
Health savings account (HSA)b
Health reimbursement account (HRA)c
On-site medical clinicsd
Coverage for a specified disease or il ness if the coverage or insurance is purchased with pretax dol ars
or able to be deducted under Section 162(l) of the IRCe
Hospital indemnity or other fixed indemnity insurance if the coverage or insurance is purchased with
pretax dol ars or able to be deducted under Section 162(l) of the IRC
Coverage for a self-employed individual, provided a deduction is allowable under Section 162(l) of the
IRC
Coverage under a group health plan offered to civilians by a federal, state, or local government
Executive physical programsf
Sources: 26 U.S.C. §4980I; Notice 2015-16.
a. In Notice 2015-16, Treasury and IRS indicate that they anticipate excluding employees’ after-tax
contributions to Archer MSAs from applicable coverage in future regulations.
b. In Notice 2015-16, Treasury and IRS indicate that they anticipate excluding employees’ after-tax
contributions to HSAs from applicable coverage in future regulations.
c. In Notice 2015-16, Treasury and IRS provide that they anticipate clarifying that HRAs are applicable
coverage in future guidance.
d. In Notice 2015-16, Treasury and IRS indicate that forthcoming proposed regulations wil provide that on-
site medical clinics that offer only de minimis medical care are not considered applicable coverage. Treasury
and IRS requested comments on how to characterize the medical care provided by on-site medical clinics.
e. IRC §162(l) allows self-employed individuals to deduct certain medical expenses, including premiums.
f.
In Notice 2015-16, Treasury and IRS provide that they anticipate clarifying that executive physical programs
are applicable coverage in future guidance. A definition for an executive physical program is not provided.
Certain arrangements are excluded from the definition of applicable coverage (Table 2).
Arrangements not considered applicable coverage are not included in the calculation for
determining the aggregate cost of applicable coverage.
Table 2. Not Considered Applicable Coverage
(for purposes of the excise tax on high-cost employer-sponsored health coverage)
Coverage only for accident or disability income insurance
Coverage issued as a supplement to liability insurance
Liability insurance (including general liability and automobile liability)
Workers’ compensation or similar insurance
Automobile medical payment insurance
Credit-only insurance
Other coverage, as specified in regulations, that is secondary or incidental to other health insurance benefits
Congressional Research Service
3
Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief
Coverage, whether through insurance or otherwise, for long-term care
Coverage under a separate policy for dental and/or vision care
Coverage for a specified disease or il ness if the coverage or insurance is not excludable from gross income
or a deduction under Section 162(l) of the IRC is not allowed with respect to ita
Hospital indemnity or other fixed indemnity insurance if the coverage or insurance is not excludable from
gross income or a deduction under Section 162(l) of the IRC is not allowed with respect to it
Coverage under a plan offered to members of the military and their families by a federal, state, or local
government
Employee after-tax contributions to HSAs and Archer MSAsb
Sources: 26 U.S.C. §4980I; Notice 2015-16.
a. IRC §162(l) allows self-employed individuals to deduct certain medical expenses, including premiums.
b. In Notice 2015-16, Treasury and IRS indicate that they anticipate excluding employees’ after-tax
contributions to HSAs and Archer MSAs from applicable coverage in future regulations.
Determining the Cost of Applicable Coverage
The cost of applicable coverage is to be determined under rules “similar to” the rules in Section
4980B(f)(4) of the IRC.12 These rules currently apply under Title X of the Consolidated Omnibus
Budget Reconciliation Act of 1985 (COBRA;P.L. 99-272). Under COBRA, an employer with 20
or more employees that provided health insurance benefits must provide qualified employees and
their families the option of continuing their coverage under the employer’s group health insurance
plan in certain cases where the employee’s coverage otherwise would end (e.g., the employee is
terminated). For COBRA purposes, the rules in Section 4980B(f)(4) of the IRC are used to
determine the cost of the premium for the health insurance plan in which the former employee
can continue.
As of the date of this report, information is not available about how the rules in Section
4980B(f)(4) of the IRC will be applied in the context of the excise tax. In Notice 2015-16,
Treasury and IRS describe potential approaches they are considering for applying the COBRA
rules to determine the cost of applicable coverage.13
The statute also includes specific calculation rules for determining the cost of applicable
coverage:
Any portion of the cost of applicable coverage that is attributable to the excise tax will
not be taken into account.
The cost of applicable coverage will be calculated separately for single coverage and
non-single coverage (e.g., family coverage).14
In the case of applicable coverage provided to retired employees, the plan can choose to
treat a retired employee who is under the age of 65 and a retired employee aged 65 or
older as similarly situated beneficiaries.15
12 26 U.S.C. §4980I(d)(2).
13 See the “Determination of Cost of Applicable Coverage” section of Notice 2015-16.
14 See 26 U.S.C. §4980I(f)(1)(B) for the definition of non-single coverage.
15 Under Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA;P.L. 99-272) rules, a former employee’s
premium is based on the cost of coverage for “similarly situated” non-COBRA beneficiaries. These similarly situated
individuals are employees and their dependents who are receiving coverage from the employer and were most similarly
(continued...)
Congressional Research Service
4
Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief
With respect to a health care FSA, the cost of applicable coverage is the greater of an
employee’s salary reduction election or the total reimbursements under the FSA.16
With respect to Archer MSAs, the cost of applicable coverage is equal to an employer’s
contributions to the Archer MSA.17
With respect to HSAs, the cost of applicable coverage is equal to an employer’s
contributions, including salary reduction contributions, to the HSA.18
If the cost of applicable coverage is not determined on a monthly basis, the cost of the
coverage will be allocated to months on a basis prescribed by the Secretary of the
Treasury.
Dollar Limits
The excise tax is assessed on the excess benefit—the portion of an employee’s applicable
coverage that exceeds a dollar limit. In 2018, the dollar limits will be $10,200 for single coverage
and $27,500 for non-single coverage (e.g., family coverage),19 as adjusted by the health cost
adjustment percentage. The health cost adjustment percentage is a one-time upward adjustment
based on premium growth in the Blue Cross Blue Shield (BCBS) Standard plan under the Federal
Employee Health Benefit (FEHB) program. The 2018 dollar limits will be adjusted upward if
premium growth in the BCBS Standard plan is more than 55% between 2010 and 2018.20
In 2019, the limits will be the 2018 limits adjusted by the Consumer Price Index for all Urban
Consumers (CPI-U) plus 1%.21 In 2020 and beyond, the limits will be the previous year’s limits
adjusted by the CPI-U. The dollar limits also could be subject to two different adjustments, which
are described below.
(...continued)
situated to the COBRA beneficiary prior to the COBRA beneficiary becoming a former employee.
16 Total reimbursements under a flexible spending account (FSA) may be greater than an employee’s salary reduction
election if an employer makes nonelective contributions (often referred to as flex credits) to the employee’s FSA and
the employee uses those funds.
17 In Notice 2015-16, Treasury and IRS indicate that they anticipate excluding employees’ after-tax contributions to
Archer medical savings accounts (MSAs) from applicable coverage in future regulations.
18 In Notice 2015-16, Treasury and IRS indicate that they anticipate excluding employees’ after-tax contributions to
health savings accounts (HSAs) from applicable coverage in future regulations.
19 Any coverage provided under a multiemployer plan (as defined in IRC §414(f)) is treated as coverage other than
single coverage. In other words, coverage provided under a multiemployer plan is always subject to the non-single
coverage threshold.
20 Currently, it seems unlikely that premium growth in the Blue Cross Blue Shield Standard plan will exceed 55%
between 2010 and 2018, as premium growth between 2010 and 2015 was about 20% for both the single and family
coverage options. Premium growth for 2016 through 2018 would have to be significantly higher than in recent years for
growth over the whole period to exceed 55%.
21 The Consumer Price Index for All Urban Consumers (CPI-U) is a measure of inflation published by the U.S. Bureau
of Labor Statistics.
Congressional Research Service
5
Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief
Demographic Adjustment
For some employers, the dollar limits for each year could be increased based on their employees’
demographic characteristics. The adjustment could occur if the age and gender characteristics of
all employees of an employer are significantly different from the age and gender characteristics of
the national workforce.22 The adjustment uses the BCBS Standard plan offered through the FEHB
program. The cost of the BCBS Standard plan is determined based on the age and gender
characteristics of the employer’s workforce and on the age and gender characteristics of the
national workforce. The amount the dollar limits could be increased is equal to the excess cost of
the BCBS Standard plan adjusted for the employer’s workforce as compared to the BCBS
Standard plan adjusted for the national workforce.
Retiree and High-Risk Profession Adjustment
The limits also may be adjusted for (1) individuals who are qualified retirees and (2) individuals
who participate in an employer-sponsored plan that has a majority of its enrollees engaged in a
high-risk profession or “employed to repair or install electrical or telecommunications lines.”23
For purposes of this adjustment, qualified retirees are retired individuals aged 55 and older who
do not qualify for Medicare. Employees engaged in high-risk professions are
law enforcement officers (as such term is defined in section 1204 of the Omnibus Crime
Control and Safe Streets Act of 1968), employees in fire protection activities (as such
term is defined in section 3(y) of the Fair Labor Standards Act of 1938), individuals who
provide out-of-hospital emergency medical care (including emergency medical
technicians, paramedics, and first-responders), individuals whose primary work is
longshore work (as defined in section 258(b) of the Immigration and Nationality Act (8
U.S.C. 1288(b)), determined without regard to paragraph (2) thereof), and individuals
engaged in the construction, mining, agriculture (not including food processing), forestry,
and fishing industries. Such term includes an employee who is retired from a high-risk
profession described in the preceding sentence, if such employee satisfied the
requirements of such sentence for a period of not less than 20 years during the
employee’s employment.24
Under this adjustment, the dollar limits are increased for these individuals by $1,650 for self-only
coverage and $3,450 for coverage other than self-only.
Coverage Providers
The excise tax is not assessed on an employee; rather it is assessed on the entity providing the
applicable coverage—the coverage provider. Table 3 lists the coverage providers identified in
statute.
22 The term national workforce is not defined in statute. Treasury and IRS explain an approach they are considering to
determine the characteristics of the national workforce in Notice 2015-52.
23 26 U.S.C. §4980I(b)(3)(C)(iv).
24 26 U.S.C. §4980I(f)(3).
Congressional Research Service
6
Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief
Table 3. Coverage Provider by Type of Coverage
(for purposes of the excise tax on high-cost employer-sponsored health coverage)
Type of Coverage
Coverage Provider
Group health plan offered by a ful y insured employera
Health insurance issuer
Employer contributions to HSA
Employer
Employer contributions to Archer MSA
Employer
Other coverage (including coverage offered by a self-
Entity that administers the plan benefitsc
insured employer)b
Source: 26 U.S.C. §4980I(c)(2).
a. A ful y insured employer is one that purchased a health plan offered by a state-licensed insurance carrier.
b. A self-insured employer sets aside funds to pay for health benefits directly and bears the risk for covering
the medical expenses generated by the individuals covered under the self-insured plan.
c. This term is not defined in statute, except to indicate that the term includes a plan sponsor if the plan
sponsor administers the plan’s benefits. In Notice 2015-52, Treasury and IRS explain the various approaches
they are considering to identify the entity that administers the plan benefits.
It is possible that an employee’s applicable coverage may not be provided by just one coverage
provider. In the case of multiple coverage providers, each coverage provider is responsible for
paying the excise tax on its applicable share of the excess benefit.25 A coverage provider’s
applicable share is based on the cost of the coverage provider’s applicable coverage in relation to
the aggregate cost of all of the employee’s applicable coverage.
In general, the employer is responsible for calculating the aggregate amount of applicable
coverage that is in excess of the threshold and determining each coverage provider’s applicable
share of the tax.26 The employer is required to notify the Secretary of the Treasury and each
coverage provider about the amount determined. A penalty may be imposed on the employer if
the excess benefit is not calculated correctly. The excise tax is nondeductible—coverage
providers cannot deduct the excise tax as a business expense.
Cost Estimate
The excise tax is one of several taxes and fees included in the ACA to raise revenue to offset the
cost of other ACA provisions (e.g., the financial subsidies available through the health insurance
exchanges). In March 2015, the Congressional Budget Office (CBO) and the Joint Committee on
Taxation (JCT) estimated the excise tax would increase federal revenues by $87 billion between
2016 and 2025.27
CBO and JCT indicate that the revenue raised by the excise tax will come from both collection of
the excise tax and increases in taxable income, with most of the revenue raised a result of
increases in taxable income.28 The relationship between the excise tax and taxable income is
discussed in the following section.
25 26 U.S.C. §4980I(c).
26 For multiemployer plans, the plan sponsor has this responsibility.
27 Congressional Budget Office, Insurance Coverage Provisions of the Affordable Care Act - CBO’s March 2015
Baseline, March 9, 2015.
28 Congressional Budget Office, Updated Estimates of the Effects of the Insurance Coverage Provisions of the
Affordable Care Act, April 2014, April 14, 2014, at http://www.cbo.gov/publication/45231.
Congressional Research Service
7
Excise Tax on High-Cost Employer-Sponsored Health Coverage: In Brief
Relationship to the Tax Exclusion for Employer-
Sponsored Insurance
Employer-sponsored health insurance and benefits generally are excluded from employees’ gross
income for purposes of determining employees’ income tax liability.29 Additionally, these
amounts generally also qualify for exclusion from Social Security and Medicare (FICA) taxes and
unemployment (FUTA) taxes.30 These exclusions often are collectively referred to as the tax
exclusion for employer-sponsored health insurance and benefits.
Modifying or repealing the tax exclusion has been discussed for many years. One reason federal
policymakers are interested in the tax exclusion is that the exclusion results in considerable
revenue loss to the federal government. JCT estimates the income tax exclusion will result in
$785 billion in foregone revenue for the federal government between 2014 and 2018.31 Ending or
modifying the tax exclusion could raise a significant amount of revenue, depending on how it
would be modified or repealed and how employers and workers would adjust.
The excise tax does not directly modify or end the tax exclusion; however, the excise tax is seen
as an indirect method for limiting the tax exclusion. As discussed above, official scores indicate
that the revenue raised by the excise tax will come both from collection of the excise tax and from
increases in taxable income. The increases in taxable income are a result of the expectation that
employers will reduce the amount of health coverage they offer to employees to avoid paying the
excise tax. Provided employers do this but keep total compensation for employees constant (i.e.,
shift the compensation from health benefits to taxable wages), the result will be generally higher
taxable wages for affected employees. CBO and JCT have estimated that about one-quarter of the
revenue raised will come from collection of the excise tax, while about three-quarters of the
revenue raised will stem from employers’ responses to the tax.32
Author Contact Information
Annie L. Mach
Analyst in Health Care Financing
amach@crs.loc.gov, 7-7825
29 26 U.S.C. §§105(b) and 106.
30 26 U.S.C. §§3121(a)(2), 3306(b)(2).
31 Joint Committee on Taxation, Estimates of Federal Tax Expenditures for Fiscal Years 2014-2018, August 5, 2014.
This estimate does not include the effect of the exclusion for employment taxes.
32 Congressional Budget Office, Updated Estimates of the Effects of the Insurance Coverage Provisions of the
Affordable Care Act, April 2014, April 14, 2014, at http://www.cbo.gov/publication/45231.
Congressional Research Service
8