Affordable Health Care Act

Affordable Health Care Act

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  T O DD E . G O R D O N , R H U P R E S I D E N T , T H E B E N E F I T S G R O U P , I N C . N A H U C E R T I F I E D P A T I E N T P R O T E C T I O N A N D A F F O R D A B L E C A R E A C T ( P P A C A ) P R O F E S S I O N A L Health Care Reform: Impact on You & Your Business
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  The Individual Mandate What are my options? 1. Employer-sponsored coverage 2. Individual coverage  Individual market exchange  „Off „ exchange 3. No coverage – pay the penalty
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  The Public Exchange/Marketplace Individuals who buy a policy from the public exchange may be eligible for credits and subsidies  Income range from 133% to 400% Federal Poverty Level (FPL)  Individual: $14,856 to $44,680  Family of four: $30,6565 to $92,200  Not have access to minimum essential coverage through their employer or have access to coverage, but it is not affordable  Premium Credits – for any level plan  Cost-Sharing Subsidies – Silver Plan only  Public exchange open enrollment begins 10/1/13
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  No Coverage –Penalties for Individuals  2014  Greater of $95 or 1% of taxable income  2015  Greater of $325 or 2% of taxable income  2016  Greater of $695 or 2.5% of taxable income  2017 and beyond  Annual adjustments
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  Essential Health Benefits Applies to:  Individual & Small Group plans  Non-grandfathered plans: On and off exchange  Does not apply to:  Large Group and ASO plans  Grandfathered plans  Benchmark plan:  Each state will select for the purposes of defining EHBs
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  Essential Health Benefits Ambulatory patient services  Emergency services  Hospitalization  Laboratory services  Maternity & newborn care  Mental health & substance abuse disorder services  Pediatric services, including oral & vision care  Prescription drugs  Preventive & wellness services and chronic disease management  Rehabilitative and habilitative services and devices
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  Reform Related Taxes& Fees What When Who Pays How Much Comparative Effectiveness Research Fee Plan/policy years ending 10/1/2012 Insurers of fully insured plans; sponsors/administrators of self-insured plans $1 per person per year; adjusted for subsequent years Reinsurance Assessment 1/1/2014 Issuers of fully insured plans Estimated at $5.25 per person per month Tax on high earners Tax year beginning 1/1/2013 Individuals .9% increase on Medicare, in excess of $200k single/$250k married Tax on unearned income Tax year beginning 1/1/2013 Individuals 3.8% on unearned income in excess of $200k single/$250k married Insurer Fees Tax year beginning 1/1/2014 Issuers of fully insured plans Estimated at 2.46% of premium, plus state fee High-cost insurance tax Tax year beginning 1/1/2018 Insurers of fully insured plans; sponsors/administrators of self-insured plan 40% on plan costs exceeding “Cadillac” thresholds
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  What About Ratesin 2014?  Most significant changes will be in markets for individuals and small employers  Rating constraints  Product constraints  Benefit mandates  New taxes  Studies & Carrier Reports  Forecasting a wide range of impact
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  Options for SmallBusinesses Employers who have less than 50 employees:  Offer a fully insured plan through either:  SHOP Exchange (full implementation has been delayed)  The off-exchange market  Offer an ASO (administrative services only)  Self-funded  Stop offering coverage  Employees go to exchange  Offer “non-affordable” coverage  Employees go to exchange
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  Options for LargeEmployer  Employer Shared Responsibility Penalty  If a “large” employer does not offer “minimum essential” health benefits to their full-time employees, they may be required to pay a penalty  If a plan is offered, but it does not meet the coverage levels required, they may be required to pay a penalty  If a plan is offered, but “unaffordable”, they may be required to pay a penalty
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  Employer “Play orPay” Mandate  Employers with 50+ employees who DO NOT offer coverage:  At least 1 employee obtains subsidized coverage from health insurance exchange  Fee equal to $2,000 X the number of full-time employees minus the first 30 employee  Employers with 50+ employees who DO offer coverage, but coverage is not “affordable”  Assessment of $3,000 X the number of employees receiving subsidized coverage  “Affordable” defined as employee‟s share of the premium is greater than 9.5% of income for employee only coverage
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  Large Employer Considerations Calculating the number of full-time and full-time equivalent employees (FTEs)  Aggregation of common ownership  Automatic Enrollment for employers with 200+ FTEs – delayed for 2014  Minimum essential coverage  Plan coverage must provide minimum value at least 60% of the total allowed cost of benefits that are expected to be incurred under the plan  HHS/IRS will provide a calculator to determine minimum value
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  Questions Todd E. Gordon,RHU President, The Benefits Group, Inc. NAHU Certified Patient Protection and Affordable Care Act (PPACA) Professional [email protected] (770) 455-3446 ext. 207 www. tbgatlanta.com