Health Care Reform Update - Amazon S3 · Changes That Will Affect Premiums •Guaranteed Issue...
Transcript of Health Care Reform Update - Amazon S3 · Changes That Will Affect Premiums •Guaranteed Issue...
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2014 & Beyond – Are You PPACA Ready?August 2015
Health Care Reform Update
Pamela Legge, RHU, CIIP, DAE, LPRT, CHRS
Sr. Vice President
BB&T John Burnham Insurance
San Diego, CA 92101
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Challenges for PPACA – Practical, Policy, and Political
• Continued technological challenges and security concerns on Healthcare.gov website as well as CoveredCA.com
• Insurance carriers cancelled millions of health plans that are not ACA-compliant
• Significant premium increases and out-of-pocket expenses for some people in some states
• Provider networks shrinking
• Public backlash and approval declining too, even from some supporters of the Obama administration
• Who wins and who loses?
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New World in 2014
Changes That Will Affect Premiums
• Guaranteed Issue – no one can be denied insurance coverage
• Broader Benefits – 10 types of Essential Health Benefits, out-of-pocket maximums, and deductible restrictions
• Changes in Rating – age, location, tobacco (not applicable in CA)
– Not gender, health in the small group market
• Actuarial Value – 60% of covered services
• New taxes and fees
• Subsidies/credits – assist lower income individuals in paying for coverage (100% to 400% FPL)
• Reinsurance Program – funded by employers to offset high cost claims in the individual marketplace
• New Marketplaces – offer new metal plans
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Individual Mandate
If NO, then If YES, then
Are you:• Part of a religious group with an exception• Incarcerated• An undocumented resident• American Indian• Paying more than 8% of take-home pay for employer coverage• So low-income you don’t pay federal income taxes• Someone who falls into a Medicaid expansion coverage hole• Some other hardship exemption
Do you have:• Coverage through a job• Coverage through an
Exchange/at least bronze individual coverage
• Medicaid, Medicare, CHIP• Tricare or VA Care• Student health plan• Grandfathered plan
Penalty2014 – Greater of 1% family income or $95
adult/$285 family maximum2015 – Greater of 2% family income or $325
adult/$975 family maximum2016 – Greater of 2.5% family income or $695
adult/$2,085 family
No Penalty
Or
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Subsidies
Provide assistance to low-income individuals:
• 100-400% of federal poverty level
• Not eligible for government programs that provide coverage
To help pay premiums or reduce cost-sharing
Not available to individuals who are either:
• Eligible for affordable, minimum-value employer coverage
• Enrolled in an employer plan
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Subsidy Settle Ups…2015
• It’s Important to Know – paybacks or clawbacks are possible if the annual actual income ends up being higher than the estimated income on the marketplace application. These are also called true-ups or reconciliations.
• Think about mid-year life change events – getting married, changing jobs, picking up a shift.
• How to fix? Update the exchange right away.
• If unreported, adjustments will be taken by the IRS from tax payer’s refund check or, if underestimation occurs, check would be sent to the tax filer.
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Five Key Employer Questions
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SHOP Options for Small Business
• Small Business Health Option Program (SHOP) – Exchange for small employers
• Small employers can offer employees enrollment in a QHP through a SHOP
– Can offer benefits through a cafeteria (Section 125) plan
– Exchange sets contribution methods
2014-15
• States can limit size to up to 50 employees
2016
• States must increase size to up to 100 employees
2017
• States can let any size employer participate
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Small Business HealthcareTax Credit
• Available for group with fewer than 25 Full Time equivalent employees
• Average salary must be less than $50k
• Only available if insured through SHOP
• Employer pays at least 50% of the employee’s premium costs
• Tax Credit is worth up to 50% of the employer contribution toward the employee’s premium cost (up to 35% for tax exempt employers)
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Taxes and fees overview
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Information Portals
• HHS created an Information Portal
• www.HealthCare.gov
• www.HealthCare.ca.gov
• www.DOL.gov
• www.kff.org
• www.IRS.gov
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Thank You!
For additional information please contact:
Pamela Legge, RHU, CIIP, DAE, LPRT, CHRS
Sr. Vice President, Employee Benefits
BB&T – John Burnham Insurance
San Diego, CA 92101
(619) 525-2675 – Direct
(888) 328-1316 – Fax