Thursday, June 27, 2013

Healthcare Reform School - Lesson # 8 - Options for Small Businesses

Welcome back.  Summer is in full swing and that out of school routine is in place for most families.  Look down the road just a few months and you will see that January is not very far away and the a change in our society will start taking place for real.  Of course I am talkiing about the Affordable Care Act or Obamacare as it has become known.  Oddly enough that term is used as a derogatory term or a term of endearment, depending on which side of the political fence you reside.

In my last lesson I discussed how individuals can prepare for January by reviewing their insurance, checking the rate calculator to see what they are in for regarding rates and subsidies, and then to talk to their health insurance agent and put a new health insurance policy in place now that will be stable through all of 2014.

This lesson will be about how small businesses can prepare for January.  This is for businesses owners with fewer than 50 full time equivalent employees (FTEs). The first thing to do is determine if a business has 50 FTEs.  This may be very simple, but if the number is close and there are part time employees to add into the mix, then it is a bit trickier. Here is how you figure out how many FTE's a company employees.  First, figure the number of full time employees that work an average of 30 hours per week in a given month.  Then add the full-time equivalent of part-time employees. To calculate that number add the number of hours worked by part-time employees in a given month and divide the total by 120.  So two part time employees that worked and average of 60 hours in one month, equal one FTE.

First and foremost, companies with less than 50 FTE's are not required to provide any type of health insurance under the Affordable Care Act.  Employees with more than 50 FTEs are required to provide "qualified" and "affordable" coverage to employees or pay a tax penalty of $2000 per employee.
Greenleaf design, www.freedigitalphotos.net

So how do these small businesses prepare for 2014.  Currently some offer benefits and some do not offer benefits.  The most popular way to offer benefits currently is through a small group plan.  In 2014 small groups will become obsolete because of the following reasons:
  • Group plans are too expensive, rates keep raising as the group gets older and submit claims to the insurance companies
  • In 2014, everyone will be eligible for insurance on the private market.   Currently many employers feel an obligation to create a group so that sick employees are able to get health insurance. This will no longer be necessary under the Affordable Care Act because the insurance companies are mandated to accept all applicants regardless of pre-existing conditions.
  • IN 2014, if an employee is eligible for a qualified group plan, then they are not eligible to go on the exhanges and purchase insurance utilizing.  This means they will not have any opportunity to take advantage of government subsidies to help pay for their insurance.
However, benefits are an important hiring and employee retention tool.  So what is the alternative?

To prepare for 2014, I recommend strongly dropping that group plan and implementing a new health insurance benefit through a Health Reimbursement Arrangement or HRA.   Why is it exciting? Because you can offer a Health Insurance Benefit to your employees that has the followoing attributes:
  • Costs are set by the business and stay fixed
  • Employees are able to buy health insurance with the benefit and still have the opportunity to receive government subsidies if they qualify based on their income.
  • The time it takes to administer the health benefits is 5 minutes per month, which can free up a lot of time.
  • This is a tax free benefit, their are no payroll taxes paid on the benefit and the employee uses the benefit tax free for health insurance and other health related expenses.
HRAs are a HUGE deal.  However they are not all created equal.  I highly recommend using Zane Benefits to implement and administer the HRA to keep the business records compliant with the laws and to use me as the health insurance agent that will help employees find the health insurance policies that they purchase with the benefits provided through the HRA.










Sunday, June 23, 2013

Healthcare Reform School - Lesson #7 - Preparing for the Affordable Care Act

Welcome back to class.  I have been delayed in getting this lesson out because I was sick and had to use my health insurance a bit. I am feeling well enough to start teaching again!  Thank goodness.
<p>Image courtesy of jscreationzs/ <a href=
"http://www.freedigitalphotos.net" 
target="_blank">FreeDigitalPhotos.net</a></p>

So just what should people do to prepare for the Affordable Care Act?   The first step is education, which you are already doing, then taking steps to put yourself in a good position.  Another excellent source for learning as much as you would ever want to know about health insurance is the Kaiser Foundation Website.  This is a non-partisan organization that has an excellent website and even has a rate calculator that will estimate your premiums in 2014.  I suggest using their rate calculator to determine how much your premiums will be in 2014 and if you will be eligible for a tax credit.  If that rate is higher than you are paying now, which it most likely will be depending on your age, then you should talk to a health insurance agent and ask what you can do to keep you rate stable  through 2014.  As an agent/broker myself, I have multiple companies that are offering stability in their policies through the entire year of 2014.  The only catch is that you have to have that insurance in place before the law goes into effect.  This advice is relevant for everyone who currently buys their own health insurance on the private market. 

But what if you are a small business owner or work for a company that offers a group plan.  For small business owners with small groups, there are other options that I will go over in my next blog, which will be very soon.  For people on a group plan, it depends on what your employer will do in 2014.  That plan may be very different for large companies versus small companies with less than 50 employees. I suggest asking  what they foresee for benefits in 2014.  If they are considering dropping their group insurance, then you should start now to prepare, remember rates are lower now then they will ever be again.  If you wait for your employer to drop your group plan and then go onto the health exchange, you could be stuck paying more than you need to.  It may make sense to find new coverage on the private market now, and then drop out of your small group once you have new insurance in place.

So it is important to know how you will be affected and then have a plan to put yourself in the best position.  Education is the first step.  Taking action is the next step and the most important step.  Feel free to contact me for advice, or your own health insurance agent for advice.  Now is the time for you to have an agent.  Their services are free to everyone, but good agents should know how to prepare you for the future based on the training they receive.

Thanks for attending class and see you soon.

To educate yourself more, please go back and review my first six lessons:
 Lesson #1 - Introduction
Lesson #2 - Basic Reason for creating the Patient Protection and Affordable Care Act
Lesson #3 - Public exchanges for Purchasing Insurance
Lesson #4 - Essential Health Benefits that will be added to all Health Insurance policies in 2014
Lesson #5 - Tax Credits to Help Pay for Health Insurance
Lesson #6 - Enforcement and Penalties in the Affordable Care Act





Tuesday, June 11, 2013

Enforcement and Penalties in the Affordable Care Act.

Healthcare Reform School - Lesson #6 - Enforcement of the Patient Protection and Affordable Care Act.

In this session I will cover the basics of how the Federal government will enforce the law and the penalties that have been published as punishment for non-compliance.

To get started, the basic premise of the law is that everyone must have major medical health insurance and the insurance companies can not deny coverage to anyone that applies for major medical health insurance.  The people will be able to purchase health insurance from on-line exchanges, through which private insurance companies will sell their policies.  The policies have minimum requirements in terms of coverage, with the least expensive being labelled Bronze, then Silver, then Gold, then Platinum.  They get more expensive and have less financial exposure as you go up the ladder.  I explain this because this, because this will come into play when going over the penalties for not having insurance.

The law states that everyone is supposed to purchase insurance and people under a specific income level will receive assistance in paying for it.  But what happens to those who decide not to comply at all?  Here is the break down.
Salvatore Vuono, courtesy FreeDigitalPhotos.net
  1. It is not considered a criminal offense.
  2. The penalties are financial fines and will be taken from tax refunds in the subsequent years.  The penalties start out small in 2014 and increase each year until 2016.  Following are the penalty amounts.
    1. In 2014 - $95 per adult, $47.50 per dependent. (up to $285 for a family) or 1.0% of income, whichever is greater
    2. In 2015 - $325 per adult and $162.50 per dependent. (up to $975 for a family) or 2.0% of income, whichever is greater
    3. 2016 and beyond - $695 per adult and $347.50 per dependent (up to $2,085 for a family) or 2.5% of income, whichever is greater.
  3. There is an exception to the federal requirement to buy health insurance.  
    1. If you have to pay more than 8% of your income for health insurance, after taking into account any employer contributions or tax credits 
    2. According to the price of the Bronze Plan (Mentioned above)
    3. There is no penalty for being without insurance
All of this being said, I personally do not recommend going without health insurance, and not just because I am an Insurance Agent/Broker.  The cost of medical care is very high and insurance can save your assets in case of a catastrophe.

Lesson #7 will be coming soon.

Previous Lessons have been:
Lesson #1 - Introduction
Lesson #2 - Basic Reason for creating the Patient Protection and Affordable Care Act
Lesson #3 - Public exchanges for Purchasing Insurance
Lesson #4 - Essential Health Benefits that will be added to all Health Insurance policies in 2014
Lesson #5 - Tax Credits to Help Pay for Health Insurance





Wednesday, June 5, 2013

Health Care Reform School, Lesson #5 - Tax Credits to help pay for health Insurance

Healthcare Reform school is back in session.  This is lesson #5 Financial Assistance provided for Health Insurance. 
Just to review very quickly, in my previous blogs I covered briefly the following topics.  For a reminder just click on them and you will be brought to that blog post.
A big part of the law is to get the large group of uninsured people with low income into the insurance pool.  Very often a big reason this group of people does not have insurance is the prohibitive cost of health insurance.  Therefore in order to get them into the "pool" the federal government will provide assistance.  Eligibility will be based on the previous years filed income taxes and will be determined through the application process through the Public Exchanges.  The amount of tax credit will be based on income and family size and the benchmark to which aid is being tied is the Federal Poverty Level (FPL).  There is a sliding scale of financial aid based on the income level and family size.  The concept is to have the insured people pay a specific percentage of their income towards health insurance.  Following is the scale that the government  is using:
Image courtesy of hin255 / FreeDigitalPhotos.net

  • People earning up to 133% of Federal Poverty Level (FPL) will pay 2% of income towards insurance
  • People earning from 133-150% of FPL will pay 3 – 4% of income towards insurance
  • People earning from 150-200% FPL 4 – 6.3% will pay 3 – 4% of income towards insurance
  • People earning from 200-250% FPL 6.3 – 8.05% will pay 3 – 4% of income towards insurance
  • People earning from 250-300% FPL 8.05 – 9.5% will pay 3 – 4% of income towards insurance
  • People earning from 300-400% FPL 9.5% will pay 3 – 4% of income towards insurance
Now to to put these numbers into context, review the following chart.

 2013 Federal Poverty Guidelines




48 Contiguous States and DC

Note: The 100% column shows the federal poverty level for each family size, and the percentage columns that follow represent income levels that are commonly used as guidelines for health programs. 

 Household Size
 100%
 133%
 150%
200% 
 300%
400% 
 1
$11,490
$15,282
$17,235
$22,980
$34,470
$45,960
 2
15,510
 20,628
23,265
  31,020
46,530
62,040
 3
19,530
 25,975
29,295
  39,060
58,590
78,120
 4
23,550
 31,322
35,325
  47,100
70,650
94,200
 5
27,570
 36,668
41,355
  55,140
82,710
110,280
 6
31,590
 42,015
47,385
  63,180
94,770
126,360
 7
35,610
 47,361
53,415
  71,220
106,830
142,440
 8
39,630
 52,708
59,445
  79,260
118,890
158,520
 For each additional person, add
$4,020
 $5,347
$6,030
  $8,040
$12,060
$16,080
Is that all clear?  Well if it is not, then feel free to contact me.