Aca healthcare options for 2013 public by michael chapman 073113 slideshare

© 2013 Michael Chapman, GroupBenefitsAdvisors.com

What You Need to Know NOW& How to prepare for 2014

• What You Need to Know• What You Need to Decide• When You Need to Act• Plus, How It Affects You, Your

Job, and Your Employer

What?When?

Why?

Healthcare Options for 2013And how to prepare for 2014


Disclaimer:

• The information presented is subject to change, and will likely change in the future.

• Subscribe to TheMedicalInsuranceExchange.com newsletter or contact us for latestupdates.

• The information presented should not to be construed as offering legal or tax advice; consult with a lawyer or tax professional.

• Some state variations may occur, the information presented is based on the laws of Texas.

What?When?

Why?

Healthcare Options for 2013


My Qualifications:

• Former CEO• Since 2003, Frequent Public Speaker on Healthcare and Insurance.• Employee Benefits Broker for Companies and Individuals.• Published Author, Blogger.• Helpful, pro bono resource to thousands of individuals and companies in

DFW with benefits-related questions and concerns.

• Mike Chapman, [email protected]• Linkedin.com/in/michaelchapman (14,000+)• 214-764-6315 tel, 214-732-3691 cell


mailto:[email protected]


My Dilemma



Door # 2:• Plunge head first

towards opportunities created from PPACA

• Mike Chapman, [email protected]• Linkedin.com/in/michaelchapman• 214-764-6315 tel., 214-732-3691 cell


mailto:[email protected]


Best Healthcare Advice for Anyone:



Best Healthcare Advice for Anyone:

• Stay Healthy• Don’t Get Injured



2nd-Best Healthcare Advice for Anyone:



2nd-Best Healthcare Advice for Anyone:

• Die Quickly• Die In Your Sleep!

• Over 80% of lifetime healthcare expenses occur in last 18 months of life.

• Medical is Leading Cause of Bankruptcies© 2013 Michael Chapman, GroupBenefitsAdvisors.com


We Don’t Get to Choose If, When,

or How

We Get Sick, Injured or Die



The Choices We MakeDetermines How Much We

Have to Spend

If and When We Get Sick, Injured or Die



A Healthy, “Hazard-Free ‘Lifestyle

Reduces How Much We’ll Eventually Pay When We Get Sick, Injured and Die, and Increases the

Length and Quality of Life



Insurance pools the $$ Risk of

Sickness Accident, and

Death



Healthcare is Expensive• 30-35% of US GDP• For many families, #1 or 2 budget item.• For many Businesses, #2 Overhead item

after salaries • High, uncontrollable inflation.



Pre-2014 Options:• COBRA• Private Insurance• “Risk Pool”• VA/Tricare (Veterans/Active Duty)• Medicare (65+)• Medicaid/CHIP (Children)• Self-Insure



Pre-2014 Options:• COBRA/State Continuation• Same plan, same $ as employer• 18 months/6 months• No exclusion of health conditions• Must elect within 60 days



Pre-2014 Options:• Private Insurance• Can exclude conditions,

increase rates based on health conditions during underwriting.



Underwriting:• Evaluation of Risk of claims• Conditions• Age• Gender• Residence



Pre-2014 Options:

• Group Insurance• Guaranteed Issue• Same cost for every employee

• Individual Insurance• Individually Underwritten



Pre-2014 Options:

• Individual Insurance• Individually Underwritten• Insuring a healthy, younger, male with

no health conditions is less risk of a claim, so they will pay less for insurance.

• Can reduce cost vs. COBRA by up to 60%



Pre-2014 Options:

• Individual Insurance• Short term plans• 0-6 months of coverage.• Easy, short application.

• “Permanent” plans• Stay in force as long as you pay premium.• Lengthy application/underwriting.

• Short term and permanent are both major medical plans.



Pre-2014 Options:

• “Risk Pool”• Option after COBRA and if either spouse

is not eligible for group plan.• Covers individuals who are ineligible or

excluded individual insurance because of health condition.



Pre-2014 Options:• Medicare• Guaranteed issue coverage at age 65, can

apply at 64 ½• A+B+D plus medicare supplement or

Medicare Advantage (HMO) plan in some areas.

• Limitation of healthcare providers who accept.



Pre-2014 Options:• Medicaid/CHIP (Children)• Children 0-18• Income/Asset qualify• Waiting list• HMO• Affordable



Pre-2014 Options:• Self-Insure• You assume risk of sickness/injury• Includes public health programs such

as Parkland and John Peter Smith in DFW



Whether you yet know it or not……ACA Impacts EVERYTHING

• Every American faces healthcare decisions Beginning 10/1/2013 for 2014.

• Every Business faces similar decisions in 2014

What?

Why?

What?When?

Why?



When Must I Make A Decision?• Huge Advertising Campaign.

• Exchanges Open October 1, 2013

• ACA Coverage Begins January 1.

• Best Time To Make A Decision is NOW!

What?When? Why?



The Obamacare Clock Is Ticking..

…The Sooner You Know WHAT to Do…The Longer You’ll Have to Adjust!



Change = Opportunities

Use Knowledge of Obamacare as Your Secret

Advantage.



Brief Overview of What it Is• Coverage Differences• How You Buy It• What It Costs You• Consequences to You and Employer

What?When? Why?



Your Health Plan will be Different

2013 2014



98% of Today’s Health Plans Will

Be Replaced

Just Kidding!



Some of the Big Plan Differences:• Different Deductibles – • Max $2,000 Deductible.• $3,500 Max Out of Pocket.

• “Guaranteed Issue,” Regardless of Your Health.• More Coverage, Examples:• Maternity Coverage, Dental Checkups to Age 6



More Big Plan Differences:• Guaranteed issue, No “Rate Ups” for Risk or Conditions• Except May Charge 50% More for Smoking• May Offer Discount for Wellness Plan Participation• 3 vs. 6 Age Bands• Community Rating.



Buzz Word: Essential Benefits

• Ambulatory patient services• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance use disorder services,

including behavioral health treatment• Prescription drugs



Essential Benefits, continued:

• Rehabilitative and habilitative services and devices• Laboratory services• Preventive and wellness services; chronic disease

management• Pediatric services, including oral and vision care



Essential Benefits, continued:

• Items or services that have an ‘A’ or ‘B’ rating• Immunizations for routine use in children,

adolescents, & adults• Evidence‐informed preventive care and screenings• No cost sharing for preventive care services (in‐

network)



Buzz Word: Actuarial Value

• Bronze plans = 60% of minimum of cost of healthcare

• Silver plans = 70% of minimum of cost of healthcare

• Gold plans = 80% of minimum of cost of healthcare

• Platinum plans = 90% of minimum of cost of healthcare



Your Premiums Will Be Different:

2013:$$$

2014:???



Anybody Want to Guess the Biggest Factor Whether You’ll Pay More or Less?



How Much You Earn!



Eligibility for Government SubsidyFamily of 4

Income LevelPercent of

Poverty LevelIndividual Can Get

Coverage In:Government

Subsidies

Above $88,200 Above 400% Federal or State Health Ins Exchange

No

$88,200 400% Federal or State Health Ins Exchange

Yes

$29,327$22,050

$0

133%100%0%

Medicaid Yes



1. How Do Find Out if I Qualify for a Subsidy for Obamacare?

2. Am I Sure I Really Want a Subsidy?

3. What’s The Penalty If Uninsured?



Tax Credit or Subsidy• Subsidies Only Available through Public and Private

Exchanges.• Employee+ Dependents NOT ELIGIBLE for a Subsidy If:

• The employer offers at least the actuarial equivalent of the Bronze Plan (60%)

• The employee cost share is not more than 9.5% of their annual income (W‐2 Employee) (AGI)



Tax Credit or Subsidy• If employer offers health insurance for employees,

employee cannot apply for subsidy for themselves or for their dependents.

• This means employee must purchase high cost, unsubsidized insurance for dependents or pay a tax penalty if they are uninsured.



Subsidy Calculator:


http://exchg.myclientdemosite.com/obamacare-subsidy-calculator/


Go to: http://TheMedicalInsuranceExchange.com/obamacare-subsidy-calculator/

or http://goo.gl/LbldeU

For Subsidy Estimates



Go to: http://themedicalinsuranceexchange.com/apply-here-for-obamacare-subsidy-and-health-insurance/

or http://goo.gl/7QAx5y

For Final Draft Copy of ACA Paper Applications



If your Adjusted Gross Income ends up exceeding your estimate, the IRS will assess and take back your subsidy.

The IRS Giveth and Taketh Away:

Examples:

• Job Seekers

• Y.E. Bonus

• Unexpected Income



Where You’ll Buy:Employer

Private

Exchange

• Employer• Federal or State Exchanges

(Federal Only in TX)• Private Exchanges• 2015: SHOP for small biz (< 25)



Public Insurance Exchanges:

• State Run (23 states + DC)

• Federal Exchange (26 states, including Texas)


“Pre-2014” Health Insurance Transaction

When?

Healthcare Costs© 2013 Michael Chapman, GroupBenefitsAdvisors.com

You and/or Your

Employer

Insurance Company

Insurance Policy

$$,Health

Information


2014 Exchange Transaction

What?

Why?


You and/or Your

Employer

Insurance Company



What?

Why?


You and/or Your

Employer

Insurance Company

Inco

me In

form

ation,

Health In

form

ation

Subsidy

Approva

l,

Taxe

s



What?

Why?


You and/or Your

Employer

Insurance Company

Inco

me In

form

ation,

Health In

form

ation

$$ Policy Subsidy,

Taxes

Subsidy

Approva

l,

Taxe

s

Information

$$ Premium Payment

Health Insurance Policy



Where:

Marketplace.CMS.Gov


Downside of Public Exchanges:

• Self-serve, with little to no

support

• Expect LONGGGGGG

Wait Times,

• WRONGGGGG Answers.



Downside of Public Exchanges:

• Inexperienced, minimally trained

“Navigators” and “Assistors”

• Navigator grant money awarded to

organizations favoring Administration



Downside of “Public Exchanges”

• Do you really want to share

your personal health & tax

information?



Downside of “Public Exchanges”

• No support or assistance

after purchase.



What is a “Private Exchange”?

• Multiple carrier venue for insurance policies

• Not just health insurance

• Run by Experienced, Trained, Licensed Agents




Example ofPrivate Exchange:

TheMedicalInsuranceExchange.com



• Out of pocket max greater than $3,500.• You don’t have guaranteed issue or maternity

coverage now.• You’re younger than age 35 (approx.)• You live in an area with high healthcare utilization.• Your employer decreases contribution or drops group

plan.

You May Pay More in Premiums If in 2013:



You May Pay Less in Premiums If in 2013:

• Out of pocket max now less than $3,500.• You have guaranteed issue coverage (Risk Pool).• You’re older than age 50 (approx.)• You live in an area with low healthcare utilization.• Your employer maintains/increases health plan

contribution or improves health plan.



• 2014: $95 per Adult, $47.50 per Child up to $285 per family or 1% of income.

Individual Tax Penalty If Uninsured:

• 2015: $325 per Adult, $162.50 per Child up to $975 per family or 2% of income.

• 2016: $695 per Adult, $347.50 per Child up to $2085 per family or 2.5% of income.



Your Choices:

COBRA

Private/Public Exchange Insurance

Short-term plan + Tax Penalty



Whatever You Choose, You’ll Pay More:

Taxes

Goods & ServicesNew Federal Tax on Insurer Premiums, 3.8% Tax on Unearned Income, dividend taxes.



Impact On Seniors:

• Harder to find doctors who accept Medicare (25% pay cut)

• Gradual Closing of Donut Hole• Reduction In Medicare Budget• Likely: Medicare Premiums Based

on Assets and Income



Employer Impact



Employer Penalties (delayed):

• $2,000 per Employee over 30 FTEs if Group Ins. or if no Essential Benefits

• $3,000 per Employee that does not enroll in Employer’s plan because it costs employee more than 9.5% of income or plan does not meet Bronze level.



Certain Industry Sectors Will Get Hammered:• Staffing• Seasonal• Hospitality• Retail



Employer Impact


• Increased cost, taxes and regulations/red tape for all businesses.

• Employer tax penalties delayed until 2015 (50+ full time employees)

• Uncertainty impacting permanent, full-time employment.


Employer Impact


• Increase in part-time employment.• Fewer employers will offer health insurance as an

employee benefit.• Fewer employees will want an employer to offer

health insurance so they can qualify for a subsidy for their whole family.


In Many Cases, It Benefits Employer to Drop Group Health Ins. Coverage


• Cost of Tax Penalty for 50+ Employees Is Less than Health Insurance and is a Fixed Cost.


In Many Cases, It Benefits Employee for Employer to Drop Group Health Ins. Coverage


• Subsidized Cost of Health Insurance for Employee + Dependents May Be Less for Employee than Employee Cost of Health Insurance for Employee Only


In Many Cases, It Benefits Employee for Employer to Drop Group Health Ins. Coverage


• For Lower Wage Employees, Its Like Getting Dependents’ Insurance for FREE!


At This Point, Which Are You?Dazed & Confused Bored Zombie



My Unique Solutions:

• Education, Expertise, Year-Round Service.• TheMedicalInsuranceExchange.com, a Private Health

Insurance Exchange• Employer consultation• Partially Self-Funded Plans for employers



The Obamacare Clock Is Ticking..

• Advertising for Fed. Exchanges Has Begun

• Open Enrollment begins October, go to TheMedicalInsuranceExchange.com

• You need to educate others what to do.



Decision-making Is Like Constipation

Taxes, Penalties,Higher Expenses, STRESS, Etc.

…The Longer You Wait, the Worse It

Gets



How I Help Employers• Consulting expertise• Rapid assessment of options & impact• Educate top management• Develop plan of action• Employee education is critical for success.



ACA Open Enrollment Preparation:“Black Tuesday”: October 1st, 61 Days Away

• Schedule an appointment now for beginning October 1st.• Write down your Family SS #s, Dates of Birth.• If Insured, Make Copy of Your Insurance Card and Bill.• Go to http

://TheMedicalInsuranceExchange.com/obamacare-subsidy-calculator or http://goo.gl/LbldeU; Print out an estimate of your subsidy.


http://themedicalinsuranceexchange.com/obamacare-subsidy-calculator




ACA Open Enrollment Preparation:

• Subscribe to http://www.TheMedicalInsuranceExchange.com for updates and information as it becomes available.

• Find a good PCP ASAP!


http://www.themedicalinsuranceexchange.com/


If You’re An Employer or Work for One:• Whether or not your employer offers health ins.,

An Employer Has An Obligation and Opportunity to Communicate ACA to Employees.

• Schedule Me for an Employee Group Meeting

• Schedule Me to Visit with Owner/CFO/CEO



How You Can Help Me• Refer me to companies that need

advice.

• What Business Leadership Groups Could Use a Subject Matter Expert Speaker?

• Bookmark/Share:TheMedicalInsuranceExchange.com

How You Can Help Yourself & Your Company

• Share This Information ASAP

• ACT on This Information ASAP



Remember:

Use Your New Knowledge of Obamacare as Your

Healthcare Advantage.

(Know enough to raise the questions, then, “I know a guy…”



Please Comment/ForwardShare/Like:

• http://TheMedicalInsuranceExchange.com • Facebook:• YouTube Channel: ObamacareInformation• LinkedIn.com/in/michaelchapman

• Subscribe, Sign Up for Updates, Upcoming Presentation Schedule and Webinars!


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Aca healthcare options for 2013 public by michael chapman 073113 slideshare