What Is Happening with Health Insurance In 2014? Do I Have Choices? Charlotte Guntkowski Dave Morrow

What is the Affordable Care Act (ACA)? Legislation passed March 23 rd, 2010 Some parts already implemented –100% Wellness, Children up to age 26, Children under 19 cannot be declined… Includes an Individual Mandate in 2014 –Everyone must have an ACA compatible health insurance plan or pay a penalty/tax –Employers with 50 or more full time employees, or full time equivalents must provide an ACA compatible group plan or pay a penalty/tax of $2000/EE in 2014

What are ACA Compatible Plans? Cover 10 categories of Mandated Essential Health Benefits Free physical/preventative care each year Limited deductibles and out of pocket expenses Unlimited coverage Everyone is insurable

Will premiums go up or down? The law mandates additional new benefits and protections Age Bands limited to 3 (currently 5) –Premiums for older adults cannot be more than 3 times the premium for young adults. Everyone will be insurable regardless of Pre-existing Conditions New Taxes and Fees - as much as $475 a year for the average family What is the answer? Higher Premiums Higher Premiums

What are Exchanges? Exchanges will be marketplaces for purchasing insurance. Each state must set up an exchange or use the Federal Government Exchange FL has opted to use the Federal Exchange Insurance carriers have the option to sell plans on the exchange or not Imagine an Amazon or Travelocity type site for purchasing health insurance

What are the Exchange Plans? Plan tiers are categorized by “actuarial value” As an example, a Gold Plan will pay 80% of their health care expenses Enrollees will pay 20% through a combination of deductibles, copays, and coinsurance

What is the timeline for enrollment? October 1 - December 15, 2013 Open Enrollment for Jan 1 st, 2014 effective date December 16th – March 31, 2014: Effective date will be out a month or two April 1, 2014 – September 30, 2014 enrollment requires a qualifying event –Job change, marriage, plan termination…

Will there be Government Subsidies? Those with a low income below the Federal Poverty Level (FPL) will qualify for Medicaid Those with household income between 100% and 400% of FPL will qualify for subsidies and must purchase on the exchange to receive them Those with FPL over 400% will not qualify for subsidies and can choose to purchase a plan on or off the exchange Some will choose a non-qualified plan and some will choose no plan and they will pay the penalty/tax

How much do Exchange plans cost? Monthly premiums are based on household size, age, and income Single Person Size 1 Age 40 Income $40,000 Total Est Premium$368 Federal Subsidy $51 Indiv. Paid Premium$317 Annual Premium Cost $3804 Family of 4 Size 4 Age 40, 40 Income $80,000 Total Est Premium $1102 Federal Subsidy$469 Family Paid Premium$633 Annual Premium Cost $7596 *Using UC Berkley calculator based on Silver plan.

Are there alternatives? Creditable Short Term Major Medical plans No Free Physical No Pre-existing Conditions Covered Annual Policy Limits of $2 Million Dollars Per Person Doctor Office Copays 12 Month Term – unlimited reapplies Why would anyone want one of these plans when they could have an Exchange plan?

How much? Any penalties? Monthly premiums are based on # insured, age, and health Single Person Size 1 Age 40 Health Good Estimated Premium $160 Monthly Penalty $34 Premium & Penalty $194 Annual Cost $2328 Annual Savings $1476 Family of 4 Size 4 Age 40, 40 Health Good Estimated Premium $402 Monthly Penalty $58 Premium & Penalty $460 Annual Cost $5520 Annual Savings $2076 *HII 1 st Med 12 month STM in Zip Code

Have Pre-x? Or are you Healthy? Pre-existing Conditions – Choose an ACA Compatible Plan Healthy – Short Term Major Medical Major Health Event – Accident, Critical Illness… After Deductible + Coinsurance 100% Coverage up to $2 Million dollars Now you have a pre-existing condition, what do you do? ACA Plan Covers Pre-existing Conditions Unlimited Coverage no waiting period

How about Tax Free Benefits? Why do employers want to offer group health plans? –To attract and maintain good employees –SAVE MONEY ON TAXES! Why then do so many small business not offer group health insurance? 1.It is expensive 2.Can’t meet 75% employee participation requirements 3.Can’t afford 50% premium participation requirements

What is a good Referral? Do you know a small business owner who does not offer group health insurance who would like to save on taxes? Do you know an employee who’s employer does not offer group health insurance and would like to save on taxes and increase their take home pay?

What will a Defined Contribution Plan do? Allows Employees to pay for ind health ins with pre-tax dollars Gross Pay $3000 Taxes: Federal Income Tax $450 SS Medicare Tax $229 Net Pay$2321 Medical Ins after taxes $500 Net Spendable Income$1821 $3000 $500 $375 $191 $1934 Medical Ins Pre-Tax Employee pay example before Defined Cont Plan After That is an increase of $113 a month or $1359 a year in Net Spendable Income!

What is in it for the Employer? $4,000An employer with 10 employees using the previous example could save $4,000 or more a year in taxes. And these benefits will help them to attract and retain good employees Do you know anyone who might be interested?

Can any of this be done today? Yes, if you are healthy you may be able to save money by switching to a Short Term Major Medical plan today. An employer can establish a Defined Contribution Plan today and save himself and his employees money on taxes today. Do you know anyone who might be interested?

What is the Hook? Charlotte Guntkowski Dave Morrow Don’t let a sickness or illness turn into a Financial Crisis! Get Health Insurance today!

What is the Federal Poverty Level?