obamacare and your bottom line
DESCRIPTION
ObamaCare and Your Bottom Line. Presented by Sandra W Moody, LUTCF CLTC, CPIA Dehan Enterprises Insurance & Financial Services LLC. How We Got Here. Total US HC Spend is more than $2.8 trillion HC Expenses now represents 17.6% of GDP 72% of HC Spend on 6% of Population - PowerPoint PPT PresentationTRANSCRIPT
Presented by
Sandra W Moody, LUTCF CLTC, CPIA
Dehan Enterprises Insurance & Financial Services LLC
ObamaCare and Your Bottom Line
How We Got Here
• Total US HC Spend is more than $2.8 trillion• HC Expenses now represents 17.6% of GDP• 72% of HC Spend on 6% of Population• Nearly 75% of HC Spend on Big 4 Diseases• 87 Mil Americans Uninsured at Some Point• 80% of the Uninsured from Working Families• Approx 15% of African Americas including 1 mil
Children Uninsured
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How We Got Here
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• Ohio ranks 8th in total Uninsured• 1.3 mil Ohioans Uninsured• Number of Employer Plans Declining Since 2000• Premiums have Risen 4 Times Wages• 61% of adults are overweight• Obesity Rate in Children Tripled Since 1980• 77% of all Rx taken by those over age 50• 46% of Ohio’s Small Businesses offer Health Insurance
Patient Protection and Affordable Care Act
• Establishes Individual Mandate • Establishes Employer Mandates• Expands Medicaid Eligibility to 133% of
FPL• Establishes Healthcare Exchange
Marketplaces• Eliminates Lifetime Maximums & Adds
Free Wellness• Dependent Coverage Extended to Age 26• Eliminates Pre-existing condition
Requirements• Closes the Medicare Donut Hole by 2020
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PPACA, Affordable Care
Act, ACA or ObamaCare
Enacted March, 2010
By President
Obama
Patient Protection and Affordable Care Act
71 mil Kids and Adults have Received no Cost Preventive Care
3.1 mil Young Adults Obtained Coverage thru Parents Plan (2012)
$1.1 Bil in Rebates to 12.8 Mil Americans
$6.1 Bil Saved on Rx by Seniors (since 2010)
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2011 Average Annual Group Premiums
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Single Family
PPOs $5,584 $15,404
HMO $5,350 $15,288
HSAs $4,793 $13,704
Individual Mandates
Requires everyone to have health insurance. Those who are not insured in 2014 will be
subject to an annual health tax penalty starting at $95 or 1% of taxable income
whichever is greater and rising to $695 or 2.5% of income in 2016.
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Open Enrollment Period - Individual
• Initial Open Enrollment October 1st, 2013• Open Enrollment closes March 31, 2014
for all individual medical plans!• Future Annual Open Enrollment October
15th until December 7th
• Coverage Effective Date January 1st, 2014
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Health Insurance Marketplaces
Special Enrollment Period Qualifying Events
Loss of Minimum Essential Coverage
Material Contract Violations by Marketplace Insurance
CarrierGaining or Becoming a
DependentGaining or Losing Eligible
Premium Tax Credits of Cost Sharing Reductions
Relocation Resulting in New or Different Qualified Health Plan
Gaining Lawful Presence
Enrollment Errors by the Marketplace
Exceptional Circumstances
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Health Insurance Marketplaces
• Premium Subsidies for 133% to 400% of FPL• Subsidies only available for individuals purchasing
through exchange• Cost sharing which lowers Out of Pocket for incomes
below 250% of FPL• People with “essential benefits” and “affordable”
group coverage cannot obtain subsidies• Those eligible for Medicaid cannot obtain subsidies• If employer has coverage thru SHOP employees are
not eligible for subsidies
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Health Insurance Marketplaces
Provides another avenue to obtain insurance coverage
Ohio’s Federally Facilitated Marketplace (FFM)12 Insurance Companies
Approx 170 Plans in 17 rating areas
Online Portalwww.healthcare.gov
26 FFM – 16 State Based – 8 Partnerships
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Determining Premium
Your age, where you live, family composition and
whether you smoke, will determine your premium!
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Ohio Geographic Rating Areas
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Essential Health Benefits
Qualified Health Plans Include at Least These 10 Benefits
Ambulatory Patient Services Prescription Services
Emergency Services Rehabilitative and Habilitative Services and Devices
Hospitalization Laboratory Services
Maternity and New Born Care Preventive and Wellness Services and Chronic Disease Management
Mental Health and Substance Abuse Disorder Services Including Behavioral Health Services
Pediatric Services, including oral and Vision
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Metal Levels of Care
Level of Coverage Plan Pays on Average
Enrollees Pay on Average(In addition to the monthly premium)
Bronze 60% 40%
Silver 70% 30%
Gold 80% 20%
Platinum 90% 10%
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Individual Carriers In the Marketplaces
• Buckeye Community Health Plan
• Anthem Blue Cross & Blue Shield
• AultCare• CareSource• HealthAmerica One• HealthSpan
• Humana Health Plans• Kaiser Foundation
Health Plan of Ohio• Med Mutual• Molina • Paramount• SummaCare
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Health Insurance Marketplaces
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Health Insurance Marketplaces
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Health Insurance Marketplaces
Enrollment Assistance
• Website Portal• Toll free Call Center• Insurance Navigators• Enrollment Counselors• In Person Assisters• Community Based Organizations• Agents and Brokers (each state’s decision)
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2013 Federal Poverty Level
Number of Persons In Household
100% FPL 400% FPL
1 $11,490 $45,590
2 $15,510 $62,040
3 $19,530 $78,120
4 $23,550 $94,120
5 $27,530 $110,280
6 $31,590 $126,360Dehan Enterprises Insurance & Financial
Services LLC
Maximum Annual Premium Paid by Those Eligible for
Subsidies in Health Care Exchanges% of FPL Max Prem
%1 PersonFamily
2 PersonFamily
3 PersonFamily
4 PersonFamily
100% 2% $230 $310 $391 $471
133% 2% $306 $413 $520 $626
133.1% 3% $456 $619 $780 $940
150% 4% $689 $931 $1,172 $1,413
200% 6.3% $1,448 $1,954 $2,461 $2,967
250% 8.05% $2,312 $3,114 $3,921 $4,728
300% 9.5% $3,275 $4,420 $5,566 $6,713
350% 9.5% $3,820 $5,157 $6,494 $7,830
400% 9.5% $4,366 $5,894 $7,421 $8,949Dehan Enterprises Insurance & Financial
Services LLC
Medicaid Expansion
Increases income eligibility to 138% of the federal poverty level.
For a single person, $15,856 Family of four, $32,499
Single adults without children eligible
24 States Moving Forward22 States Not Implementing
4 States Debating (Ohio is one)Dehan Enterprises Insurance & Financial
Services LLC
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SHOP ExchangeSmall Business Health Options Program
Ohio’s FF-SHOPEmployers with less than 50 employees from 2014 through 2016. After 2017 may allow businesses with more than 100 employees to access coverage here.
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Small Business Tax Credits
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The credit equals 35% of the employer share of the premium. Business must pay at least 50 percent of the full
premium and have fewer than 25 employees with less than a $50,000 average salaries. Owners are excluded.
To continue receiving the credit after 2013, business must purchase group coverage through the Exchange.
Credit increases to a maximum of 50% in January, 2014.
Determining FTE Eligibility
• Employers choses a “look-back” period of between 3 and 12 months to measure if an employee has worked an average of 30 hours per week.
• If meets the 30 hour threshold, during the look-back period, considered FTE for the “stability period” of at least the next six months, regardless of how many hours the employee works
• Employer must provide FTE with health insurance or pay a tax penalty.
• Guidance pending on seasonal and temporary workers
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Pay or Play Employer Tax Penalty
Employers will face tax penalties if the coverage offered is unaffordable or does meet minimum essential benefits value and an employee receives a subsidy from the Exchange for coverage.
Penalty excludes first 30 FTE.Affordability - Employee’s share of the employee only premium cannot exceed 9.5% of W-2 income.
Delayed until January, 2015 Dehan Enterprises Insurance & Financial
Services LLC
Pay or Plan Employer Tax Penalty
Penalty for No Coverage
Large employer that does not offer coverage and at least 1 employee receives premium subsidy from the exchange, will incur a penalty of $2000 per FTE.
Penalty for Unaffordable Coverage
Large employers who do offer coverage and at least 1 employee receives premium subsidy from exchange, will pay lesser of $3,000 for each receiving the subsidy or $2,000 for each FTE.
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Large Employer Requirements
• By 2014, employers with more than 200 employees, requires automatic enrollment into employer health plan.
• By 2015, mandatory reporting for large employers, health insurance issuers and government agencies.
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ObamaCare and Its Your Bottom Line
Employer Reporting
W-2s required to include cost of employer provided health insurance.
Summary of benefit to all eligible employees Fair Standards Labor Act – Healthcare Exchange
Notification
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ObamaCare and Your Bottom Line
Health Savings Accounts (HSAs) – tax on non-qualified medical expenses increases from 10% to 20%
Over the counter drugs no longer reimbursable under HSAs, HRAs, FSAs
FSAs contributions decreases from $5,000 to $2,500 Itemized federal deduction threshold increases from
7.5% to 10% of AGI
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32
Long Term Care Insurance . . . An Extension of Your Medical Insurance
Fed’s Encourage LTC
Health & Welfare Reform of 1996
Deficit Reduction Act of 2005TAX-DEDUCTIBLE premiums & TAX-FREE benefits
Increased look back period to 5 years
State Partnership ProgramsMedicaid spend down protection
Affordable Care Act - CLASS ActVoluntary Government LTCi Plan (repealed Jan 2013)
Long Term Care Insurance . . . An Extension of Your Medical Insurance
Skilled CareMedically needed
Intermediate CareLess frequent skilled care
Custodial CareHelp with ADLs or memory
1st 60 Days Next 40 Days After 100 Days
Covered Not Covered
Covered
Not Covered
Not Covered
The gaps in your traditional medical insurance!
Long Term Care Insurance . . . An Extension of Your Medical Insurance
What Is Long Term Care?
It is the delivery of medical and personal care, other than hospital care to persons with chronic medical conditions resulting
from illness or frailty.
Post Retirement Disability
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Long Term Care Insurance…An Extension of Your Medical Insurance
IT CAN HAPPEN TO ANYONE
AT ANY TIME
AUTO INJURIES
CANCER
INJURIES FROM ACTIVITIES
DIABETES
STROKE &HEART ATTACK
ARTHRITIS &OSTEOPOROSIS
Long Term Care Insurance . . . An Extension of Your Medical Insurance
Activities of Daily Living
• Bathing• Dressing• Transferring• Toileting• Continence• Eating or• Severe Cognitive Impairment
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Long Term Care Insurance . . . An Extension of Your Medical Insurance
LTCi Provides Services For . . .
• Home Health Care• Personal & Homemaker Care• Assisted Living Facilities• Adult Day Care Facilities• Alzheimer Facilities• Nursing Homes• Hospice Facilities
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Long Term Care Insurance . . . An Extension of Your Medical Insurance
Average Annual Cost of Care In Ohio 2012$81,213 Private Room In a Nursing Home
$73,000 Semi-Private Room in Nursing Home
$44,550 Assisted Living Facility (private, one bedroom)
$43,197 Medicare Certified Home Health Aid (50 hrs per week)
$42,328 Homemaker Services (50 hrs per week)
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Long Term Care Insurance . . . An Extension of Your Medical Insurance
Working Caregivers Are Costing Your Business
Lost ProductivityEmployers lose an estimated $33.6 billion a
year on productivity due to employee caregiving.
Health Insurance UtilizationWorking caregivers consume 8% or $13.4 billion more in healthcare services per year.
Dehan Enterprises Insurance & Financial Services LLC
ObamaCare and Your Bottom Line
Now What?• Continue to Get Informed• Engage Accounting and Benefits Professionals• Educate Your Employees and Family Members• Explore Adding Ancillary Benefits• Institute a Culture of Wellness• Use Current Insurance Carriers & Agent Websites• Buy Medical and Long Term Care Insurance Now• Get Healthy, Stay Healthy
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Resources• www.dehaninsurance.com• www.Healthcare.gov• www.barackobama.com/health-care• www.medicare.gov• Kaiser Foundation – Health Care Reform
kff.org/health-reform• www.longtermcare.gov• www.marketplace.cms.gov• www.moodyLTC.com• SBA, IRS, HHS, Dept of Labor• Your Current Health Carrier and Insurance BrokerDehan Enterprises Insurance & Financial
Services LLC
ObamaCare and Your Bottom Line
Dehan Works on Your Behalf
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Helping You in the Creation,
Accumulation, and Protection of Wealth!
www.dehaninsurance.comwww.moodyltc.com
• Individual & Group Medical Plans• Commercial/Business Insurance• Employee Benefits & Exec Benefits• Long Term Care Insurance Plans• Personal Financial Planning• Personal Auto/Home/Motorcycle• Voluntary Payroll Deduction Plans• Surety, Fidelity & Contract Bonds• Financial Education Training