The ACA in 2015 Top 5 Facts for Business Owners

Transcription

1 The ACA in 2015 Top 5 Facts for Business Owners

2 The Affordable Care Act (ACA) Built on the existing healthcare system Aimed to rein in healthcare costs Upheld by U.S. Supreme Court Implementation primarily the responsibility of the states

3 The ACA Why it matters to you Most Americans are required to have health insurance There are new opportunities for employers to provide insurance to their employees Whether choosing to provide insurance or not, questions are coming! Owners and managers are being asked about ACA.

4 The 5 things you need to know 1. Your responsibilities under the ACA 2. How the Marketplace can benefit you & your employees 3. Ways that the ACA can make coverage more affordable 4. How to access the SHOP Marketplace for Employers 5. Where to find strategic help

5 1. Businesses have responsibilities under the ACA

6 What is the Requirement? Beginning January 1, 2014 There was a shared responsibility provision of the Affordable Care Act requiring everyone to have health care coverage Questions you may have Can I keep my current plan? Are there exceptions? How will I be penalized? Are there new options to help people that don t have an employer plan?

7 Marketplace Model notice Most employers must distribute notice by October 1 that Marketplaces are open. Department of Labor Regulation Questions: How do I know what to say? Where do I get a copy? What if my employees have questions?

8 Small Employers (2-50 Employees) Small employers are not required to offer coverage no penalty will apply. Some MAY choose to do so and have a new options under the Marketplace. Employers with less than 25 employees, and average incomes below $50,000 can qualify for the small business tax credit to help offset premium contributions if they buy a plan in the SHOP.

9 Large Employers (51+ Employees) Businesses with employees required to offer in 2016 Businesses with more than 100 employees required to provide insurance to 70% of employees in 2015, 95% in 2016 and beyond

10 Employer shared responsibility requirement Am I above or below 100 full-time employee threshold in 2015? Size determined annually; amount owed determined monthly Potential requirements: Failing to offer coverage- $2,000 for each full-time employee per year, excluding the first 30 full-time employees Failing to offer affordable coverage that provides minimum value- $3,000 per year for each full-time employee receiving federal financial assistance in marketplace What does it mean to be affordable and meet minimum value?

11 2. How can the Marketplace benefit you and your employees?

12 What Exactly IS the Marketplace? One stop shop web portal for individuals & small businesses (fewer than 50 employees) to purchase or enroll in BOTH private and public health coverage. Individuals can NOT be discriminated against based on existing medical history Application is web-based, and due to its goal of being user friendly, many will be able to enroll without assistance Benefits will be standardized and must meet minimum standards called the Essential Health Benefits package. Plan information and pricing can be easily compared

13 Insurance OUTSIDE the Marketplace Still be available for Individuals and Businesses Will need to meet minimum requirements (being phased in over 2014) May have additional options that are not seen on the Marketplace New financial help is not available OUTSIDE the Marketplace

14 Individuals & self-employed Individuals can purchase coverage for themselves, families, dependents on your state s individual marketplace Plans organized by metal level; varying levels, premiums, out-ofpocket costs Bronze lower premium, higher out-of-pocket costs Platinum highest premiums, lowest out-of-pocket costs All plans have same set of essential health benefits: package of items and services in 10 categories

15 Benefits of the plans First-dollar (no deductible/cost-sharing) coverage on preventive health Limits out-of-pocket limits to those specified in the federal tax code (can vary annually) All plans must cover a benchmark list of Essential Health Benefits. 15

16 What are the essential health benefits? All health plans in the Marketplace, individual & small group, are qualified health plans (QHP). Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services including chronic disease management 16 Pediatric services including oral and vision care

17 How does ACA impact preventive services? Well woman visit QHPs provide first-dollar preventive services Screening for gestational diabetes Human papillomavirus testing Counseling for sexually transmitted infections. Counseling and screening for HIV Type of Preventive Service Alcohol misuse screening and counseling Blood pressure/cholesterol screening Immunizations Depression screening Type 2 diabetes screening Contraceptive methods and counseling Breastfeeding support, supplies, and counseling Screening and counseling for interpersonal and domestic violence Breast cancer mammograms Colorectal cancer screenings Developmental screening for children Full list of no additional cost preventive screenings available on healthcare.gov 17

18 What About Medicare? Medicare will continue as is. Part A&B have not been changed. If you have a Medicare Supplement or Part D Prescription Drug Coverage you will continue to buy that privately NOT on the Marketplace. Financial Help Available? Some seniors MAY qualify for the Medicare Savings Program Ongoing reductions in the Prescription Donut hole over the next few years.

19 3. There ARE ways to make coverage more affordable.

20 Financial Assistance for Individuals Understanding the Federal Poverty Level FPL Expanded Medicaid Eligibility in Illinois (Up to 138%) AllKids (Up to 300%) New Financial help on paying premiums in the Marketplace for those earning up to 400% FPL (about $46,000 for single, $94,000 for family of four). Cost Sharing subsidies (for deductibles/copays) in the Marketplace for those earning up to 250% FPL 20

21 Helping keep costs low Example: Family of 4; 2 45-year-old adults, 2 children under 20, $80,000 annual household income Unsubsidized insurance premium, silver plan through individual marketplace = $12,549/yr or $1,045.75/mo Eligible for premium assistance at 340% FPL = $4,949 credit ($412/mo) Total out-of-pocket cost = $7,600 in 2014 or $633/mo Kaiser Family Foundation Premium Assistance Calculator

22 How do I get the tax credit? Once your eligibility is determined, you pick a plan on the marketplace. Paid in advance on a monthly basis to your insurance company. OR Paid to you at year end when you file taxes.

23 Who is eligible for advance premium tax credits? Ineligible for government insurance 1 (eg: Medicaid, Medicare, CHIP) Household income 2 between 100% - 400% FPL, with exceptions; 3 Not offered affordable or minimum value employersponsored coverage 4 Get coverage through Marketplace Be a part of tax filing unit Be Marketplace eligible 23

24 4. Illinois SHOP Marketplace is Open Year-Round!

25 SHOP in November 2014 Employers will be able to browse plans and pricing online Enroll themselves and their employees online Offer Medical and Dental Options Begin planning offers for 2015 Coverage Identify a Broker or Navigator to assist them 25

26 Financial Help for Small businesses Establishes competitive marketplace for small businesses (SHOP) and self-employed (individual) Immediate tax credits for many small businesses

27 Small business tax credits Available to businesses with employees Available now (took effect tax year 2010) Which businesses are eligible? Fewer than 25 full-time employees Average annual wages <$50,000 Employer pays at least 50% of the premium cost

28 Small business tax credits Tax credits on a sliding scale: o Up to 35% o Up to 50% any two years beginning in 2014 Premium expenses: comprehensive medical coverage, incl. dental, vision, long-term care Tax credits do not cover premium expenses of owners or their families Can amend your taxes for past years

29 Small business tax credits Small Business Majority s report: More than 3.2 million small businesses are eligible (70.1% of all businesses); 1.3 million eligible for maximum credit

30 Small business tax credits: How to claim it! Small employers (businesses or tax-exempt) use Form 8941, available on Include amount of credit as part of general business credit on income tax returns Can be reflected in determining estimated tax payments for a year Applies toward income tax, not employment tax

31 SHOP Tools You Can Use Tax Credit Estimator The SHOP Tax Credit Estimator can help to estimate the eligibility and worth of the tax credit for those small employers who participate in SHOP. 31

32 SHOP Tools You Can Use FTE Calculator 32

33 Tools You Can Use NOW Paper Apps - Don t Wait for Open Enrollment 33

34 5. Strategic Help is Available

35 Strategic Help Websites Navigators/Assisters Brokers Advocacy Organizations

36 Strategic Help Available:

37 Resources lbusiness/ Enrollment Help Presentations Contact: Jillian Philips, Director of Policy ty.org Enrollment Resource Presentations Contact: Jesse Greenberg Director West & Midwest ssmajority.org Enrollment Help Presentations Contact: Michele Thornton, Health Insurance Consultant

38 Resources Timely, relevant, unbiased healthcare and health coverage information for individuals, organizations and small businesses in Illinois.

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40 Thank You! Questions?