Introduction to the New Health Care Laws Michelle Walker, Rocky Mountain Health Plans January 14, 2015

Transcription

1 Introduction to the New Health Care Laws Michelle Walker, Rocky Mountain Health Plans January 14, 2015

2 Agenda Basics of Health Care Reform Changes in Individual Healthcare Coverage Mandates Affordability Access Employers How are they impacted? Early Statistics on first year

3 The Affordable Care Act Sometimes called Obamacare Signed by the President on March 23, 2010 Goals: to provide quality, affordable health care for all Americans improve competition & transparency Includes funding responsibilities from Federal/State government, employers, individuals, and insurance carriers.

4 Changes for Individual Healthcare Coverage Guaranteed Issue National Open Enrollment Periods Individual Mandate Essential Health Benefit Packages Exchanges Health Insurance Market Places Premium tax credits

5 Guaranteed Issue Individual Plans Pre-2014 Health Questions Carriers able to Rate Up Or Decline Coverage based on health 2014 & Beyond No Health Questions Carriers must accept all applicants regardless of health status.

6 National Open Enrollment Period November 15, 2014 Through February 15, 2015 Individuals/Families can enroll in private insurance. If you miss the annual open enrollment period, you can enroll if you have a qualifying event.

7 Individual Mandate Must obtain minimum essential coverage or pay penalty. Penalty is much less than cost of insurance Three year phase-in period % or $95, whichever is greater % or $325, whichever is greater % or $695, whichever is greater Penalty for people under 18 is reduced by 50%

8 Individual Responsibility - Exemptions Qualified religious exemptions Unauthorized aliens Incarcerated individuals US citizens living abroad Taxpayers with income less than the filing threshold Members of Indian tribes Less than three continuous months during calendar year without coverage (only 1 allowed per year)

9 Individual Mandate Do Individuals Need to Report Health Coverage on their 2014 Tax Return? YES, by checking a box on Form 1040, 1040A or 1040EZ Individuals enrolled through the Federal or State Exchange Will receive tax forms in the mail in January Include with their 2014 tax returns

10 Essential Health Benefits (EHB) WHAT is covered What is Covered Ambulatory patient services Emergency Services Hospitalization Maternity/newborn care Mental health/substance abuse Prescription drugs Rehab/habilitative services and devices Laboratory services Preventive and wellness care/chronic disease management Pediatric dental services

11 Standardized Labels Cost Sharing How is it Covered? Bronze (60%) Silver Gold (80%) Platinum (90%) (70%) Benchmark plan for Premium Credits

12 Where can I enroll in an Individual Plan? Individual/Family Plans can be purchased one of two ways: Directly from a Carrier No access to federal assistance Through the Exchange/Marketplace Access to federal assistance to lower premiums Same plans can be offered inside and outside the Marketplace No difference in rates for same plans

13 Connect for Health Colorado Health Insurance Marketplace for Individuals and Small Employers Individuals Premium and cost sharing assistance Small employers Small Business Marketplace: Small business tax credits

14 National Overview

15 Who is eligible for Premium Tax Credits? Individuals with certain income levels may be eligible for Premium Tax Credits (Premium Assistance)*. 2013/2014 data *If individual is employed full-time and/or is determined to have access to affordable health coverage through an employer Premium Assistance is not available.

16 Levels of Premium Tax Credits Federal Poverty Level (FPL) Source: Kaiser Family Foundation Percent of Income for Health Insurance Example Average Monthly Premium with Tax Credit on SLSP % 3-4% $ % 4-6.3% $ % 6.3% % $ % 8.05% - 9.5% $ % 9.5% $316 *If individual is employed full-time and/or is determined to have access to affordable health coverage through an employer Premium Assistance is not available.

17 Cost Sharing Reductions Qualified Individuals 133% - 250% of FPL* Qualified Individuals will have lower out-of-pocket costs when they receive care. Available with Silver Plans offered through the Marketplace.

18 Access to Affordable Coverage Employee considered to have access to Affordable Coverage when: Employee s share of the premium for Self-Only coverage is < 9.5% of their annual income (as provided in Box 1 of the W2 form) Family Glitch Dependents considered to have access to Affordable coverage too. No Premium Tax Credit is available to any family member.

19 Employers

20 Small Employer Options Up to 50 full-time employees Can participate in the Small Business Health Options Program (SHOP). Can purchase coverage outside the SHOP directly from carriers. Stop offering coverage and let employees buy through the Individual market.

21 Small Employer Small Employer Obligations If a small business offers health coverage Coverage must be ACA compliant (Metal Plans) Bronze, Silver, Gold, Platinum No pay or play provisions apply to small employers. There are no requirements for a small employer to offer group health coverage. No requirements for a small employer to offer affordable coverage. There are no penalties if they don t.

22 Large Employers 50 or more full-time employees (including full-time equivalents) Purchase health coverage directly from health carrier Three key requirements to offering coverage

23 Three Large Employer Responsibilities 1. Offer Coverage to at least 95% of all fulltime employees and their dependents which qualifies as: 2. Minimum Essential Coverage (MEC) 3. Affordable Coverage

24 Responsibility #1 Offer Coverage to Full-Time Employees Large Employer Offer Coverage to at least 95% of all full-time employees and their dependents Do I get health coverage? Full Time Employee defined as Employees working 30 hours or more per week Dependents defined as Children (not spouses) Large Employers forced to make a decision: Cut the hours of employees or offer health coverage.

25 Responsibility #1 Offer Coverage to Full-Time Employees What about Seasonal Employees? Do I get health coverage? New Variable Hour/Seasonal Employees Not entitled to health coverage if employer does not reasonably expect employee to average at least 30 hours of service per week over a specific period of time..

26 Responsibility #2 Provide Minimum Essential Coverage Large Employer not required to enroll in Metal Plans but there are still benefit rules 2. Minimum Essential Coverage (MEC) Coverage must provide value of at least 60% of the total allowed costs of benefits. Deductible and out-of-pocket costs no more than $6,600 for one person Equivalent to a BRONZE Plan

27 Responsibility #3 Affordable Coverage 3. Affordable Coverage Employer must contribute enough toward the monthly premium to make coverage affordable for the employee. Employee s share of the premium costs (for Employee-Only Coverage) is no more than 9.5% of that employee s annual household income. If employer offers more than one plan, employer can base affordable contribution on the lowest cost plan. Remember Family Glitch

28 Large Employer Penalties Not Offering Coverage Penalty A If at least one full-time employee receive premium tax credit: Employer Payment equal to: $2,000 for each full-time employee employed for the year (minus 30) Coverage offered is not Affordable - Penalty B Employer payment equal to: $250 per month for each full-time employee who receives premium tax credit for that month. Computed separately each month. (Monthly payment for any month is capped at Penalty A.)

29 Large Employer Responsibilities Some Responsibilities Delayed Mid-size employers - delayed until 2016 Groups with employees Transition Relief Available in Offer Coverage to at least 70% of all full-time employees and their dependents which qualifies as: Changing required number of full-time employees to be offered coverage (70% instead of 95%) Determine affordability by Employee Wages instead of household.

30 2014 Statistics

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34 Bottom Line with the ACA Negatives Law is complicated Increased fees for Employers and Consumers Does not address underlying cost of health care Positives Provides access to health coverage for more Americans Makes insurance more affordable for consumers with lower income Assures everyone can get insurance regardless of health

35 Questions?

36 Thank you!