afs affordable care act
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The Affordable Care Act
You need to know….
Dr. Ann HawkinsWellCare Dimensions Inc.
24hour MD Now214.886.1113
www.24hourmdnow.com
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What To Do Now
Effect of ACA
All About Health
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• If you have less than 50 employees the ACA does not affect you!
•But you need coverage
•Offering programs to your employees could help recruit and retain employees
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If you have a plan now
• Stay on the insurance plan through 2015• If you have been dropped from your previous
plan Call your agent and get their advice
• If you have a high deductible, look into alternative coverage and gap plans
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If you
• Offer insurance to your employees and dependents you can not pay toward dependents coverage By releasing dependents they qualify for
subsidies Coverage - available through state exchanges
or private companies like Blue Cross Blue Shield, Humana
• Contact insurance company or carrier about your changes
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Trend
• ACA “provides strong incentives for employers—with the agreement of their employees—to drop Employer Sponsored health insurance for as many as 35 million Americans.” • Douglas Holtz-Eakin, president of the American Action Forum
• Many companies, with the concurrence of the employees, will drop insurance
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Trend
• Many full time employees will be dropped to part time and not be covered Get a 2nd job Start their own business
• Buy less expensive limited medical programs with other health benefits, pay the penalty
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Healthy and younger people are economically incented to pay penalty vs. paying for “qualified” health insurance Supplemental insurance Accident Medical Telemedicine Catastrophic
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At this point in 2015
• Employers – if you pay toward employees insurance Employee after tax impact Whatever the $ amount an employer pays
toward an employees insurance counts as part of the employees taxable income
Salary of $40,000 plus $500/month paid by employer for insurance = total taxable income of $46,000
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Self Employed
Metal Exchange Plans
Cost
Tax Penalty
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Metal Plans
• Bronze• Silver • Gold• Platinum• Private
Blues Humana
• Public plan available through the exchanges
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Plans coverage and cost Vary dependent if you go through a private or
public exchange Need to talk to an agent
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Metal Plans
• Max out-of-pocket $6,350 individual/$12,700 family Excluding monthly premium % of coverage – 60-90% Deductible: Bronze $5,000/Silver $2,000 Most plans are HMO’s – restrictive
• IRS cost estimate of the Bronze plan – family of 4 – $20,000
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The Tax Penalty
No “qualified” health insurance whichever is higher: • 2015
$95 per person up to three people ($285) or 1% of taxable income ($100K = $1,000)
• 2016 $325 per person up to three people ($975) or 2% of taxable income ($100K = $2,000)
• 2017 $695 per person up to three people ($2,085) or 2.5% of taxable income ($100K = $2,500)
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Those who opt out
• Look into group supplemental/gap insurance • You and most of your employees are:
Young Fit Healthy
• Health concerns are related to accidents and doctor visits
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Affordable, Alternative Coverage
• Accident• Disability• Short Term Medical• Vision• Dental• Telehealth - Doctor Visits by phone• Prescription Savings• Lab and Imaging Savings• Diabetic supplies Savings
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Great News• U.S. healthcare system will revolve around
wellness and prevention• Medical model, of treating illness, financially
unsustainable • New England Journal of Medicine
• Healthcare services will transition from treating illnesses/injuries to maintaining good health as far into old age as possible• Dr. Daniel Alexander
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It’s All About Health• True economic need to stay healthy
Focus marketing on the non elderly who want to stay healthy in lieu of buying health insurance
• Pay IRS penalty not get major medical Supplemental Accident/Medical Catastrophic Telehealth/Telemedicine
• Focus on staying healthy Provide educational classes Build the aspect of community in the club Partner with small businesses Make exercise – play, add fun, innovative ideas
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Suggestions
• If you have an individual plan – renew, keep it until the end of 2014 • If you have been cancelled from your individual
plan and have a pre-existing condition Take a look at one of the exchange plans
• If you need insurance and are healthy Research individual plans from a Major Medical
provider before year end and keep that policy through 2014
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Suggestions
• If you can not afford a Major Medical Plan look at alternatives Accident Short term Major Medical – no pre-existing
conditions Telehealth for doctor visits
• Look at Metal Plans with subsidy
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For more information:
Dr Ann [email protected]
www.24hourmdnow.com214.886.1113
For direct questionsGuy Gilson
303 579 8783