What happens if my income changes after I receive an Insurance Subsidy?

Question: If I'm unemployed a the beginning of the year and sign up for health insurance, I will probally get a subsidy because my income will be low. What happens when I get a job later in the year and start earning a good salary? Will I have to pay the money back? Answer: Yes, you may have to pay some of that money back, but the amount you'd owe will most likely be capped. Each individuals circumstances are different, but here's how it might work in a typical situation. When you apply for health insurance on the state's exchange, or marketplace or thru an independent agent, you will be asked about your income. If you're collecting $300 a week in unemployment benefits, you'd probably qualify for a premium credit and out of pocket subsidy. You can choose your credit paid directly to the Insurance Company which will reduce your monthly premiums. The government will send that amount directly to the insurer. Let's say that you land a job in July with a $60,000 annual salary, but it doesn't offer health insurance. At that point, you'd need to inform the marketplace about your change in circumstance. "The key is to reach out immediately when things change," says Brian Haile, senior vice president for tax policy at Jackson Hewitt Tax Service. At your new salary, you'd no longer qualify for a premium tax credit, and you'd have to pay the full premium. At tax time, the government will reconcile the amount that you received in tax credits against your income for the year, in our example, roughly $38,000 including six months of salary and six months of unemployment insurance. If the amount you received in tax credits is higher than it should have been based on your annual income, you'll have to pay back the difference. But under the law your liability is limited if your income is less than 400 percent of the federal poverty level. Someone like you with income between 300 and 400 percent of poverty ($34,470 to $45,960 in 2013) would be liable to repay no more than $1,250.

About Medicare Open Enrollment

Are you happy with your current Medicare Plan? If you are happy with your Meidicare plan, you do not need to take action during Medicare Open Enrollment. You do no have to sign up for Medicare each year, however, if you would like to make changes to your Medicare plan, Medicare Open Enrollment is the time to make those changes, Visit www.medicare.gov for more information about open enrollment. Know the differences between enrollment periods. Medicare's Open Enrollment period (October 15, 2013 to December 7, 2013) is different from the enrollment period for the Affordable Care Act, also known as "Obamacare". If you are enrolled in a Medicare plan, you do not need to take action during "Obamacare" enrollment (October 1, 2013 to March 31, 2014). It is illegal for a person to knowingly sell "Obamacare" plans to those on Medicare. If you're unsure, call for help If you have additional questions about the Medicare Enrollment Period, you call call me at (740) 654-4055.

Family Member Eligibility for Premium Credits

Question:
In 2014 will an employee's non-working spouse be eligible for a premium credit or subsidies on the Exchange if
1) the employee's employer does not offer medical coverage to employee's spouse or
2) the employer offers medical coverage to the employee spouse's but does not pay for any portion of the premium for such spouse's coverage?

Answer:
Under Treasury Regulations Section 1.36B-2(c)(3)(v)(A)(2), an eligible employer-sponsored plan will be affordable for related individuals (family members) if the cost of self-only coverage does not exceed 9.5% of the employee's household income.
In other words, for purposes of determining whether family members are eligible for premium tax credits, the cost of family coverage is no taken into account-all that matters is whether the cost of self-only coverage is affordable to the employee.

Therefore, if an employer offers coverage to the employee's spouse, but does not pay for any part of his or her premium, he or she will not be eligible for credits and subsidies if the coverage offered to the employee is affordable.

If an employer does not offer coverage to the employee's spouse, he or she would be eligible for credits and subsidies depending on the family's household income.

Round 2 of ObamaCare Enrollment Delayed

The Obama administration plans to delay the start of next year's ObamaCAre enrollment period, a move pitched as a way to give consumers and insurance companies more time to study their options-but which also conveniently pushes the second round of enrollment past the 2014 midterm elections. 
The decision does not affect those trying to enroll this year, despite the myriad problems with the launch of the law and HealthCare.gov.  It only affects those who will sign up late next year for 2015 coverage. 
This move will allow consumers to start signing up on Nov 15, 2014 as opposed to Oct 15.  Enrollment will last until Jan 15, 2015 instead of Dec. 7th.
By pushing off next year's enrollment period, the administration coveniently pushes off the possibility of any ObamaCare hicccups until after the midterm elections.  Some of the biggest critics of the current roll out have been Democrats up for reelection next year.

Final Rules on Workplace Wellness Programs

The Affordable Care Act (ACA) includes provisions to encourage the use of wellness programs related to group health coverage. Effective for plan years beginning on or after Jan. 1, 2014, ACA adopts the existing HIPAA nondiscrimination requirements for health-contingent wellness programs, while also increasing the maximum reward that can be offered under these programs. On May 29, 2013, the Departments of Labor, Health and Human Services and the Treasury (Departments) released final regulations that implement ACA’s nondiscrimination requirements for wellness programs. The final regulations clarify and reorganize the rules outlined in previous proposed regulations. They are intended to ensure that every individual participating in a wellness program can receive the full amount of any reward or incentive, regardless of any health factor. Specifically, the final regulations:  Formally adopt the proposed nondiscrimination rules for health-contingent wellness programs, such as giving individuals an opportunity to qualify for the reward each year and providing an alternative standard or waiver for individuals with health conditions;  Divide health-contingent wellness programs into two categories: activity-only wellness programs and outcome-based wellness programs; and  Increase the permissible reward for meeting a health-related standard to 30 percent of the total cost of employee-only coverage (or 50 percent, if the program is designed to prevent or reduce tobacco use). The regulations apply to both grandfathered and non-grandfathered group health plans and group health insurance coverage for plan years beginning on or after Jan. 1, 2014.

Obamacare Mandate YouTube

ACA "Obamacare" Mandate Under the Affordable Care Act you are required to Purchase health insurance for 2014. You may be eligible for a advanced federal premium subsidy which will be paid to the insurer you choose To offset the total monthly premium for your insurance you may also be eligible for a cost sharing subsidy to pay expenses required by your new health plan. View Vidio: http://youtu.be/AU7rgN7DEXw www.millerlewishemahelp.com

What is the Medicare Plan Star Rating

"Stars" is a Center for Medicare and Medicaid Services (CMS) program to improve quality for Medicare Advantage members. This program measurers how well plans perform on over 50 measurers. Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans. A plan can get a rating between 1 and 5 stars. a 5-star rating is considered excellent. These ratings help you compare plans based on quality and performance. The ratings are updated each fall and can change each year.

Important announcement regarding FSA policy

Moments ago, the Department of Treasury issued a press release and informational fact sheet announcing a major policy change relating to flexible spending accounts (FSAs) that has many positive implications for all FSA constituents – including administrators, employers and participants. The Department of Treasury has modified its FSA “use-it-or-lose-it” provision to allow a limited rollover of FSA funds. Details are as follows: • Effective in plan year 2014, employers that offer FSA programs will have the option of allowing participants to roll over up to $500 of unused funds at the end of the plan year. • Effective immediately, employers that offer FSA programs that do not include a grace period will have the option of allowing employees to roll over up to $500 of unused funds at the end of the current 2013 plan year. From my perspective, the major benefits of this new “rollover” provision include: • Eliminating the most significant impediment to FSA adoption (use-it-or-lose-it) – creating significant upside for FSA adoption growth, which has been limited over the past several years • Enhancing healthcare options and offering greater funds protection for FSA participants, particularly lower & middle income workers who are highly concerned about cash flow • Minimizing risk for constituents with unpredictable healthcare expenses, such as those dealing with chronic conditions that may necessitate high-cost procedures/services with ambiguous timing or medical necessity • Curbing wasteful & potentially unnecessary end-of- year spending by FSA participants seeking to avoid losing unused funds

The week in review October 11, 2013

Exchanges continue to work througth some initial growing pains, as the government teeters ever closer to default; while a pair of House hears seeks to shed some light on implementation efforts, and Medicare Advantage starts to feel the pinch. 
Exchange Marketplace is heading into its second week of open enrollment, the health insurance exchange marketplace continues to experience some gowing pains.  While polling suggests that American's initial impressionof the new marketplace has left some room for improvement, the Administrationcontinues to urge patience, attributing the early hiccups to overwhelming demand. 

Given the changes that continue to reverberate across the health care reform landscape, it's hardly surprising that few, if any, corners of the health care world should escape completely unscathed.  Already we've seen stakeholders-large employers to small businesses, hospitals and providers, state and local governments-step gingerly into this new landscape, uncertain of what les ahead. And while we already know the havoc that certain provisions threaten to wreak if ultimately unacted, we're only now starting to see some of the damage from what's already been put in place.  One such program, Medicare Advantage (MA), some believe now finds itself at the forefront of how these changes could ripple out.  Dispite its high satisfaction rate amongst beneficiaries and better reported quality of care, a new study from health care consulting firm, Avalere Health, projects that MA plans will decreases by 5.3% in 2014, amidst continued payment reductions under the health care low, monifications to the risk adjustment model my the Centers for Medicare & Medicaid Services (CMS) and the application of the health insurance tax (HIT).  

www.millerlewishemahelp.com

This website can show you your estimated subsidy. Also run your own quote. 

Call me with further questions. 

Subsidy Calculator

The Kaiser Foundation has come out with this subsidy Calculator that shows an estimate of what Premium Assistance for coverage in the Exchanges or Marketplaces. http://kff.org/interactive/subsidy-calculator This tool illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance exchanges (or Marketplaces) creasted by the Affordable Care Act (ACA). Beginning October 2013, middle-income people under age 65, who are not eligible for coverage through their employer, Medicaid, or Medicare, can apply for tax credit subsidies available throught state based exchanges. IMPORTANT - Those who are NOT eligible for coverage through their employer! Additionally, states have the option to expand their Medicaid programs to cover all people makeing up to 138% of the federal poverty level (which is about $33,000 for a family of four). In state that opt out of expanding Medicaid, some people making below this amount will still be eligible for Medicaid, some will be eligible for subsidized coveage through Maretplaces, and others will not be eligible for subsidies.

Want productive employees? Keep them happy

n a memo to staff dated Aug. 30, Trader Joe’s CEO Dan Bane announced that the company would cut insurance benefits for those who log fewer than 30 hours a week. Bane said the company will cut part-timers a check for $500 in January and assist them in finding a new insurance plan under the Patient Protection and Affordable Care Act. In a statement to Huffington Post recently, a spokeswoman for the company said the changes “will be a benefit to all Crew Members working in our stores.” I’m not so sure the “Crew Members” feel the same way. It doesn’t take a Wharton grad who also doubles as a health insurance expert to figure out that this is — solely — a benefit for the corporation. Trader Joe’s, along with other companies, are using the Affordable Care Act as a scapegoat – an excuse to abolish benefits. True, it may not be cost-effective for the company to continue offering health care benefits, but it keeps employees happy. And luckily, there are actually a few individuals out there who realize that happy employees are critical to success. A few days ago, Robert Crisan, senior vice president for health care reform and strategic growth at Hylant, told me: “I recently worked with a 283-employee company that determined it would pay $506,000 in yearly penalties if it decided to drop health care benefits. Those fees would be a relative bargain compared to the firm’s current annual net cost of $1.8 million for employee health care. However, the company will likely stick with its current benefit offerings to keep its employees happy. If you’re the employer next door and you offer benefits, you’re going to get your pick of those employees.” Unhappy workers are unproductive workers, and, over time, unproductive workers cost even more money than what a company such as Trader (also known as Traitor) Joe’s may have forked over for health insurance for all workers. Want productive employees? Keep them happy.

Good news for Small Employers who use SHOP

If you’re a small employer with fewer than 25 full-time equivalent employees, there is good news. Did you know you may qualify for a tax credit worth up to 50% of your premium costs when you buy health insurance through the Small Business Health Options Program (SHOP)? Non-profit employers may qualify for a tax credit worth as much as 35% of premium costs. Here’s how the tax credit works. If you had 10 employees making $25,000 each and your contribution to employee premiums was $70,000, your tax credit amount would be $35,000— 50% of your contribution. For non-profit employers, the tax credit amount would be $24,500—35% of your contribution. This means you get health insurance for your workers, and keep more of your cash in your business. Call me for more information on how to figure if your employoees are considered full or part time. The rules have changed.

New PPACA Requirement for employers effective Oct 1st

A new Patient Protection and Affordable Care Act (PPACA) requirement will be in effect for employers beginning October 1, 2013. In order to comply, employers must provide written notice informing the employee about health care coverage options at the time of the employee’s hire. Additionally, employees hired prior to October 1, 2013, must be provided the written notice or before October 1, 2013. The PPACA requires that employers must provide the notice to each employee, regardless of full- or part-time status or whether or not the employee has previously elected to participate in the company health care coverage options. The notice may be delivered electronically or via first-class mail and must include the following: 1. Information about the existence of state or federal benefits exchanges (Exchanges/Marketplaces) 2. Explanation that if the employer plan’s share of the total allowed costs of benefits provided under the plan is less than 60 percent, the employee may be eligible for a federal premium tax credit if the employee elects to purchase a qualified health plan through an Exchange/Marketplace. 3. A statement informing the employee that if he or she purchases a qualified health plan through an Exchange/Marketplace, he or she may lose the employer contribution to any health benefits plans offered by the employer. The statement must also inform the employee that all or a portion of such contribution may be excludable from income for federal income tax purposes. The notice must be written so that the average employee can understand its contents. The Department of labor (DOL) provided two model notices as part of Technical Release 2013-02, dated May 8, 2013; one for employers that provide health care benefits and the other for employers that do not. Employers may modify the model language so long as the modified notice satisfies the content requirements previously described.

Limit on Consumer Costs delayed in Health Care Law

New York Times WASHINGTON - In another setback for President Obama's health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care. The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014. The grace period has been outlined on the Labor Department's Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language - which appeared as an answer to one of 137 "frequently asked questions about Affordable Care Act implementation" - department officials confirmed the policy. The discovery is likely to fuel continuing Republican efforts this fall to discredit the president's health care law. Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors' services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager. Some consumers may have to pay even more, as some group health plans will not be required to impose any limit on a patient's out-of-pocket costs for drugs next year. If a drug plan does not currently have a limit on out-of-pocket costs, it will not have to impose one for 2014, federal officials said Monday. The health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another. A senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: "We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person's out-of-pocket costs. They asked for more time to comply." Health plans are free to set out-of-pocket limits lower than the levels allowed by the administration. But many employers and health plans sought the grace period, saying they needed time to upgrade their computer systems. "Benefit managers using different computer systems often cannot keep track of all the out-of-pocket costs incurred by a particular individual," said Kathryn Wilber, a lawyer at the American Benefits Council, which represents many Fortune 500 companies that provide coverage to employees. Last month the White House announced a one-year delay in enforcement of another major provision of the law, which requires larger employers to offer health coverage to full-time employees. Valerie Jarrett, Mr. Obama's senior adviser, said that the delay of the employer mandate showed "we are listening" to businesses, which had complained about the complexity of federal reporting requirements. Although the two delays are unrelated, together they underscore the difficulties the Obama administration is facing as it rolls out the health care law. Advocates for people with chronic illnesses said they were dismayed by the policy decision on out-of-pocket costs. "The government's unexpected interpretation of the law will disproportionately harm people with complex chronic conditions and disabilities," said Myrl Weinberg, the chief executive of the National Health Council, which speaks for more than 50 groups representing patients. For people with serious illnesses like cancer and multiple sclerosis, Ms. Weinberg said, out-of-pocket costs can total tens of thousands of dollars a year. Despite the delay, consumers in 2014 will still have many new protections. They cannot be denied health insurance or charged higher premiums because of pre-existing conditions, and many will qualify for subsidies intended to lower their costs. In promoting his health care plan in 2009, Mr. Obama cited the limit on out-of-pocket costs as one of its chief virtues. "We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick," Mr. Obama told a joint session of Congress in September 2009. Advocates for patients said the promise of the law was being deferred. "We have wonderful new drugs, the biologics, to treat rheumatoid arthritis, but they are extremely expensive," said Dr. Patience H. White, a vice president of the Arthritis Foundation. "In the past, patients had to live in constant pain, often became disabled and had to leave their jobs. The new drugs can make a huge difference, and we were hoping that the cap on out-of-pocket costs would make them affordable. But now many patients will have to wait another year." The American Cancer Society shares the concern and noted that some new cancer drugs cost $100,000 a year or more. "If a prescription drug plan does not currently have a limit, then it will not have to have one in 2014," said Molly Daniels, deputy president of the lobbying arm of the American Cancer Society. "Patients who require expensive drugs could continue to have enormous financial exposure, despite the clear intent of the law to limit a patient's total out-of-pocket exposure." Federal officials said they were offering transition relief to certain health plans in 2014. But, they said, by 2015, health plans must comply with the law and must have an overall limit on out-of-pocket costs for medical, drug and other benefits combined. Theodore M. Thompson, a vice president of the National Multiple Sclerosis Society, said: "The promise of out-of-pocket limits was one of the main reasons we supported health care reform. So we are disappointed that some plans will be allowed to have multiple out-of-pocket limits in 2014." The law also requires coverage of dental care for children, but these benefits can be offered in a separate health plan with its own limit on out-of-pocket costs. Federal rules say that a free-standing dental plan must have "a reasonable annual limitation on cost-sharing." In states where the new health insurance marketplace will be run by the federal government, the limit on out-of-pocket costs for pediatric dental benefits can be no more than $700 for coverage of one child and $1,400 for a plan covering two or more children in the same family.

Health Reform-W2 and 2013

Many have asked what rules will apply for reporting health coverage on Form W-2 for 2013. So far, the IRS has not released any guidance for 2013. This relates to the Form W-2 provided to employees by end of January 2014. But, what will apply? According to questions and answers released by the IRS, the transition relief provided by the IRS in Notice 2012-9 for 2012 will continue to apply unless IRS publishes guidance giving at least six months of advance notice of any change to this relief. For 2013, this time period has just passed and it looks like the rules for 2012 will continue to apply for 2013.

OH Dept of Insur-41% increase coming

Press Release STATE OF OHIO DEPARTMENT OF INSURANCE COMMUNICATIONS OFFICE 8/1/2013 Health Insurance Premiums to Increase 41 Percent Due to Affordable Care Act Premiums for Federal Exchange Show Higher Costs for Ohio Consumers and Small Businesses Page Content COLUMBUS — The Ohio Department of Insurance announced today that individual consumers buying health insurance on the federal government's health insurance exchange for Ohio will pay an average of 41 percent more than they did in 2013. In addition, ODI confirmed previously-released preliminary calculations that insurance companies’ costs to provide individual health coverage will increase by 83 percent. “Ohio has traditionally had a more competitive health insurance market than other states with a wider range of prices and choices – from simple, high deductible coverage to comprehensive, full service plans,” Lieutenant Governor Mary Taylor said. “That level of diversity is essentially outlawed under Obamacare so Ohio's rates and premiums are going up significantly, and going up more than in other states where prices were already high.” Premiums Increase 41 Percent: The Department utilized a National Association of Insurance Commissioners (NAIC) report of premiums reported by Ohio companies at the end of 2012 to compare premiums. Individual exchange plan premiums are expected to increase on average by 41 percent in 2014 compared to 2013, while exchange plans for Ohio's small businesses will increase on average by 18 percent. For individual health insurance plans, a total of 12 companies offering 200 different plans have been approved by the Department for the exchange. Open enrollment for the exchange will begin on October 1, 2013. For small group health insurance plans, 6 companies offering 184 plans have been approved to sell on the exchange. Based on premiums for the current individual market, plans in Ohio today cost on average $236.29 per month compared to $332.58 in 2014. For the small group market, today’s premiums average is $341.03 per month compared to $401.99 in 2014. An example of the difference between premium and the cost to provide coverage is that premiums do not include cost sharing paid by the consumer, whereas cost includes both the cost to the company to provide the coverage and the cost sharing paid by the consumer. Insurance Companies’ Costs to Insure Increase 83 Percent: Estimates from a Society of Actuaries study released in 2013 showed Ohio’s current average cost to provide individual health insurance coverage is $223. Based on the rate filings approved by the Department, the average cost to provide coverage for individuals purchasing health insurance on the exchange in 2014 is $409 representing an increase of 83 percent when compared to the Society of Actuaries study. During the two month review process, the Department requested changes to submissions that in some cases resulted in rate adjustments. Ohio law requires all companies selling products in Ohio, including on the exchange, to justify rate submissions and any rate changes for 2014 by using sound actuarial judgment. The intense review process the Department conducted (as it does with all insurance products sold in Ohio) is to protect consumers from rates that are too high and to protect against company insolvency in which rates are too low and companies are unable to pay a consumer’s claim. Ohio is one of many states to recently release final exchange rate numbers and each state’s experience is different. Ohio’s rates are going up while some other states are seeing rates remain stable or even decrease as the ACA drives rates across the country closer together. For states where prices were already much higher and that had more coverage mandates, rates are not increasing as much. In Ohio, where rates have been among the most competitive in the country, rates are increasing significantly as consumers are faced with fewer options and a higher level of required coverage. "These kinds of significant costs increases are bad for job creation and why the governor and I continue to call for the repeal and replacement of this flawed law with reforms that improve access by lowering costs.” Taylor said. “Ohio said 'no' to running the federal government's health care exchange in our state and 'no' to federal takeovers of both our health insurance regulations and our Medicaid eligibility process. As the problems with this law continue to appear even the federal government has begun to balk, with its recent announcement to delay the employer mandate for a year. Hopefully it's just the beginning of more such news and an eventual total rethinking of this law." In 2010 the ACA, which includes sweeping changes to America’s health insurance system, became law. It includes the creation of health care exchanges in which individuals and small business owners in every state can purchase subsidized coverage. According to the federal government, initial open enrollment on the exchange is set to begin October 1, 2013 with coverage becoming effective January 1, 2014.

Premium Subsidies-What you need to know

The Affordable Care Act (ACA) provides premium Tax Credits and Cost Sharing subsidies to help low and moderate income American afford coverage.  While subsidies will help many people purchase coverage, millions of individuals and families are not eligible for subsidies and the amount of the subsidy declines significantly as incomes rise.  Furthermore, the ACA includes a new $100 billion health insurance tax costly benefit requirements, and restrictions on age rating that will drive up the cost of coverage, increasing the likelihood that younger and healthier people will forgo purchasing insurance until they get sick or injured, further driving up costs for everyone else. 

Subsidies do not lower the underlying premium

• Subsidies will help many families pay for health Care coverage, but subsidies do nothing to bring down the actual cost of that coverage.
• Subsidies do not lower premiums any more that Pell Grants reduce the cost of college tuition.  Pell Grants are an asset to families looking to cover the high cost of education, but they do not lower tuition levels.  Meanwhile, tuition prices soar.

Millions of American are not eligible for any premium subsidies

• According to the Congressional Budget Office (CBO), more than 40% of people purchasing coverage in the individual market today would be ineligible for premium subsidies.

The amount of the subsidy declines significantly for those with higher incomes

• Individuals with incomes between 250-300% of the federal poverty line (FPL) would receive subsidies sufficient to cover 42% of the cost of the second lowers-cost "Silver" plan. Those with incomes between 350-400% of the FPL would receive subsidies sufficient to cover just 13% of the premium
• Due to how the subsidies are indexed, CBO states that over time "the shares of the premiums that the subsidies cover will decline."

Even for individuals who qualify for subsidies, their share of the premium may still be higher than the penalty for not having insurance

• The penalty for failing to carry insurance in 2014will be as low as $96 for the entire year-far below the cost of purchasing insurance, even for people eligible for subsidies.
• The ACA's new $100 billion health insurance tax, costly benefit mandates, and age rating restrictions will further add to the cost of health care coverage.
• As costs rise, many younger and healthier people may choose to pay the penalty and wait to purchase insurance until they get sick or injured.  If that happens, costs will rise for everyone else.

Subsidies-How They Work

• The ACA provides premium and cost-sharing subsidies to help low and moderate income Americans afford health care coverage n the new exchanges.  Premium subsidies are available on a sliding scale to individuals and families with incomes between 100 - 400% of the Federal Poverty Level (FPL).  Additional cost-sharing subsidies are available for those with incomes below 200% of the FPL to help reduce out-of-pocket cost, such as deductible, co-pays, and co-insurance. 

Plans filed with Dept of Insur show higher costs

Health Insurance costs to increase significantly under Affordable Care Act.

These are the headlines from the State of Ohio Department of Insurance Communications office on June 6, 2013.

COLUMBUS — The Ohio Department of Insurance today released details of health insurance plans that insurers have submitted for approval to sell on the coming federal insurance exchange for Ohio.  The Department's preliminary analysis of the proposed plans for the individual market reveal that insurers expect the cost to cover health care expenses for consumers will significantly increase.  

Based on a report released by the Society of Actuaries earlier this year, the Department estimates this increase is an average of 88 percent.  While those costs do not specifically track with the premiums insurers charge individual customers, it is expected that these increases in costs will also translate to significant premium increases for many Ohioans.

 

A total of 14 companies filed proposed rates for 214 different plans to the Department.  Projected costs from the companies for providing coverage for the required essential health benefits ranged from $282.51 to $577.40 for individual health insurance plans.

 

“We have warned of these increases since a state-specific study in 2011 indicated Ohio would be significantly impacted by the ACA,” Lieutenant Governor Mary Taylor said.  “The Department’s initial analysis of the proposed rates show consumers will have fewer choices and pay much higher premiums for their health insurance starting in 2014.”  

 

Estimates from a Society of Actuaries study released in 2013 showed Ohio’s current average cost to cover medical expenses for an individual health insurance plan is $223.  Based on the proposals submitted to the Department, the average to cover those costs in 2014 is $420 representing an increase of 88 percent when compared to the Society of Actuaries study.  The proposed rates are not effective and are currently undergoing the Department’s review process. During this process, rates may change before becoming effective.

 

The Department released the information today to help health insurance consumers continue to prepare for the expected price increases.  Specific premium information varies widely and can be unique to each individual or employer, but it is hoped that the information on proposed costs and rates can help consumers and health insurance consultants determine how their particular situations will be impacted.

 

With the large employer mandates being pushed back till 2015, it is important to remember that the individual mandate is still effective Jan 1, 2014. 

 

 

 

 

When I Die......

Life Insurance is a simple answer to a very difficult question:

How will my family manage financially when I Die ? ?

It is a subject no one really wants to think about.  But if someone depends on you financially, it's one you cannot avoid.

There are many types of Life Insurance, but for all of them the bottom line is the same:
They pay cash to your family after you die, allowing loved ones to remain financially secure.  Life Insurance payments can be used to cover daily living expenses, mortgage payments, outstanding loans, college tuition and other essential expenses. 
And, importantly, the death-benefit proceeds of a Life Insurance policy are almost never subject to Federal Income Taxes. 

If you've worked hard to establish a solid financial framework for your family-investments, home equity, a savings plan, retirement accounts-Life Insurance is the foundation upon which it all rests.  It can guard against the need for your loved ones to make drastic changes to future plans when you Die.  Certain types of Life Insurance even have a built-in cash-accumulation feature that can help you reach savings goals.

Most Americans need Life Insurance, and many who already have it may need to update their coverage. 

 

Employer Mandate Delayed

On July 2, 2014, the Obama administration delayed part of the Affordable Care Act (ACA or health care reform law) that affects employers. The parts of the law listed below will now go into effect in 2015 instead of 2014:

1.        Employers will not have to report certain information to the IRS. This has been referred to as “employer reporting requirements.” We are waiting for the IRS to give details on what requirements this includes.

2.        The rule that says large employers have to offer coverage to full-time workers or pay a penalty. “Large employer” in this case is a business that has 50 or more full-time or full-time equivalent employees (that work an average of 30 hours a week).

3.        The rule that says coverage offered by large employers cannot be more than 9.5% of a worker’s pay for self-only coverage.

The delay notice changes the employer mandate part of the law only. The individual mandate and other parts of the law are unchanged. We are evaluating the impact and waiting for more information. The IRS has said it will release more details about the delay soon. We will share more information as soon as possible.

Marketplaces Enrollment-Phase I and II

Phase I:
Open enrollment for the Federal Marketplaces, or Exchanges, will begin October 1, 2013 and will run through December 15th, 2013.  This enrollment for the Marketplaces will coincide with the AEP or the "Over 65" Annual Enrollment Period.  For those who enroll during this period, their coverage will be effective January 1, 2014.  If you miss this enrollment period, there will be a Phase II enrollment period.
Phase II:
This enrollment will begin December 16, 2013 and run through March 31, 2014.  The effective date of coverage for this phase will be either the first of the month following enrollment, or the first of the 2nd month following enrollment depending on the time of the month enrolled.
If you miss both of these enrollment periods, you will not be eligible for coverage until enrollment opens up again on October 1st 2014. 

There will be help on these premiums. It will be based on a percentage of the FPL or Federal Poverty Level.  Help with premiums isn't just for low income.  For example based on a family of 4, incomes below $94,000 per year will be eligible some kind of help with premiums.

If your plan is currently considered "Grandfathered" you may be exempted from some of the other changes. 

Best to reach out to me and we can talk about the changes you will be seeing with your heathcare.
As a certified and licensed Agent, I can help steer you to the best possible options.

HHS Launches Marketplace tools

HHS Launches Health Insurance Marketplace Educational Tools

June 24, 2013 The Obama administration today kicked off the Health Insurance Marketplace education effort with a new, consumer-focused HealthCare.gov website and the 24-hours-a-day consumer call center to help Americans prepare for open enrollment and ultimately sign up for private health insurance.  The new tools will help Americans understand their choices and select the coverage that best suits their needs when open enrollment in the new Health Insurance Marketplace begins October 1. "The new website and toll-free number have a simple mission: to make sure every American who needs health coverage has the information they need to make choices that are right for themselves and their families-or their businesses," said Health and Human Services Secretary Kathleen Sebelius. "The re-launched Healthcare.gov and new call center will help consumers prepare for the new coverage opportunities coming later this year," said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. "In October, HealthCare.gov will be the online destination for consumers to compare and enroll in affordable, qualified health plans." HealthCare.gov is the destination for the Health Insurance Marketplace.  Americans may now access new educational information and learn what they can do to begin to get ready for open enrollment this fall.  The website will add functionality over the summer so that, by October, consumers will be able to create accounts, complete an online application, and shop for qualified health plans.  For Spanish speaking consumers, CuidadoDeSalud.gov will also be updated to match HealthCare.gov's new consumer focus. Key features of the website, based on consumer research and online commercial best practices include integration of social media, sharable content, and engagement destinations for consumers to get more information.  The site will also launch with web chat functionality to support additional consumer inquiries. The website is built with a responsive design so that consumers may access it from their desktops, smart-phones, and other mobile devices. In addition, the website is available via an application interface at www.healthcare.gov/developers. Between now and the start of open enrollment, the Marketplace call center will provide educational information and, beginning Oct. 1, 2013, will assist consumers with application completion and plan selection.  In addition to English and Spanish, the call center provides assistance in more than 150 languages through an interpretation and translation service.  Customer service representatives are available for assistance via a toll-free number at 1-800-318-2596 and hearing impaired callers using TTY/TDD technology can dial 1-855-889-4325 for assistance. To view the new look and new focus of the website, visit www.HealthCare.gov. HHS is on target for open enrollment in the Marketplace, which begins Oct. 1, 2013, and other key milestones approaching in the months ahead.  Coverage will begin Jan. 1, 2014.

"Pay or Play"-An Employer's biggest decision

The most critical decision employers face under Health Care Reform is this:
Will the Employer offer health care coverage to employees, or pay a penalty instead?
This decision must be made in time for employees to begin receiving coverage in 2014.

Many factors go into this decision.  Not all employers are required to "pay or play" and not all employees are required to have coverage.  To determine whether they need to pay a penalty, and how much that penalty will be, employers need to determine:

• Whether they are large enough for the law to apply to them
• Whether the coverage they offer (or plan to offer) provides essential health benefits and is affordable

Companies must have 50 or more full-time equivalent employees and 31 or more actual full-time employees to be subject to the pay or play penalty.

Actual full-time employees are individual people who work at least 30 hours per week or 130 hours per month.  But a company may have more full-time equivalent (FTS) employees, based on the number of hours part-time and seasonal workers, work in a month. 

Sounds confusing?  I can help work this out.  Call or email and I will set up an appointment to meet with you or your HR. 

Jeff@JeffreyMetzger.com

Dependent Coverage to Age 26

The PPACA requires dependents under age 26 be covered regardless of marital, student, residency or financial status. The Department of Health and Human Services requires plans to cover those:

• Currently enrolled on the plan
• Previously terminated from the plan
• Never enrolled on the plan

Spouses and children of dependents are not eligible unless the plan already covers these individuals.

Until 2014, grandfathered plans are not required to cover dependents that have access to another employer-sponsored plan.

Cover that College Debt

It's June, and there is another crop of college graduates starting their first job out of school.  A recent article from the Pew Research Center states that among households headed by someone younger than 35, a record 40% had student loan debt outstanding.  The average student loan balance outstanding for the graduating class of 2013 was $35,200, according to a new study from Fidelity, but 10% of student debtors owed more than $61,894.  Students leaving college upon graduation today have the highest debt level they've ever had. 
Any new College Graduates:  Cover the debts you have with life insurance.  A $50,000 life policy could run less than a dollar a day.  A $100,000 policy will run less than $10 per week.  This will give you as a college grad, a base of permanent life insurance coverage. 
And to the Parents of recent high school graduates:  As your kids head off to college in the fall think that they will be the ones that will have to deal with the increasing cost of college education.  It is likely that their college education could cost $100,000 or more over a four or five year period.  Much of that cost will be paid through student loans.


With a purchase of a term life insurance plan, all this debt can be covered, and the student can start to build a base of life insurance coverage for latter after graduation. 
In one sense this is protection for the parents.  The parents are the ones that will be ultimately responsible for paying off the student loans if something unexpected happens to the student because the parents are generally required to co-sign for the loans.  Covering the debt with life insurance makes sense. 
Term insurance would be an obvious choice in this situation because it provides the coverage needed at the lowest out-of-pocket cost.  A $200,000, 20 year level term on an 18 year old male would run about $18.53 per month with Waiver of Premium included.  The parent can pay the premium while the student is in school, then turn the policy over to him or her after graduation.

Life Insurance can help pay Death Taxes

Death Taxes must be paid in cash to the State and Federal Governments when they fall due. 
The Government doesn't want your house, your business, or your stocks and bonds.  It wants
cold, hard cash and wants it within nine months of your death.

If you have made arrangements for an executor to take charge of your affairs after your death, have you provided him or her with the necessary cash to pay these charges??
If not, he may be forced to sacrifice a part of your estate by disposing of it for less than actual value in order to raise the money quickly.

We all know people that have died too soon, and have not provided for their loved ones. They just died to soon!  and had just not had time to plan yet!!

I can discuss a plan to help you preserve your hard-earned estate for your family.

Proper planning, for those times, will save your estate and make it easier for those who are left behind.  Nothing would be worst that those loved ones having to make those hard decisions. 

CMS, HHS, DOL, EHBs, OOP, ACA-OMG!

On February 20, 2013, a new round of rules was released by the Centers of Medicare & Medicaid Services (CMS), the Department of Health and Human Services (HHS) and the Department of Labor (DOL), collectively referred to as the "The Departments." 
Be aware of these three departments as we move towards implementation of ObamaCare.

Effective for new and renewing plans on and after January 1, 2014, all "Non-Grandfathered" fully insured small group and individual health plans must cover essential health benefits (EIBs). 

Also effective for new and renewing plan on and after January 1, 2014, all health plans, regardless of group size or funding type, must apply all member cost share for in-network srevices and out-of-network emergency services to the in-network out-of-pocket (OOP) maximum, which cannot exceed $6,350/$12,700. 

All copayments, coinsurance and deductible amounts for EHSs must apply to the out-of-pocket maximum.  No annual or lifetime dollar limits are allow on EIBs but other types of limits can be put in place, including:

• Visit limits
• Day limits
• Occurrence limits
• per episode or per service limits

EHB Categories of Benefits:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs  (Must cover the greater of either one drug in every US Parmacopea (USP) category and class, or the same number of prescription drugs in each category and class as the EHB-Benchmark plan.
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care-services for individuals under the age of 19.

Large group and self-funded (ASO) health plans do not need to offer all of these 10 categories of Essential Health Benefits, or meet actuarial value requirements that non-grandfathered small group and individual policies have to meet.  The rule is still important to large group and self-funded (ASO) plans because they are subject to many rules tied to EHBs such as:

• The out-of-pocket maximum applies to EHBs
• EHSs covered by a large group or self-funded (ASO) plan cannot have annual or lifetime dollar limits.

Why Life Insurance?

If you are thinking about life insurance and have questions, call me. 

I will be able to evaluate your family's current and future financial obligations and determine what amount and type of insurance will allow them to maintain their quality of life in the event of your premature death.

There is no substitute for evaluating one's needs with a the aid of a qualified insurance professional.  A good rule of thumb is to buy life insurance equal to ten to twenty times your annual gross income. This is only an estimate because no one's needs are the same.  I will be sitting down with you and your family to determine your specific needs.

But what kind of coverage do you need?  There are many kinds of life insurance, but they generally fall into two categories:  Term insurance and permanent insurance.  Term insurance provides protection for a specific period of time (the "Term") and pays a benefit only if you die during the term.  In contrast, permanent insurance provides protection for as long as you pay the premiums (and no loans, withdrawals or surrenders are taken).  Because it is designed to last a lifetime, permanent life insurance pay accumulate cash values and is priced for you to keep it over a long period of time. 

If someone depends on you, you probably need life insurance.  If you to die today, life insurance would provide cash to your dependents that can help meet everyday living expenses, pay down the mortgage, finance longer-term goals like education and retirement, and generally maintain their quality of life. 

Health Care Reform-Small Business Concerns

Health Care Reform

Small Business Concerns: With so much uncertainty darkening their horizons, it should perhaps come as no surprise that sentiment regarding the Affordable Care Act amongst small businesses runs towards the pessimistic.  In a Gallup poll released earlier this month, almost half of respondents (48 percent) believed that the health care law will be bad for business, compared to the just 9 percent who said the opposite.  Additionally, 55 percent of these small employers said they anticipate their costs to rise, while 52 percent also expect the quality of the health care benefits they currently provide to their employees to be reduced as a result of the law.  Separately, many small business owners worry that a little known component of the Affordable Care Act, the new health insurance tax (HIT) on insurance providers, will result in higher premiums for them.  While revenue from this new tax is meant to help cover the costs of the health care overhaul, it has been acknowledged that small firms will likely “shoulder most of the burden.”  In fact, a recent study by the National Federation of Independent Business (NFIB) suggests that the HIT could result in hundreds of thousands of job losses over the next decade, more than half of which would be borne by small businesses.  While some argue that the forecast need not be quite so bleak, it’s clear to others that the law has already forced a new decision-making model on business owners coming to grips with their new obligations under its sweeping reach.

Four new Fees-PPACA (Taxes ?)

The Patient Protection and Affordable Care Act (PPACA) introduced new fees for health insurance companies and plan sponsors, which are typically employers. Below are some highlights on the four new fees:  The Health Insurance Fee, Reinsurance Assessment Fee, Patient-Centered Outcomes Research Institute Fee, and the Federally Facilitated Exchange User Fee.

1. The Health Insurance Industry Fee-This is to help off-set the cost generating provisions of the PPACA.  It is an annual fee effective in 2014, and is due no later than September 30th annually. The Insurance Companies are responsible to pay this fee, but customer rates will be impacted. This applies to Fully insured plans only.  This fee is estimated to increase premiums in the fully insured marekt on average by 1.9% to 2.3% in 2014 and, by 2023 to increase premiums 2.8% to 3.7%.
2. Reinsurance Assessment Fee-This is to fund a three-year reinsurance program designed to reimburse companies that insure high-cost patients through the individual health insurance market.  It is an annual fee assessed from 2014 to 2016, which is due within 30 days after the date of the HHS notification of contribution due.  This fee applies to both fully insured and self funded plans.  Beginning in 2014, the fee is $5.25 per covered person per month, or $63 per year.  This amount is subject to change thereafter. With fully insured plans Insurance Companies pay but customer rates will be impacted. With Self-Insured plans the Plan Sponsor (typically the employer) will be responsible for payment.
3. Patient-Centered Outcomes Research Institute Fee-This is to fund research by the Patient-Centered Outcomes Research Institute (PCORI) that will compare different medical treatments and interventions to determine what treatments are most effective.  This non-profit institute was established by the PPACA.  This is an annual fee assessed from 2013 to 2019, which must be reported on IRS Form 720 by July 31, 2013.  This fee applies to both fully insured and self insured group plans.  The fee is $1.00 per covered person for plan years ending on or after Oct 1, 2012, through September 30, 2013.  $2.00 per covered person for plan years ending on or after October 1, 2013 through Sept 30, 2014.  Rates in subsequent years are tied to increases in the per capita amount of the National Health Expenditures.  Fees will not apply to plans with coverage periods that begin after September 30, 2019.  On fully insured plans, the Insurance Company pays this fee, but the customer rates will be impacted.  With Self-Insured plans the Plan Sponsor (typically the employer) will be responsible to pay the fee.
4. Federally Facilitated Exchange User Fee-The purpose of this fee is to pay for access to exchanges facilitated by the Federal Government.  It is a monthly fee which is effective in 2014.  The actual due date of this fee is yet Unknown.  The insurance Companies offering health insurance products through exchanges facilitated by the Federal Government will be responsible for paying this.  This fee applies to Fully insured plans only.  The amount of this fee is the monthly user fee based on a percent of premium attributed to an insurer's exchange-based sales. For 2014, the percent of premium proposed is 3.5%

Medicare Advantage enrollees could take hit in 2014

In an article in the LifeHealthPro magazine, Karen Ignagni, president of America's Health Insurance Plans, stated that the potential 2.3% reduction in Medicare Advantage payments proposed by an arm of the Dep of Health and Human Services combined with PPACA's payment cuts will result in benefit reductions and premium increases. This will result in an increase average $50 to $90 per month for typical Medicare Advantage beneficiary next year, warned by AHIP. 
These proposed cuts will effect 14 million seniors, or roughly 28% of all Medicare beneficiaries. 
The new analysis prepared for AHIP states that the combined effect of the changes included in PPACA and the new payment cuts will result in an estimated 6.9% to 7.8% cut to Medicare Advantage plnas in 2014, causing the net out of pocket for seniors and those with disabilities to rise, accouding to AHIP.

You Need Life Insurance

Life Insurance is a very simple answer to a very difficult question: 

How will my Family manage when I die?

It's a subject no one really wants to think about, but if someone depends on you financially, it is one that you cannot and should not, avoid.

There are many types of Life Insurance, but for all of them the bottom line is the same:

Pay Cash to your Family after you die, allowing your loved ones to remain financially secure. 

Life Insurance payments can be used to cover daily living expenses, mortgage payment, outstanding loans, college tuition and other essential expenses. 

The Death-Benefit proceeds of a Life Insurance policy are almost never subject to Federal Income Taxes.

You have worked hard to establish a solid financial framework for your family-with investments, home equity, a savings plan, retirement accounts. 

Life Insurance is the Foundation upon which it all rests.

It can guard against the need for your loved ones to make drastic changes to future plans when you die.

Certain types of Life Insurance even have a Built-In Cash Accumulation feature that can help you reach savings goals.

We all need Life Insurance. 

Many who already have it may need to update or check on coverages or beneficiaries. 

I can help you find and check what needs to be done.

Call me for a free interview including a fact finder that will show us what you need to be concerned about.



PPACA for Small Group Employers

The PPACA law currently names small group employers as employers who have 50 or fewer full time employees.  I will get into how a full time employee is figured latter.
Small businesses also can use an exchange to find insurance for their employees. These are called
"Small Business Health Options Programs" or SHOPs for short. 

Small Businesses have three options for health insurance in 2014:

1. Offer a fully insured plan through either;

• A SHOP exchange
• The traditional market

    2.   Offer an ASO plan.
 Administrative Services Only (ASO) is essentially a self-funded plan by the employer.

    3.  Stop offering coverage and let employees buy an individual plan on or off the exchange.


Subsidies for Small Employers:

Tax credits will increase for employers with 25 or fewer employees (with an average wage of less that $50,000 a year) who offer coverage through an exchange.

 

• The credit will cover up to 50% of the employer's cost (35% for small nonprofit organizations)
• Employers will be eligible for credits in the first two years they offer coverage through an exchange
• Credits decrease on a sliding scale as group size and employee wages increase.

Subsidies and credits in the Marketplace or Exchange

For those people who don't have access to affordable, minimum essential health coverage can buy a health plan from the Marketplace, or exchange, and get a credit or subsidy if they meet income requirements. Credits and subsidies help with the cost of premiums and out-of-pocket health care expenses.

To be eligible for one of these two, your income must be between 133% and 400% of the federal poverty level. 

For an individual, that equals $15,282 to $45,960 per year in 2013.
For a family of four, that equals $31,322 to $94,200 for year 2013. 

Those who meet the income level, can get a Tax Credit  that may be applied to any level exchange plan (bronze, silver, gold, or platinum).

The Cost Sharing Subsidy is available to those who earn up to 250% of federal poverty level and enroll in a silver exchange plan only. 

Podcast-from Anthem group HealthCare Reform

Here is a replay from the MyAnthem page.  It is a replay from the podcast series-Making Health Care Reform Work for you

find the audio here

Will you save with the new Federal Health Law?

Here is a worksheet that works.  Just plug in your own info and see if you are eligable for either a subsidy or a tax credit beginning January 2014, for your individual health insurance.

Open enrollment begins this October.  As a Health Agent, i will be licensed and realy to help you enter the Marketplace. 


http://laborcenter.berkeley.edu/healthpolicy/calculator/

Basics of Exchanges

As part of the Affordable Care Act (ACA) or health care reform starting in 2014, all Americans must have a minimum amount of health insurance or be taxed by the government.
 People who don't get health insurance at work, or can't afford it, my be able to get it through an exchange, or Marketplace.  The exchanges do not replace buying insurance privately.  They are simple a new place to shop and buy.  In the State of Ohio, the US Department of Health and Human Services (HHS) will run the exchange, because the State choose not to create one.
There will be four levels, or tiers, of coverage on the exchanges. The tiers are named after metals: bronze, silver, gold, and platinum.  Each tier will have several plans to choose from and will include "Essential Health Benefits".  Bronze plans will have the lowest monthly premium, but cost shares will be more when health care services are provided.  Platinum plans will have the highest monthly premiums, but cost shares will be less.
The different exchange tiers are:
Platinum-90% coverage
Gold-80% coverage
Silver-70% coverage
Bronze-60% coverage


All plans must include " Essential Health Benefits" as defined by the health care reform law and the HHS.  Specifically, the plans must include items and services from at least these 10 categories of care:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

Penalties for individuals who do not have a minimum amount of health coverage will receive a penalty of $95 or 1% of their taxable income, whichever is greater.  The penalty for year #2 is the greater of $325 or 2% of taxable income, and year #3 is $695 or 2.5% of taxable income.
Penalties will increase each year through 2016.  In future years, the penalties will adjust annually.

The exchanges don't replace private health insurance.  They are simply a new place for qualified individuals and small group employers to shop for and buy it.

Keeping your Grandfathered Plan

For employers who decided to "Grandfather" their health benefit plan, some of the health reform changes are not required.  Grandfathering a plan means that you decided to keep the plan that you had in effect on March 23, 2010, and made no or only minimal changes as permitted by the grandfather rules.  However, there are a number of changes that apply to all plans whether or not they are a grandfathered plan.

As we approach 2014, grandfathered plans will not be required to implement a number of health reform law provisions, including:

• Rating restrictions such as adjusted community rating (for small group plans only)
• Capping deductibles and/or implementation of the ACA's out-of-pocket limits
• Providing essential health benefits (for small groups only)
• Providing coverage for clinical trials

In general, plan changes that can cause loss of grandfathered status include eliminating certain benefits, increasing coinsurance, increasing fixed-dollar cost sharing (co payments, deductibles and out-of-pocket limits) beyond allowed amounts, and the plan sponsor's decrease in its contributions toward the cost of coverage by more that 5 percent below the contribution rate on March 23, 2010.

SOOOOOO, if you have chosen to maintain grandfathered status, you will need to satisfy the notice and record keeping obligations that are required to maintain that grandfathered status.

Obama Care-do you know?

I am just wondering if you know that this is the law?  Do you know when and why it is happening?  Where will you be buying your healthcare coverage next year?  Do you work for a company that will be getting you healthcare coverage? Costs are going up.  Do you know if you will be help buying coverage?  Wow, lots of questions. 

Disability isn't always caused by a devastating accident or illness

(Video)
http://www.lifehappens.org/portfolio/alysia-lim-you-need-a-plan/

A disability isn’t always caused by a devastating accident or illness. It can mean a health crisis that takes away your ability to earn a living as you always have. That was the case for Alysia Lim’s father. An aneurysm, and resulting surgery to address it, has made it impossible for him to continue working as an emergency room physician. But Dr. Lim had prepared for the unforeseen with adequate amounts of insurance, including disability insurance.

Now he works as a professor at a local college, but his drop in salary has not changed the way the Lim family lives. His disability insurance has supplemented his income, allowing the Lims to stay in the dream house they built and to maintain their lifestyle.

This lesson hasn’t been lost on Alysia. She had thought her dad overprotective when he would mention that if anything were to happen to him or Alysia’s mother that the kids would be taken care of with the help of insurance. Alysia admits that her dad was right. “It’s a good thing he planned ahead,” she says, and adds that now she really understands the importance of preparing “for whatever may happen.”

Obama Admin simplifies-shortens health application

The Centers for Medicare & Medicaid Services (CMS) today announced that the application for health coverage has been simplified and significantly shortened. The application for individuals without health insurance has been reduced from twenty-one to three pages, and the application for families is reduce by two-thirds. The consumer friendly forms are much shorter than industry standards for health insurance applications today.

In addition, for the first time consumers will be able to fill out one simple application and see their entire range of health insurance options, including plans in the Health Insurance Marketplace, Medicaid, the Children's Health Insurance Program (CHIP) and tax credits that will help pay for premiums.

Will this be ready in October?  We are being told that the open enrollment will begin October 2013 for a January 1, 2014 effective date. 

Anthem Health Care Reform and You

Here is a website from Anthem.  Great info for individual health coverage changes we will be seeing.

http://www.healthcarereformforyou.com/home

More Life Insur? I have Group Term at work or do I?

When talking to my clients about increasing their life insurance coverage, I often hear: "I really don't need extra coverage.  I've got life insurance where I work".  Unfortunately, most of these prospects don't realize that group term insurance is not enough to adequately secure their family's future.  Let me explain.

Many employers provide group term life insurance in multiples of an individuals salary.  Under current tax law, face amounts above $50,000 are taxable to the employees.  That means that employees have to report income using IRS Table 1 each year and pay income taxes on that amount.  The older they get, the higher the premium reported out will be.

Premiums for group term insurance, by nature, utilize healthy employees to somewhat offset a portion of the cost of covering other employees who may have chronic conditions or unhealthy lifestyles. Costs are also kept low because most employees discontinue the coverage before they reach the point where they are most likely to die-after retirement.  Group term coverage ends at retirement or whenever the employee terminates his employment with the employer.  Of course the coverage may be converted to individual coverage, but that can be very expensive, especially at older ages. 

This is not to say that group term insurance is a bad thing. Group term provides a valuable benefit, but is should only be considered temporary insurance coverage and not the basis for a financial plan.

An individual term policy would be a better alternative.  You can save money and purchase larger face amounts, with premiums guaranteed level for up to 30 years.  And if you are in good health now, the cost for an individual policy can be lower than the reportable premium for group term.  An individual policy will allow you to guarantee your insurability in care it changes in the future.

By taking the time to talk to me about the advantages of an individual life insurance policy over group term, you will see that your group term insurance policy is just a temporary part of your overall plan.  An Individual life insurance policy can save you money and help secure your financial future, for both you and your family. 

Young Adult CoverageUnder the Affordable Care Act, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old.  This is the Federal Law. The State of Ohio has their own law which extents this to the age of 28, with additional stipulations. 

Achieve Immortality on Installment plan

Everyone has something to give-I can help put the pieces together
No matter how old we are, what we do for a living, how much money we make, or where we live, we all want to be able to make a difference.
We make contributions of our time and our money to our favorite charities throughout our lifetimes, but once we die, those contributions stop. But what if there were a way to continue those monetary contributions beyond the grave?
A Life Insurance policy naming the charity as owner and beneficiary can be the perfect way to provide that lasting legacy. 
The satisfaction of giving to a charity combined with the practical benefits of tax deductions can be accomplished through life insurance, turning affordable contributions into major gifts. 
A tremendously large benefit can be created with life insurance compared to an outright gift of the same out-of-pocket cost.
A gift of a life insurance policy is a practical and affordable way to make a charitable contribution that is much larger than might be made through direct contributions alone.  You don't have to be wealthy to make a significant and meaningful gift.  Even modest annual gifts can have a substantial impact.

PPACA’s Impact on Insurance Premiums: Actuarial Study Predicts 32% Increase in Costs Over Next Five Years

A new report by the Independent Society of Actuaries predicts that individual market health insurers could experience as much as a 32% increase on average in health care costs from 2014 through 2017 due to changes brought on by the Patient Protection and Affordable Care Act (PPACA). This would result in higher premiums as the increased costs are passed on to those who purchase health insurance in the individual markets. 
The report refers to an “average” increase in costs, but the actual increase in “per member per month” (pmpm) claims expenses will vary from state to state.  

Health Care Reform-Are you ready for the next step?

With implementation of PPACA in full swing, employers need to understand how the Affordable Care Act will impact their employees and their health plans starting in 2014.  Come learn how to navigate the employer responsibilities under ACA, including the time lines for upcoming changes, the impact of health care exchanges and the penalty implicaitons for employers of all sizes.  I invite you to be my guest at this free MedBen university presenation, sponsored by Miller-Lewis Benefit Consultants featuring speaker Caroline Fraker.  Caroline is VP of Compliance and Chief Privacy Officer at MedBen.   She will examine the immediate and long-term effects of health care reform-and offer timely advice to help you stay ahead of the latest federal rules.  Event will be at the Fairfield Medical Center; 410 N Ewing St., Lancaster, OH-Registration-9AM; Presentation-9:30 AM; Adjournment-11:30 AM.  Space is limited, so register today by contacting me at (740) 654-4055. 

What is "Never" Money? Ask me

There are three types of Money
Everyday Money-This is money used to pay for current livng expenses like food, clothing, prescription drugs, et.
Someday Money- This is money that might be needed someday in the future to disburse for travel, second home, etc.
Never Money-This is money that is planned for bequeathing to a spouse, children, grandchildren, or as a gift to a favorite charity.

Do you know your wealth transfer options?
How do you want your money to work for you and your beneficiaries?
You decide! -Taxable, Tax-Deferred, or Tax-Free.

Taxable (CD's, Money Market Accounts)

• safety (FDIC insured)
• Liquidity (Withdrawals permitted subject to bank penalty)
• Good rate of return
• Interest taxable each year to owner
• Subject to probate process

Tax-Deferred (Annuities)

• Safety (Backed by insurance company reserves)
• Liquidity (partial withdrawals permitted without company penalty)
• Good rate of return
• Tax-deferred accumulation (until withdrawn or death)
• No probate delay (payable directly to named beneficiaries)

Tax-Free (Preferred Whole Life Insurance)

• Safety (backed by insurance company reserves)
• Liquidity (loans permitted without company penalty)
• Guaranteed cash values
• Tax-deferred accumulation
• No probate delay (payable directly to named beneficiaries)
• Income TAX-FREE death benefit

I can offer you Annunities and Preferred Whole life Insurance as alternatives to traditional vehicles, such as certificates of deposit and money market accounts.