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.