The Patient Protection
Affordable Care Act /
What Does It Do, To Whom, When,
and How Does It Change Things?
As a Small Business Owner What Should I Do?
Presented by Jim Curis
Curis Benefits, LLC
October 2013 for Chapel Hill-Carrboro
Chamber of Commerce
Current Costs of BCBSNC Individual Plans
Percentages listed below in Red are current BCBSNC plans versus the new
Platinum and Catastrophic BCBSNC ACA compliant plans costs (lower ACA
premium chosed for comparison)
Premiums listed below in Green are best rate costs for current BCBSNC Plan
offerings (Blue Advantage A and Blue Saver C)
60-Year old40-Year old25-Year old
5 Things Small Businesses Need to
Know About ObamaCare Before Oct. 1
1: Notify your employees about the exchanges.
2: You can email the notices.
3: Small businesses with 50 or fewer employees can renew
their plans early.
4: Small businesses operating in multiple states can choose
between different exchanges.
5: If your business grows above 50 employees during 2014,
you won’t get kicked out of the exchange.
6 Things Individuals Need to Know About
Obamacare Before 2014
1. You won't be directly affected too much -- if you have health
insurance through your employer.
2. You could have to pay a penalty if you don't have health
3. You might qualify for Medicaid -- depending on where you live.
4. You could qualify for federal tax credits or subsidy to help buy
5. If you need to buy insurance, you might buy it through an online
health insurance exchange.
6. Your health insurance might be more expensive -- but it could be
less costly if a subsidy is involved.
Bullet points about Obamacare and how it affects you (part 1)
• Group Insurance Changes
*If you have over 50 employees full time (meaning workers that
average over 30 hours per week) then you must provide health
insurance…………or pay a penalty.
*Company is required to pay 60% of the total insurance benefit if you
have more than 50 employees….(of the employee only portion)
*Beginning in January 2014, there will be no more pre-existing or
underwriting on all health plans
*Every person will be required to have health insurance, or pay a
penalty of $95 dollars per adult & $47.50 per child……….or 1% of your
income (whichever is greater)……these penalties go up after 2014
Bullet points about Obamacare and how it affects you (part 2)
• Government Subsidies- You will qualify for a subsidy if you meet the
*You must fill out an application for your subsidy. This will let you know what
percent the government will pay towards your health care……..or you will find
out that you do not qualify for a subsidy and you need to really look at all
your options (group insurance) to make sure you are making the right choice.
*Single adult-If you make less than $45,000 per year you will receive a
subsidy to help purchase insurance in the individual market……….only if you
do not have access to group insurance or if you have access to group
insurance but your cost is over 9.5% of your annual income
*Families- (more than one person) If you make less than $93,000 per year
as a family your family may receive a subsidy to help purchase insurance in
the individual market……..only if you do not have access to group insurance or
if you have access to group insurance but your “employee only” cost of
insurance is over 9.5% of your annual family income………….this is referred to
as the “Family Glitch”
Types of Plans allowed in the New Health Care Exchange
*Platinum Plans- Will be very low co-pays and low drug card co-
pays……very rich in benefits, but very expensive
*Gold Plans- Will be low co-pays and reasonable drug card co-
pays……expect deductibles to be in the 500-1000 dollar range. Won’t
be as expensive as platinum, but still very expensive.
*Silver Plans- Will be the benchmarked plans that the rates are set
on. Most people will probably pick up a silver plan. Deductibles will
range from 1500-2500, copays will probably be in the range of 25-50
copays and will come with drug cards.
*Bronze Plans- Health Savings Accounts will fall under these bronze
plans. These plans will be more affordable for the younger population
who really don’t use their health insurance much. Expect higher
deductibles and higher co-pays, and plans that just have a deductible
and no co-pays attached.
Bullet points about Obamacare and how it affects you (part 3)
Bullet points about Obamacare and how it affects you (part 4)
Individual Policies -Starting in January 1, 2014 the following will be
true for individual health policies
*No Health Questions anymore & No Pre-Existing conditions
*Maternity coverage included on all
*Females and Males will have the same rates
*Rates will be based on age and the geographical location
*Currently the older population pays between 5-7 times the premium
of a younger person……The new law states that the older
population (60-65) can only pay 3 times the premium of someone
who is younger.
*Expect rates to go up
*If you qualify for a subsidy, in many cases you may be paying less
than you do today.
*Males rates will go up (now they will be paying the same as females)
Small Business Health Care Tax Credit
Although the Affordable Care Act does not require that businesses provide health insurance, it does offer
tax credits for eligible small businesses that choose to provide insurance to their employees for the first
time, or maintain the coverage they already have.
Does My Business Qualify for the Health
Care Tax Credit?
Through 2013, to qualify for a small business tax credit of up to 35% (up to 25% for non-
profits) of your premium contributions, you must have all of these criteria:
• Fewer than 25 full-time equivalent employees
•Pay average annual wages below $50,000
•Contribute 50% or more toward your employees’ self-only health insurance costs
Beginning in 2014, this tax credit increases to 50% (35% for non-profits) and will be
available to small businesses who meet the criteria listed above and who purchase
coverage through the new Small Business Health Options Program (SHOP)
Marketplaces (also known as Exchanges).
This enhanced credit can be claimed for any two consecutive taxable years beginning in
2014 (or beginning in a later year) through the SHOP.
Who Will the Small Business Tax Credit Help Most?
While any business meeting the above standards may be eligible to receive a tax
credit of up to 35% (25% for non-profits), the Small Business Health Care Tax Credit
works on a sliding scale and is specifically targeted for those businesses with low- and
For this reason, to qualify for the maximum small business tax credit, you must
contribute at least 50% toward your employees’ self-only premium costs and meet the
following two standards:
•10 or fewer full-time employees
•Annual average wages at or below $25,000
Penalty is $95 per adult and $47.50 per child (up to
$285 for a family) or 1.0% of family income,
whichever is greater.
Penalty is $325 per adult and $162.50 per child (up to
$975 for a family) or 2.0% of family income,
whichever is greater.
Penalty is $695 per adult and $347.50 per child (up to
$2,085 for a family) or 2.5% of family
income, whichever is greater.