Are You Ready for Obamacare?


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At the Chamber's October Small Business Roundtable Jim Curis presented our members with the latest on the Affordable Care Act - also known as Obamacare.

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Are You Ready for Obamacare?

  1. 1. The Patient Protection and Affordable Care Act / Obamacare 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
  2. 2. Network Providers Overall Concerns…… Plan Design Subsidy Levels Costs Viability of the exchanges Federally Managed Exchanges Healthcare cost containment May 2013
  3. 3. Current Costs of BCBSNC Individual Plans Male $180.12 177% Female $266.44 120% Male $242.34 132% Female $365.47 111% Male $494.15 174% Female $541.06 159% Male $39.82 365% Female $54.67 266% Male $50.53 776% Female $71.72 547% Male $93.87 418% Female $101.94 384% 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
  4. 4. 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.
  5. 5. 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 insurance. 3. You might qualify for Medicaid -- depending on where you live. 4. You could qualify for federal tax credits or subsidy to help buy health insurance. 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.
  6. 6. 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
  7. 7. Bullet points about Obamacare and how it affects you (part 2) • Government Subsidies- You will qualify for a subsidy if you meet the following requirements: *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”
  8. 8. 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)
  9. 9. 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)
  10. 10. 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.
  11. 11. 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 moderate-income workers. 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
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  13. 13. 2014 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. Individual Penalty 2015 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. 2016 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. May 2013
  14. 14. Jim Curis Email: Phone: 919-451-8536