Aca healthcare options for 2013 public by michael chapman 073113 slideshare

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Affordable Care Act Enrollment Update presentation for Individuals and Businesses

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Aca healthcare options for 2013 public by michael chapman 073113 slideshare

  1. 1. What You Need to Know NOW & How to prepare for 2014 • What You Need to Know • What You Need to Decide • When You Need to Act • Plus, How It Affects You, Your Job, and Your Employer What? When? Healthcare Options for 2013 And how to prepare for 2014 © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  2. 2. Disclaimer: • The information presented is subject to change, and will likely change in the future. • Subscribe to TheMedicalInsuranceExchange.com newsletter or contact us for latestupdates. • The information presented should not to be construed as offering legal or tax advice; consult with a lawyer or tax professional. • Some state variations may occur, the information presented is based on the laws of Texas. What? When? Healthcare Options for 2013 © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  3. 3. My Qualifications: • Former CEO • Since 2003, Frequent Public Speaker on Healthcare and Insurance. • Employee Benefits Broker for Companies and Individuals. • Published Author, Blogger. • Helpful, pro bono resource to thousands of individuals and companies in DFW with benefits-related questions and concerns. • Mike Chapman, mtchapman@endeavorgroup.net • Linkedin.com/in/michaelchapman (14,000+) • 214-764-6315 tel, 214-732-3691 cell © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2013
  4. 4. © 2013 Michael Chapman, GroupBenefitsAdvisors.com My Dilemma Healthcare Options for 2013
  5. 5. Door # 2: • Plunge head first towards opportunities created from PPACA • Mike Chapman, mtchapman@endeavorgroup.net • Linkedin.com/in/michaelchapman • 214-764-6315 tel., 214-732-3691 cell © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2013
  6. 6. Healthcare Options for 2013 Best Healthcare Advice for Anyone: © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  7. 7. Healthcare Options for 2013 Best Healthcare Advice for Anyone: • Stay Healthy • Don‟t Get Injured © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  8. 8. Healthcare Options for 2013 2nd-Best Healthcare Advice for Anyone: © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  9. 9. Healthcare Options for 2013 2nd-Best Healthcare Advice for Anyone: • Die Quickly • Die In Your Sleep! • Over 80% of lifetime healthcare expenses occur in last 18 months of life. • Medical is Leading Cause of Bankruptcies © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  10. 10. Healthcare Options for 2013 We Don‟t Get to Choose If, When, or How We Get Sick, Injured or© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  11. 11. Healthcare Options for 2013 The Choices We Make Determines How Much We Have to Spend If and When We Get Sick, Injured or Die © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  12. 12. Healthcare Options for 2013 A Healthy, “Hazard-Free „Lifestyle Reduces How Much We‟ll Eventually Pay When We Get Sick, Injured and Die, and Increases the Length and Quality of Life © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  13. 13. Healthcare Options for 2013 Insurance pools the $$ Risk of Sickness Accident, and Death © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  14. 14. Healthcare Options for 2013 Healthcare is Expensive • 30-35% of US GDP • For many families, #1 or 2 budget item. • For many Businesses, #2 Overhead item after salaries • High, uncontrollable inflation. © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  15. 15. Healthcare Options for 2013 Pre-2014 Options: • COBRA • Private Insurance • “Risk Pool” • VA/Tricare (Veterans/Active Duty) • Medicare (65+) • Medicaid/CHIP (Children) • Self-Insure © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  16. 16. Healthcare Options for 2013 Pre-2014 Options: • COBRA/State Continuation • Same plan, same $ as employer • 18 months/6 months • No exclusion of health conditions • Must elect within 60 days © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  17. 17. Healthcare Options for 2013 Pre-2014 Options: • Private Insurance • Can exclude conditions, increase rates based on health conditions during underwriting. © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  18. 18. Healthcare Options for 2013 Underwriting: • Evaluation of Risk of claims • Conditions • Age • Gender • Residence © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  19. 19. Healthcare Options for 2013 Pre-2014 Options: • Group Insurance • Guaranteed Issue • Same cost for every employee • Individual Insurance • Individually Underwritten © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  20. 20. Healthcare Options for 2013 Pre-2014 Options: • Individual Insurance • Individually Underwritten • Insuring a healthy, younger, male with no health conditions is less risk of a claim, so they will pay less for insurance. • Can reduce cost vs. COBRA by up to 60% © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  21. 21. Healthcare Options for 2013 Pre-2014 Options: • Individual Insurance • Short term plans • 0-6 months of coverage. • Easy, short application. • “Permanent” plans • Stay in force as long as you pay premium. • Lengthy application/underwriting. • Short term and permanent are both major medical plans. © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  22. 22. Healthcare Options for 2013 Pre-2014 Options: • “Risk Pool” • Option after COBRA and if either spouse is not eligible for group plan. • Covers individuals who are ineligible or excluded individual insurance because of health condition. © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  23. 23. Healthcare Options for 2013 Pre-2014 Options: • Medicare • Guaranteed issue coverage at age 65, can apply at 64 ½ • A+B+D plus medicare supplement or Medicare Advantage (HMO) plan in some areas. • Limitation of healthcare providers who accept. © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  24. 24. Healthcare Options for 2013 Pre-2014 Options: • Medicaid/CHIP (Children) • Children 0-18 • Income/Asset qualify • Waiting list • HMO • Affordable © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  25. 25. Healthcare Options for 2013 Pre-2014 Options: • Self-Insure • You assume risk of sickness/injury • Includes public health programs such as Parkland and John Peter Smith in DFW © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  26. 26. Whether you yet know it or not… …ACA Impacts EVERYTHING • Every American faces healthcare decisions Beginning 10/1/2013 for 2014. • Every Business faces similar decisions in 2014 What? What? When? © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014
  27. 27. When Must I Make A Decision? • Huge Advertising Campaign. • Exchanges Open October 1, 2013 • ACA Coverage Begins January 1. • Best Time To Make A Decision is NOW! © 2013 Michael Chapman, GroupBenefitsAdvisors.com What? When ? Healthcare Options for 2014
  28. 28. The Obamacare Clock Is Ticking.. …The Sooner You Know WHAT to Do …The Longer You‟ll Have to Adjust! © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014
  29. 29. Change = Opportunities © 2013 Michael Chapman, GroupBenefitsAdvisors.com Use Knowledge of Obamacare as Your Secret Advantage. Healthcare Options for 2014
  30. 30. Brief Overview of What it Is • Coverage Differences • How You Buy It • What It Costs You • Consequences to You and Employer © 2013 Michael Chapman, GroupBenefitsAdvisors.com What? When ? Healthcare Options for 2014
  31. 31. Your Health Plan will be Different © 2013 Michael Chapman, GroupBenefitsAdvisors.com 2013 2014 Healthcare Options for 2014
  32. 32. © 2013 Michael Chapman, GroupBenefitsAdvisors.com 98% of Today‟s Health Plans Will Be Replaced Just Kidding! Healthcare Options for 2014
  33. 33. Some of the Big Plan Differences: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Different Deductibles – • Max $2,000 Deductible. • $3,500 Max Out of Pocket. • “Guaranteed Issue,” Regardless of Your Health. • More Coverage, Examples: • Maternity Coverage, Dental Checkups to Age 6 Healthcare Options for 2014
  34. 34. More Big Plan Differences: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Guaranteed issue, No “Rate Ups” for Risk or Conditions • Except May Charge 50% More for Smoking • May Offer Discount for Wellness Plan Participation • 3 vs. 6 Age Bands • Community Rating. Healthcare Options for 2014
  35. 35. Buzz Word: Essential Benefits © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Prescription drugs Healthcare Options for 2014
  36. 36. Essential Benefits, continued: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services; chronic disease management • Pediatric services, including oral and vision care Healthcare Options for 2014
  37. 37. Essential Benefits, continued: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Items or services that have an „A‟ or „B‟ rating • Immunizations for routine use in children, adolescents, & adults • Evidence‐informed preventive care and screenings • No cost sharing for preventive care services (in‐network) Healthcare Options for 2014
  38. 38. Buzz Word: Actuarial Value © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Bronze plans = 60% of minimum of cost of healthcare • Silver plans = 70% of minimum of cost of healthcare • Gold plans = 80% of minimum of cost of healthcare • Platinum plans = 90% of minimum of cost of healthcare Healthcare Options for 2014
  39. 39. Your Premiums Will Be Different: © 2013 Michael Chapman, GroupBenefitsAdvisors.com 2013: $$$ 2014: ??? Healthcare Options for 2014
  40. 40. Anybody Want to Guess the Biggest Factor Whether You‟ll Pay More or Less? © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014
  41. 41. How Much You Earn! © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014
  42. 42. Eligibility for Government Subsidy Family of 4 Income Level Percent of Poverty Level Individual Can Get Coverage In: Government Subsidies Above $88,200 Above 400% Federal or State Health Ins Exchange No $88,200 400% Federal or State Health Ins Exchange Yes $29,327 $22,050 $0 133% 100% 0% Medicaid Yes © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014
  43. 43. 1. How Do Find Out if I Qualify for a Subsidy for Obamacare? © 2013 Michael Chapman, GroupBenefitsAdvisors.com 2. Am I Sure I Really Want a Subsidy? 3. What‟s The Penalty If Uninsured? Healthcare Options for 2014
  44. 44. Tax Credit or Subsidy • Subsidies Only Available through Public and Private Exchanges. • Employee+ Dependents NOT ELIGIBLE for a Subsidy If: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • The employer offers at least the actuarial equivalent of the Bronze Plan (60%) • The employee cost share is not more than 9.5% of their annual income (W‐2 Employee) (AGI) Healthcare Options for 2014
  45. 45. Tax Credit or Subsidy • If employer offers health insurance for employees, employee cannot apply for subsidy for themselves or for their dependents. • This means employee must purchase high cost, unsubsidized insurance for dependents or pay a tax penalty if they are uninsured. © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014
  46. 46. © 2013 Michael Chapman, GroupBenefitsAdvisors.com Subsidy Calculator: Healthcare Options for 2014
  47. 47. Go to: http://TheMedicalInsuranceExchange.com/ obamacare-subsidy-calculator/ or http://goo.gl/LbldeU For Subsidy Estimates © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014
  48. 48. Go to: http://themedicalinsuranceexchange.com/apply- here-for-obamacare-subsidy-and-health-insurance/ or http://goo.gl/7QAx5y For Final Draft Copy of ACA Paper Applications © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014
  49. 49. If your Adjusted Gross Income ends up exceeding your estimate, the IRS will assess and take back your subsidy. © 2013 Michael Chapman, GroupBenefitsAdvisors.com The IRS Giveth and Taketh Away: Examples: • Job Seekers • Y.E. Bonus • Unexpected Income Healthcare Options for 2014
  50. 50. Where You‟ll Buy: © 2013 Michael Chapman, GroupBenefitsAdvisors.com Employer Exchange • Employer • Federal or State Exchanges (Federal Only in TX) • Private Exchanges • 2015: SHOP for small biz (< 25) Healthcare Options for 2014
  51. 51. Public Insurance Exchanges: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • State Run (23 states + DC) • Federal Exchange (26 states, including Texas) Healthcare Options for 2014
  52. 52. “Pre-2014” Health Insurance Transaction When? Healthcare Costs © 2013 Michael Chapman, GroupBenefitsAdvisors.com You and/or Your Employer Insurance Company Insurance Policy $$, Health Information Healthcare Options for 2014
  53. 53. 2014 Exchange Transaction What? Healthcare Costs © 2013 Michael Chapman, GroupBenefitsAdvisors.com You and/or Your Employer Insurance Company Healthcare Options for 2014
  54. 54. 2014 Exchange Transaction What? Healthcare Costs © 2013 Michael Chapman, GroupBenefitsAdvisors.com You and/or Your Employer Insurance Company Healthcare Options for 2014
  55. 55. 2014 Exchange Transaction What? Healthcare Costs © 2013 Michael Chapman, GroupBenefitsAdvisors.com You and/or Your Employer Insurance Company $$ Premium Payment Health Insurance Policy Healthcare Options for 2014
  56. 56. Where: © 2013 Michael Chapman, GroupBenefitsAdvisors.com Marketplace.CMS.Gov Healthcare Options for 2014
  57. 57. Downside of Public Exchanges: • Self-serve, with little to no support • Expect LONGGGGGG Wait Times, • WRONGGGGG Answers. Healthcare Options for 2014 © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  58. 58. Downside of Public Exchanges: • Inexperienced, minimally trained “Navigators” and “Assistors” • Navigator grant money awarded to organizations favoring Administration Healthcare Options for 2014 © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  59. 59. Downside of “Public Exchanges” • Do you really want to share your personal health & tax information? Healthcare Options for 2014 © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  60. 60. Downside of “Public Exchanges” • No support or assistance after purchase. Healthcare Options for 2014 © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  61. 61. What is a “Private Exchange”?• Multiple carrier venue for insurance policies • Not just health insurance • Run by Experienced, Trained, Licensed Agents Healthcare Options for 2014 © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  62. 62. Example of Private Exchange: © 2013 Michael Chapman, GroupBenefitsAdvisors.com TheMedicalInsuranceExchange.com Healthcare Options for 2014
  63. 63. © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Out of pocket max greater than $3,500. • You don‟t have guaranteed issue or maternity coverage now. • You‟re younger than age 35 (approx.) • You live in an area with high healthcare utilization. • Your employer decreases contribution or drops group plan. You May Pay More in Premiums If in 2013: Healthcare Options for 2014
  64. 64. You May Pay Less in Premiums If in 2013: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Out of pocket max now less than $3,500. • You have guaranteed issue coverage (Risk Pool). • You‟re older than age 50 (approx.) • You live in an area with low healthcare utilization. • Your employer maintains/increases health plan contribution or improves health plan. Healthcare Options for 2014
  65. 65. • 2014: $95 per Adult, $47.50 per Child up to $285 per family or 1% of income. © 2013 Michael Chapman, GroupBenefitsAdvisors.com Individual Tax Penalty If Uninsured: • 2015: $325 per Adult, $162.50 per Child up to $975 per family or 2% of income. • 2016: $695 per Adult, $347.50 per Child up to $2085 per family or 2.5% of income. Healthcare Options for 2014
  66. 66. Your Choices: © 2013 Michael Chapman, GroupBenefitsAdvisors.com COBRA Private/Public Exchange Insurance Short-term plan + Tax Penalty Healthcare Options for 2014
  67. 67. Whatever You Choose, You‟ll Pay More: © 2013 Michael Chapman, GroupBenefitsAdvisors.com Taxes Goods & Services New Federal Tax on Insurer Premiums, 3.8% Tax on Unearned Income, dividend taxes. Healthcare Options for 2014
  68. 68. Impact On Seniors: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Harder to find doctors who accept Medicare (25% pay cut) • Gradual Closing of Donut Hole • Reduction In Medicare Budget • Likely: Medicare Premiums Based on Assets and Income Healthcare Options for 2014
  69. 69. Employer Impact © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014
  70. 70. Employer Penalties (delayed): © 2013 Michael Chapman, GroupBenefitsAdvisors.com • $2,000 per Employee over 30 FTEs if Group Ins. or if no Essential Benefits • $3,000 per Employee that does not enroll in Employer‟s plan because it costs employee more than 9.5% of income or plan does not meet Bronze level. Healthcare Options for 2014
  71. 71. Certain Industry Sectors Will Get Hammered: • Staffing • Seasonal • Hospitality • Retail © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014
  72. 72. Employer Impact © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014 • Increased cost, taxes and regulations/red tape for all businesses. • Employer tax penalties delayed until 2015 (50+ full time employees) • Uncertainty impacting permanent, full-time employment.
  73. 73. Employer Impact © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014 • Increase in part-time employment. • Fewer employers will offer health insurance as an employee benefit. • Fewer employees will want an employer to offer health insurance so they can qualify for a subsidy for their whole family.
  74. 74. In Many Cases, It Benefits Employer to Drop Group Health Ins. Coverage © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014 • Cost of Tax Penalty for 50+ Employees Is Less than Health Insurance and is a Fixed Cost.
  75. 75. In Many Cases, It Benefits Employee for Employer to Drop Group Health Ins. Coverage © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014 • Subsidized Cost of Health Insurance for Employee + Dependents May Be Less for Employee than Employee Cost of Health Insurance for Employee Only
  76. 76. In Many Cases, It Benefits Employee for Employer to Drop Group Health Ins. Coverage © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014 • For Lower Wage Employees, Its Like Getting Dependents‟ Insurance for FREE!
  77. 77. At This Point, Which Are You? © 2013 Michael Chapman, GroupBenefitsAdvisors.com Dazed & Confused Bored Zombie Healthcare Options for 2014
  78. 78. My Unique Solutions: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Education, Expertise, Year-Round Service. • TheMedicalInsuranceExchange.com, a Private Health Insurance Exchange • Employer consultation • Partially Self-Funded Plans for employers Healthcare Options for 2014
  79. 79. The Obamacare Clock Is Ticking.. • Advertising for Fed. Exchanges Has Begun • Open Enrollment begins October, go to TheMedicalInsuranceExchange.com • You need to educate others what to do. © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014
  80. 80. Decision-making Is Like Constipation © 2013 Michael Chapman, GroupBenefitsAdvisors.com Taxes, Penalties, Higher Expenses, STRESS, Etc. …The Longer You Wait, the Worse It Gets Healthcare Options for 2014
  81. 81. How I Help Employers • Consulting expertise • Rapid assessment of options & impact • Educate top management • Develop plan of action • Employee education is critical for success. © 2013 Michael Chapman, GroupBenefitsAdvisors.com Healthcare Options for 2014
  82. 82. © 2013 Michael Chapman, GroupBenefitsAdvisors.com ACA Open Enrollment Preparation: “Black Tuesday”: October 1st, 61 Days Away • Schedule an appointment now for beginning October 1st. • Write down your Family SS #s, Dates of Birth. • If Insured, Make Copy of Your Insurance Card and Bill. • Go to http://TheMedicalInsuranceExchange.com/obamacare- subsidy-calculator or http://goo.gl/LbldeU; Print out an estimate of your subsidy. Healthcare Options for 2014
  83. 83. © 2013 Michael Chapman, GroupBenefitsAdvisors.com ACA Open Enrollment Preparation: • Subscribe to http://www.TheMedicalInsuranceExchange.com for updates and information as it becomes available. • Find a good PCP ASAP! Healthcare Options for 2014
  84. 84. © 2013 Michael Chapman, GroupBenefitsAdvisors.com If You‟re An Employer or Work for One: • Whether or not your employer offers health ins., An Employer Has An Obligation and Opportunity to Communicate ACA to Employees. • Schedule Me for an Employee Group Meeting • Schedule Me to Visit with Owner/CFO/CEO Healthcare Options for 2014
  85. 85. How You Can Help Me • Refer me to companies that need advice. • What Business Leadership Groups Could Use a Subject Matter Expert Speaker? • Bookmark/Share: TheMedicalInsuranceExchange.com © 2013 Michael Chapman, GroupBenefitsAdvisors.com How You Can Help Yourself & Your Company • Share This Information ASAP • ACT on This Information ASAP Healthcare Options for 2014
  86. 86. © 2013 Michael Chapman, GroupBenefitsAdvisors.com Remember: Use Your New Knowledge of Obamacare as Your Healthcare Advantage. (Know enough to raise the questions, then, “I know a guy…” Healthcare Options for 2014
  87. 87. Please Comment/Forward Share/Like: • http://TheMedicalInsuranceExchange.com • Facebook: • YouTube Channel: ObamacareInformation • LinkedIn.com/in/michaelchapman © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Subscribe, Sign Up for Updates, Upcoming Presentation Schedule and Webinars! Healthcare Options for 2014

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