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Obamacare 411 for employees

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  • 1. Countdown to Action 2013Obamacare 411What?When?Healthcare Costs© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 2. Obamacare 411© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 3. Obamacare 411© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 4. Countdown to Action 2013:What every Employee Needs to Know NOW• What You Need to Know• What You Need to Decide• When You Need to Act• Plus, How It Affects Your Jobor Job SearchWhat?When?Obamacare 411© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 5. Obamacare 411My Qualifications:• Since 2003, Frequent Public Speaker on Healthcare and Insurance.• Successful Employee Benefits Broker for Companies and Individuals.• Published Author, Blogger.• Helpful, pro bono resource to thousands of individuals and companies inDFW with personal questions and concerns.• Malcolm Gladwell, “Outliers 10,000 Hours” qualification on the subject.• Mike Chapman, mtchapman@endeavorgroup.net• Linkedin.com/in/michaelchapman (14,000+)• 214-764-6315 tel, 214-732-3691 cell© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 6. Obamacare 411My Dilemma:• 66% of a benefits broker’s subject matter expertise won’t matter in 2014.• 80+% of a benefits broker’s income will disappear in 2014.• I’m uniquely qualified to serve the DFW community by providing simpleto follow information that people and companies can use to makehealthcare decisions and to move on.• Mike Chapman, mtchapman@endeavorgroup.net• Linkedin.com/in/michaelchapman (14,000+)• 214-764-6315 tel, 214-732-3691 cell© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 7. Obamacare 411Here’s How You Can Help Me• Mike Chapman, mtchapman@endeavorgroup.net• Linkedin.com/in/michaelchapman (14,000+)• 214-764-6315 tel, 214-732-3691 cell© 2013 Michael Chapman, GroupBenefitsAdvisors.comI Am Committed to Serve
  • 8. Countdown to Action 2013:Other Presentations For Following Groups:• What Every President / CFO Needs to Know NOW• What Every HR Professional Needs to Know NOW• What Every Business Owner Needs to Know NOWWhat?Obamacare 411What?When?© 2013 Michael Chapman, GroupBenefitsAdvisors.com…Do You Know A Business Group Above That Needs a Speaker?
  • 9. Obamacare 411About Me:• Search Candidate for position of President / COO / CEO for small to mid-size businesses.• Accomplished CEO/President/CEO/US Managing Director for International Companies.• Experience in Internet/Ecommerce/Manufacturing/Fin. Services/BtoC/BtoB Companies.• Startup and Operational Turnaround Experience, both domestic and international.• Twice earned Employee of the Year for well-known Fortune 100 company voted “MostAdmired Company” in US by Forbes Magazine. Average US Home owns 4.5 products that Ideveloped and brought to market.• Since 2003, small business owner in employee benefits field.• Mike Chapman, mtchapman@endeavorgroup.net• Linkedin.com/in/michaelchapman• 214-764-6315 tel., 214-732-3691 cell© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 10. Obamacare 411About Me:• I’m Available, who do you know?• Business Owner or Ownership, in need of a newleader.• International company, needs a US managingdirector or president.• Mike Chapman, mtchapman@endeavorgroup.net• Linkedin.com/in/michaelchapman• 214-764-6315 tel., 214-732-3691 cell© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 11. Obamacare 411Opinions Are Like This:…Unless you’re a Supermodel, keep it to yourself!--Everybody Has One……It’s the LAW of the LAND.…Quit Your Whining, Listen to what youneed to know! © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 12. Obamacare 411Why Obamacare?• Runaway Healthcare Inflation• Major Segment of Americanspriced out of Health Insurance.• THE WHY DOESN’TMATTER, THE MAJORITY HASVOTED! © 2013 Michael Chapman, GroupBenefitsAdvisors.comWhat?When?
  • 13. Obamacare 411Secy. HHS Sebelius:Health and Human Services (HHS)Secretary Kathleen Sebelius.• Second Most Powerful Person in US.• Not An Elected Position.• The phrase “secretary shall” appears 858 times in HR 3509(2,409 pages) and 24 times in HR 4872 (1,037 pages)© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 14. Obamacare 411Disclaimers:“Health and Human Services (HHS)Secretary Kathleen Sebelius said MondayApril 8, 2013 that she did not anticipatehow complicated implementing thepresident’s signature healthcare lawwould be.”• Due to the constant changes in the interpretation and application of Obamacare, thispresentation is guaranteed NOT to be 100% accurate. Information covered in thispresentation is guaranteed to change. You must do your own due diligence.• This presentation should not be construed as offering legal, insurance, or taxadvice, nor is it providing ACA Exchange Navigator advice. This presentation is forTexas only. © 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 15. Obamacare 411WHAT: PPACA, ACA, or Obamacare• Social Legislation• Redistribution of Wealth and Income• Redistribution of HealthCare• Regulation of Healthcare Providers andIndustry• Funds Technology to Reduce Waste andPrograms for Public Health.© 2013 Michael Chapman, GroupBenefitsAdvisors.comWhat?When?
  • 16. Obamacare 411WHAT: PPACA, ACA, or ObamacareEmancipation of HealthCare:• From Who Can Write a Check For It…• …To a Basic Right of Citizenship.© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 17. Obamacare 411WHAT: PPACA, ACA, or ObamacareMarket-Based vs. Regulated• From Free Market Pricing &Availability.• To Government Control of Pricing &Availability Healthcare© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 18. Obamacare 411Take a Deep Breath…• Impact on You and Your FamilyIt’s Time to Adapt to theNew Order!• Impact On Your Budget• Impact On Your Job and Your Employer© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 19. Obamacare 411When Must I Make A Decision?• Exchanges Open October 1, 2013• Obamacare Plans Begin January 1.• Best Time To Make A Decision is NOW!© 2013 Michael Chapman, GroupBenefitsAdvisors.comWhat?When?
  • 20. The Obamacare ClockIs Ticking..…The Sooner You KnowWHAT to Do© 2013 Michael Chapman, GroupBenefitsAdvisors.comObamacare 411…The Longer You’ll Haveto Adjust!
  • 21. ConstipatedDecision-making=© 2013 Michael Chapman, GroupBenefitsAdvisors.comObamacare 411More Taxes,Penalties,More Expenses,Anxiety, Etc.
  • 22. Change =Opportunities© 2013 Michael Chapman, GroupBenefitsAdvisors.comObamacare 411Use Knowledge ofObamacare as aCompetitive Advantage.
  • 23. Obamacare 411Nobody is AnExpert…Be the Expert!“Health and Human Services (HHS)Secretary Kathleen Sebelius saidMonday April 8, 2013 that she did notanticipate how complicatedimplementing the president’ssignature healthcare law would be.”© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 24. Obamacare 411Brief Overview of What it Is• Coverage Differences• How You Buy It• What It Costs You• Consequences to You and Employer© 2013 Michael Chapman, GroupBenefitsAdvisors.comWhat?When?
  • 25. Obamacare 411Your Health Plan will be Different© 2013 Michael Chapman, GroupBenefitsAdvisors.com2013 2014
  • 26. Obamacare 411© 2013 Michael Chapman, GroupBenefitsAdvisors.com98% of Today’sHealth Plans WillBe ReplacedJust Kidding!
  • 27. Obamacare 411Some 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
  • 28. Obamacare 411More Big Plan Differences:© 2013 Michael Chapman, GroupBenefitsAdvisors.com• 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.
  • 29. Obamacare 411Buzz Word: Essential Benefits© 2013 Michael Chapman, GroupBenefitsAdvisors.com• Ambulatory patient services• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance use disorderservices, including behavioral health treatment• Prescription drugs
  • 30. Obamacare 411Essential 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
  • 31. Obamacare 411Essential 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)
  • 32. Obamacare 411Your Premiums Will Be Different:© 2013 Michael Chapman, GroupBenefitsAdvisors.com2013:$$$2014:???
  • 33. Obamacare 411© 2013 Michael Chapman, GroupBenefitsAdvisors.com• Out of pocket max greater than $3,500.• You don’t have guaranteed issue or maternitycoverage now.• You’re younger than age 35 (approx.)• You live in an area with high healthcare utilization.• Your employer decreases contribution or dropsgroup plan.You May Pay More in Premiums If in 2013:
  • 34. Obamacare 411You 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 plancontribution or improves health plan.
  • 35. Obamacare 411Anybody Want toGuess the BiggestFactor WhetherYou’ll Pay More orLess?© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 36. Obamacare 411How Much You MakeHow Much You Own© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 37. Obamacare 411Your Choices:© 2013 Michael Chapman, GroupBenefitsAdvisors.comPayPlayDelay
  • 38. Obamacare 411Your Choices:© 2013 Michael Chapman, GroupBenefitsAdvisors.comPay:PlayDelayA Penalty for No InsurancePurchasePrivate, Group, Medicare, Exchange InsuranceRenew / Change Plan in Nov ‘13
  • 39. Obamacare 411Whatever You Choose, You’ll Pay More:© 2013 Michael Chapman, GroupBenefitsAdvisors.comTaxesGoods & ServicesNew Federal Tax on Insurer Premiums, 3.8%Tax on Unearned Income.
  • 40. Obamacare 411Your Employer Will Pay More:© 2013 Michael Chapman, GroupBenefitsAdvisors.com+ 2% Payroll TaxesComplianceInsurance Premiums
  • 41. Obamacare 411Impact On Seniors:© 2013 Michael Chapman, GroupBenefitsAdvisors.com• Reduction In Medicare Budget• Likely To Pay More Based onAssets and Income• Review Boards / Ration Care• Chronic Illness Management
  • 42. Where You’ll Buy:© 2013 Michael Chapman, GroupBenefitsAdvisors.comEmployerExchange• Employer• Private Insurance (Broker)• Medicare/Tricare/Govt. Jobs.• Online Exchanges• Private Exchanges• Federal or State Exchanges(Federal Only in TX)• 2015: SHOP for small biz (< 25)Obamacare 411
  • 43. Obamacare 411Where:© 2013 Michael Chapman, GroupBenefitsAdvisors.comMedicare.Gov
  • 44. Obamacare 411Where:© 2013 Michael Chapman, GroupBenefitsAdvisors.comHealthcare.Gov
  • 45. Obamacare 411Where:© 2013 Michael Chapman, GroupBenefitsAdvisors.comMarketplace.CMS.Gov
  • 46. Obamacare 411Where:© 2013 Michael Chapman, GroupBenefitsAdvisors.comMarketplace.CMS.Gov
  • 47. Obamacare 411Where:© 2013 Michael Chapman, GroupBenefitsAdvisors.comMarketplace.CMS.Gov
  • 48. Obamacare 411Where:© 2013 Michael Chapman, GroupBenefitsAdvisors.comMarketplace.CMS.Gov
  • 49. Obamacare 411Where:© 2013 Michael Chapman, GroupBenefitsAdvisors.comYouTube.CMS.Gov
  • 50. Obamacare 411TX Employer Impact© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 51. Obamacare 411WHO: All Businesses, 50 Full TimeEmployees*© 2013 Michael Chapman, GroupBenefitsAdvisors.com30 Hr. Part-Time Employees*(Unless Received a Waiver)Seasonal Employees
  • 52. Obamacare 411Fact: 78% of US Businesses are FamilyOwned, 2-99 Employees© 2013 Michael Chapman, GroupBenefitsAdvisors.com• 2005: 47% offered health insurance• 2012: 40% offered health Insurance• (Fewer offer in Texas)• Recession: cut-backs, closings• Premium InflationWhy?
  • 53. Obamacare 411Employer Penalties:© 2013 Michael Chapman, GroupBenefitsAdvisors.com1) If ACA-Mandated Employer doesn’t offer a MEC plan covering 95%of FTEs, they will be assessed a $2,000 TAX Penalty peremployee for every FTE over 30 employees.Example:• Employer with 100 FTEs (full time equivalent employees) payspenalty of $2,000 per employee in taxes for 70 FTEs, or $140,000more in taxes.
  • 54. Obamacare 411Employer Penalties:© 2013 Michael Chapman, GroupBenefitsAdvisors.com2) If ACA-Mandated Employer offers a MEC plan covering 95% ofFTEs, but if the employee cost share is greater than 9.5% of lowestwage employee’s AGI (W-2), Employer they will be assessed a$2,000 TAX Penalty for every FTE over 30 employees.Example:• Employer with 100 FTEs has one full-time janitor who is paidminimum wage.• Janitor’s premium share of MEC is 10% of his or her wages.• Employer will be assessed a Tax Penalty of $140,000.
  • 55. Obamacare 411Employer Penalties:© 2013 Michael Chapman, GroupBenefitsAdvisors.com3) If ACA-Mandated Employer offers a MEC plan covering 95% ofFTEs, they will be $3,000 TAX Penalty per employee for EveryFTE who applies for Insurance through a State or Federal Exchangeand receives a subsidy.Example:• Employer with 100 FTEs (full time equivalent employees) will pay apenalty of $6,000 if two employees apply for insurance through aState or Federal Exchange.• (Suggestion: Don’t be “That Guy.”)
  • 56. Obamacare 4111. How Do Find Out if I Qualify for aSubsidy for Obamacare?© 2013 Michael Chapman, GroupBenefitsAdvisors.com2. Am I Sure I Really Want a Subsidy?3. What’s The Penalty If Uninsured?
  • 57. Obamacare 411Tax Credit or SubsidyCongressional Budget Office Estimated that 127M PeoplePotentially Qualify for Subsidies.• CBO Estimated that Only 18 Million Will Participate.• The Subsidy Application Is estimated to be 62 pages!© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 58. Obamacare 411Tax Credit or Subsidy• Subsidies Only Available through Federal/State Exchanges.• An Employee Is NOT Eligible for a Subsidy If:© 2013 Michael Chapman, GroupBenefitsAdvisors.com• The employer offers at least the actuarial equivalent ofthe Bronze Plan (60%)• The employee cost share is not more than 9.5% of theirannual income (W‐2 Employee) (AGI)
  • 59. Obamacare 411Eligibility for Government SubsidyFamily of 4Income LevelPercent ofPoverty LevelIndividual Can GetCoverage In:GovernmentSubsidiesAbove $88,200 Above 400% Federal or State HealthIns ExchangeNo$88,200 400% Federal or State HealthIns ExchangeYes$29,327$22,050$0133%100%0%Medicaid Yes© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 60. Obamacare 411• 2014: $95 per Adult, $47.50 per Child up to $285 per familyor 1% of income.© 2013 Michael Chapman, GroupBenefitsAdvisors.comWhat’s The Penalty If Uninsured?• 2015: $325 per Adult, $162.50 per Child up to $975 perfamily or 2% of income.• 2016: $695 per Adult, $347.50 per Child up to $2085 perfamily or 2.5% of income.
  • 61. Obamacare 411If your Adjusted Gross Incomeends up exceeding yourestimate, the IRS willassess and take backyour subsidy.© 2013 Michael Chapman, GroupBenefitsAdvisors.comThe IRS Giveth andTaketh Away:Examples:• Job Seekers• Y.E. Bonus• Unexpected Income
  • 62. Obamacare 411If you qualify for Medicaid and yourAdjusted Gross Income ends upexceeding your estimate, the IRSwill assess and take backyour subsidy and couldattach assets.© 2013 Michael Chapman, GroupBenefitsAdvisors.comThe IRS Giveth andTaketh Away:Examples:• Job Seekers• Y.E. Bonus• Unexpected Income
  • 63. Obamacare 411Business Pay or Play Calculator© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 64. Obamacare 411For Companies, Business Owners,Presidents, CFO’s, HR Directors:• Whole new level of fiduciary responsibility.• Increased complexity with majorP&L, Tax, HR, and hiring consequences.© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 65. Obamacare 411For individuals or organizations with multipleownership, you can’t escape the 50+ FTE Rule• PEOs• Staffing Firms• Private Equity Groups• Multiple Franchise Owners© 2013 Michael Chapman, GroupBenefitsAdvisors.comIRS To Look back to 6/1/13 for FTEs
  • 66. Obamacare 411Certain Industry Sectors Will Get Hammered:• Staffing• Seasonal• Hospitality• Retail© 2013 Michael Chapman, GroupBenefitsAdvisors.comIRS To Look back to 6/1/13 for FTEs
  • 67. © 2013 Michael Chapman, GroupBenefitsAdvisors.comObamacare 411Remember:Use Your New Knowledgeof Obamacare as aCompetitive Advantage.
  • 68. Obamacare 411If You KnowThisMuch, You’reNowAn Expert!• As of Today, Very Few Businesses, Upper Management andEmployees Know This Much About Obamacare.• Even Fewer have made decisions on what they should do.© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 69. Obamacare 411• To Learn More:• http://Obamacare411.co• Facebook:• YouTube Channel: ObamacareInformation• Twitter:© 2013 Michael Chapman, GroupBenefitsAdvisors.com• Subscribe and Sign Up for Updates,upcoming presentations and webinars:
  • 70. Obamacare 411Please Comment/ForwardShare/Like:• http://Obamacare411.co• Facebook:• YouTube Channel: ObamacareInformation• Twitter:• LinkedIn.com/in/michaelchapman© 2013 Michael Chapman, GroupBenefitsAdvisors.com• Subscribe, Sign Up for Updates, UpcomingPresentation Schedule and Webinars!
  • 71. Obamacare 411How You Can Help Me• Who Do You Know ThatNeeds Executive Leadership?• What Leadership GroupsCould Use a Subject MatterExpert Speaker?© 2013 Michael Chapman, GroupBenefitsAdvisors.comHow You Can HelpYourself and DFW• Share This InformationASAP• ACT on This InformationASAP
  • 72. Obamacare 411© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 73. Countdown to Action 2013Obamacare 411What?When?Healthcare Costs© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 74. Obamacare 411© 2013 Michael Chapman, GroupBenefitsAdvisors.com
  • 75. Obamacare 411© 2013 Michael Chapman, GroupBenefitsAdvisors.com