Obamacare 411 for employees

Countdown to Action 2013
Obamacare 411
What?
When?
Healthcare Costs
© 2013 Michael Chapman, GroupBenefitsAdvisors.com

Obamacare 411

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 Job
or Job Search
What?
When?
Obamacare 411

Obamacare 411
My 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 in
DFW 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

Obamacare 411
My 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 simple
to follow information that people and companies can use to make
healthcare decisions and to move on.
• 214-764-6315 tel, 214-732-3691 cell

Obamacare 411
Here’s How You Can Help Me
• 214-764-6315 tel, 214-732-3691 cell
I Am Committed to Serve

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 NOW
What?
Obamacare 411
What?
When?
…Do You Know A Business Group Above That Needs a Speaker?

Obamacare 411
About 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 “Most
Admired Company” in US by Forbes Magazine. Average US Home owns 4.5 products that I
developed and brought to market.
• Since 2003, small business owner in employee benefits field.
• Linkedin.com/in/michaelchapman
• 214-764-6315 tel., 214-732-3691 cell

Obamacare 411
About Me:
• I’m Available, who do you know?
• Business Owner or Ownership, in need of a new
leader.
• International company, needs a US managing
director or president.
• Linkedin.com/in/michaelchapman
• 214-764-6315 tel., 214-732-3691 cell

Obamacare 411
Opinions 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 you
need to know! © 2013 Michael Chapman, GroupBenefitsAdvisors.com

Obamacare 411
Why Obamacare?
• Runaway Healthcare Inflation
• Major Segment of Americans
priced out of Health Insurance.
• THE WHY DOESN’T
MATTER, THE MAJORITY HAS
VOTED! © 2013 Michael Chapman, GroupBenefitsAdvisors.com
What?
When
?

Obamacare 411
Secy. 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)

Obamacare 411
Disclaimers:“Health and Human Services (HHS)
Secretary Kathleen Sebelius said Monday
April 8, 2013 that she did not anticipate
how complicated implementing the
president’s signature healthcare law
would be.”
• Due to the constant changes in the interpretation and application of Obamacare, this
presentation is guaranteed NOT to be 100% accurate. Information covered in this
presentation is guaranteed to change. You must do your own due diligence.
• This presentation should not be construed as offering legal, insurance, or tax
advice, nor is it providing ACA Exchange Navigator advice. This presentation is for
Texas only. © 2013 Michael Chapman, GroupBenefitsAdvisors.com

Obamacare 411
WHAT: PPACA, ACA, or Obamacare
• Social Legislation
• Redistribution of Wealth and Income
• Redistribution of HealthCare
• Regulation of Healthcare Providers and
Industry
• Funds Technology to Reduce Waste and
Programs for Public Health.
What?
When
?

Obamacare 411
Emancipation of HealthCare:
• From Who Can Write a Check For It…
• …To a Basic Right of Citizenship.

Obamacare 411
Market-Based vs. Regulated
• From Free Market Pricing &
Availability.
• To Government Control of Pricing &
Availability Healthcare

Obamacare 411
Take a Deep Breath…
• Impact on You and Your Family
It’s Time to Adapt to the
New Order!
• Impact On Your Budget
• Impact On Your Job and Your Employer© 2013 Michael Chapman, GroupBenefitsAdvisors.com

Obamacare 411
When Must I Make A Decision?
• Exchanges Open October 1, 2013
• Obamacare Plans Begin January 1.
• Best Time To Make A Decision is NOW!
What?
When
?

The Obamacare Clock
Is Ticking..
…The Sooner You Know
WHAT to Do
Obamacare 411
…The Longer You’ll Have
to Adjust!

Constipated
Decision-making
=
Obamacare 411
More Taxes,
Penalties,
More Expenses,
Anxiety, Etc.

Change =
Opportunities
Obamacare 411
Use Knowledge of
Obamacare as a
Competitive Advantage.

Obamacare 411
Nobody is An
Expert…
Be the Expert!
“Health and Human Services (HHS)
Secretary Kathleen Sebelius said
Monday April 8, 2013 that she did not
anticipate how complicated
implementing the president’s
signature healthcare law would be.”

Obamacare 411
Brief Overview of What it Is
• Coverage Differences
• How You Buy It
• What It Costs You
• Consequences to You and Employer
What?
When
?

Obamacare 411
Your Health Plan will be Different
2013 2014

Obamacare 411
98% of Today’s
Health Plans Will
Be Replaced
Just Kidding!

Obamacare 411
Some of the Big Plan Differences:
• 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

Obamacare 411
More Big Plan Differences:
• 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.

Obamacare 411
Buzz Word: Essential Benefits
• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder
services, including behavioral health treatment
• Prescription drugs

Obamacare 411
Essential Benefits, continued:
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services; chronic disease management
• Pediatric services, including oral and vision care

Obamacare 411
Essential Benefits, continued:
• 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)

Obamacare 411
Your Premiums Will Be Different:
2013:
$$$
2014:
???

Obamacare 411
• 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:

Obamacare 411
You May Pay Less in Premiums If in 2013:
• 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.

Obamacare 411
Anybody Want to
Guess the Biggest
Factor Whether
You’ll Pay More or
Less?

Obamacare 411
How Much You Make
How Much You Own

Obamacare 411
Your Choices:
Pay
Play
Delay

Obamacare 411
Your Choices:
Pay:
Play
Delay
A Penalty for No Insurance
Purchase
Private, Group, Medicare, Excha
nge Insurance
Renew / Change Plan in Nov ‘13

Obamacare 411
Whatever You Choose, You’ll Pay More:
Taxes
Goods & Services
New Federal Tax on Insurer Premiums, 3.8%
Tax on Unearned Income.

Obamacare 411
Your Employer Will Pay More:
+ 2% Payroll Taxes
Compliance
Insurance Premiums

Obamacare 411
Impact On Seniors:
• Reduction In Medicare Budget
• Likely To Pay More Based on
Assets and Income
• Review Boards / Ration Care
• Chronic Illness Management

Where You’ll Buy:
Employer
Exchange
• 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

Obamacare 411
Where:
Medicare.Gov

Obamacare 411
Where:
Healthcare.Gov

Obamacare 411
Where:
Marketplace.CMS.Gov

Obamacare 411
Where:
YouTube.CMS.Gov

Obamacare 411
TX Employer Impact

Obamacare 411
WHO: All Businesses, 50 Full Time
Employees*
30 Hr. Part-Time Employees
*(Unless Received a Waiver)
Seasonal Employees

Obamacare 411
Fact: 78% of US Businesses are Family
Owned, 2-99 Employees
• 2005: 47% offered health insurance
• 2012: 40% offered health Insurance
• (Fewer offer in Texas)
• Recession: cut-backs, closings
• Premium Inflation
Why?

Obamacare 411
Employer Penalties:
1) If ACA-Mandated Employer doesn’t offer a MEC plan covering 95%
of FTEs, they will be assessed a $2,000 TAX Penalty per
employee for every FTE over 30 employees.
Example:
• Employer with 100 FTEs (full time equivalent employees) pays
penalty of $2,000 per employee in taxes for 70 FTEs, or $140,000
more in taxes.

Obamacare 411
Employer Penalties:
2) If ACA-Mandated Employer offers a MEC plan covering 95% of
FTEs, but if the employee cost share is greater than 9.5% of lowest
wage 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 paid
minimum wage.
• Janitor’s premium share of MEC is 10% of his or her wages.
• Employer will be assessed a Tax Penalty of $140,000.

Obamacare 411
Employer Penalties:
3) If ACA-Mandated Employer offers a MEC plan covering 95% of
FTEs, they will be $3,000 TAX Penalty per employee for Every
FTE who applies for Insurance through a State or Federal Exchange
and receives a subsidy.
Example:
• Employer with 100 FTEs (full time equivalent employees) will pay a
penalty of $6,000 if two employees apply for insurance through a
State or Federal Exchange.
• (Suggestion: Don’t be “That Guy.”)

Obamacare 411
1. How Do Find Out if I Qualify for a
Subsidy for Obamacare?
2. Am I Sure I Really Want a Subsidy?
3. What’s The Penalty If Uninsured?

Obamacare 411
Tax Credit or Subsidy
Congressional Budget Office Estimated that 127M People
Potentially Qualify for Subsidies.
• CBO Estimated that Only 18 Million Will Participate.
• The Subsidy Application Is estimated to be 62 pages!

Obamacare 411
Tax Credit or Subsidy
• Subsidies Only Available through Federal/State Exchanges.
• An Employee Is NOT Eligible for a Subsidy If:
• 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)

Obamacare 411
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

Obamacare 411
• 2014: $95 per Adult, $47.50 per Child up to $285 per family
or 1% of income.
What’s The 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.

Obamacare 411
If your Adjusted Gross Income
ends up exceeding your
estimate, the IRS will
assess and take back
your subsidy.
The IRS Giveth and
Taketh Away:
Examples:
• Job Seekers
• Y.E. Bonus
• Unexpected Income

Obamacare 411
If you qualify for Medicaid and your
Adjusted Gross Income ends up
exceeding your estimate, the IRS
will assess and take back
your subsidy and could
attach assets.
The IRS Giveth and
Taketh Away:
Examples:
• Job Seekers
• Y.E. Bonus
• Unexpected Income

Obamacare 411
Business Pay or Play Calculator

Obamacare 411
For Companies, Business Owners,
Presidents, CFO’s, HR Directors:
• Whole new level of fiduciary responsibility.
• Increased complexity with major
P&L, Tax, HR, and hiring consequences.

Obamacare 411
For individuals or organizations with multiple
ownership, you can’t escape the 50+ FTE Rule
• PEOs
• Staffing Firms
• Private Equity Groups
• Multiple Franchise Owners
IRS To Look back to 6/1/13 for FTEs

Obamacare 411
Certain Industry Sectors Will Get Hammered:
• Staffing
• Seasonal
• Hospitality
• Retail
IRS To Look back to 6/1/13 for FTEs

Obamacare 411
Remember:
Use Your New Knowledge
of Obamacare as a
Competitive Advantage.

Obamacare 411
If You Know
This
Much, You’re
Now
An Expert!
• As of Today, Very Few Businesses, Upper Management and
Employees Know This Much About Obamacare.
• Even Fewer have made decisions on what they should do.

Obamacare 411
• To Learn More:
• http://Obamacare411.co
• Facebook:
• YouTube Channel: ObamacareInformation
• Twitter:
• Subscribe and Sign Up for Updates,
upcoming presentations and webinars:

Obamacare 411
Please Comment/Forward
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Presentation Schedule and Webinars!

Obamacare 411
How You Can Help Me
• Who Do You Know That
Needs Executive Leadership?
• What Leadership Groups
Could Use a Subject Matter
Expert Speaker?
How You Can Help
Yourself and DFW
• Share This Information
ASAP
• ACT on This Information
ASAP

Obamacare 411 for employees

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