The document provides information about how the Affordable Care Act affects individuals and employers, including details on health insurance plan options both on and off the exchanges. It recommends that those who can afford major medical plans renew existing individual policies through 2014, while those who cannot should consider lower-cost supplemental plans and alternatives to traditional insurance to avoid penalties under the ACA. Employers with 50 or more employees must provide qualifying health insurance to full-time workers or pay a penalty.

1. The Affordable Care Act
You need to know….
Dr. Ann Hawkins
WellCare Dimensions Inc.
24hour MD Now
214.886.1113
www.24hourmdnow.com

2. What To
Do Now
Effect of
ACA
All About
Health

3. • If you have less than 50 employees
the ACA does not affect you!
• But you need coverage
• Offering programs to your employees
could help recruit and retain
employees

4. If you have a plan now
• Stay on the insurance plan through 2015
• If you have been dropped from your previous
plan
 Call your agent and get their advice
• If you have a high deductible, look into
alternative coverage and gap plans

5. If you
• Offer insurance to your employees and
dependents you can not pay toward dependents
coverage
 By releasing dependents they qualify for
subsidies
 Coverage - available through state exchanges
or private companies like Blue Cross Blue
Shield, Humana
• Contact insurance company or carrier about
your changes

6. Trend
• ACA “provides strong incentives for employers—
with the agreement of their employees—to drop
Employer Sponsored health insurance for as
many as 35 million Americans.”
•
Douglas Holtz-Eakin, president of the American Action Forum
• Many companies, with the concurrence of
the employees, will drop insurance

7. Trend
• Many full time employees will be dropped to
part time and not be covered
 Get a 2nd job
 Start their own business
• Buy less expensive limited medical programs
with other health benefits, pay the penalty

8. Healthy and younger people are
economically incented to
pay penalty vs. paying for “qualified”
health insurance




Supplemental insurance
Accident Medical
Telemedicine
Catastrophic

9. At this point in 2015
• Employers – if you pay toward employees
insurance
 Employee after tax impact
 Whatever the $ amount an employer pays
toward an employees insurance counts as
part of the employees taxable income
 Salary of $40,000 plus $500/month paid by
employer for insurance = total taxable
income of $46,000

10. Self Employed
Metal Exchange Plans
Cost
Tax Penalty

11. Metal Plans
• Bronze
• Silver
• Gold
• Platinum
• Private
 Blues
 Humana
• Public plan available through the exchanges

12. Plans coverage and cost
 Vary dependent if you go through a private or
public exchange
 Need to talk to an agent

14. Metal Plans
• Max out-of-pocket $6,350 individual/$12,700
family
 Excluding monthly premium
 % of coverage – 60-90%
 Deductible: Bronze $5,000/Silver $2,000
 Most plans are HMO’s – restrictive
• IRS cost estimate of the Bronze plan – family
of 4 – $20,000

15. The Tax Penalty
No “qualified” health insurance whichever is
higher:
• 2015
 $95 per person up to three people ($285) or
 1% of taxable income ($100K = $1,000)
• 2016
 $325 per person up to three people ($975) or
 2% of taxable income ($100K = $2,000)
• 2017
 $695 per person up to three people ($2,085) or
 2.5% of taxable income ($100K = $2,500)

16. Those who opt out
• Look into group supplemental/gap insurance
• You and most of your employees are:
 Young
 Fit
 Healthy
• Health concerns are related to accidents and
doctor visits

17. Affordable, Alternative
Coverage
• Accident
• Disability
• Short Term Medical
• Vision
• Dental
• Telehealth - Doctor Visits by phone
• Prescription Savings
• Lab and Imaging Savings
• Diabetic supplies Savings

18. Great News
• U.S. healthcare system will revolve around
wellness and prevention
• Medical model, of treating illness, financially
unsustainable
•
New England Journal of Medicine
• Healthcare services will transition from treating
illnesses/injuries to maintaining good health as
far into old age as possible
•
Dr. Daniel Alexander

19. It’s All About Health
• True economic need to stay healthy
 Focus marketing on the non elderly who want to stay
healthy in lieu of buying health insurance
• Pay IRS penalty not get major medical
 Supplemental Accident/Medical
 Catastrophic
 Telehealth/Telemedicine
• Focus on staying healthy




Provide educational classes
Build the aspect of community in the club
Partner with small businesses
Make exercise – play, add fun, innovative ideas

20. Suggestions
• If you have an individual plan – renew, keep it
until the end of 2014
• If you have been cancelled from your individual
plan and have a pre-existing condition
 Take a look at one of the exchange plans
• If you need insurance and are healthy
 Research individual plans from a Major Medical
provider before year end and keep that policy
through 2014

21. Suggestions
• If you can not afford a Major Medical Plan look
at alternatives
 Accident
 Short term Major Medical – no pre-existing
conditions
 Telehealth for doctor visits
• Look at Metal Plans with subsidy

22. For more information:
Dr Ann Hawkins
drann@24hourmdnow.com
www.24hourmdnow.com
214.886.1113
For direct questions
Guy Gilson
303 579 8783