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“Making Hay in the ACA”. “what is in it for me?” Call 1-866-309-0557 Access Code *1291180*. During a live webinar. For the courtesy of all participants, please: Place your phone on mute Either press *6* Or press the mute button on your phone device
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“Making Hay in the ACA” “what is in it for me?” Call 1-866-309-0557 Access Code *1291180*
During a live webinar For the courtesy of all participants, please: • Place your phone on mute • Either press *6* • Or press the mute button on your phone device • To unmute, press *6* or the unmute button on your phone device • Do not place you phone on hold at anytime • Either remain on mute or hang up if you need a break
Agenda • Important resources to help you and your prospects • Health Insurance Marketplace Certification • BCBSTX Certification • 2014 BCBSTX ACA plans & agent commissions • Using tax subsidies to prospect and grow your clientele
Agenda Continued • SHOP Exchange Update • Small Group Health Insurance Tax Credits (HITCs) • Using HITCs to get more small group health insurance • Early renewal strategies • Marketing tips
Disclaimer • This presentation is tailored for independent health insurance agents in the state of Texas that intend to write BCBSTX in the HIMs. 09-27-13
Valuable ACA Resources All located in our Health Care Reform section at www.TheBrokerageInc.com
Scroll down to “Health Care Reform”, where ACA related resources may be found.
Hola? • 9-26-13: The Spanish version of www.healthcare.gov will not be able to accept new HIM enrollments “for a few weeks” • 10-25-13: Spanish online enrollment is not going to happen…this year • An estimated 10 million Latinos are eligible for coverage, and 4 million of them speak Spanish primarily. • The state of Texas is 40%+ Latino
Registration Process for Agents / Brokers • Note: the agent distribution channel did not create the problems…but we must deal with them. • Know that we would like to help you register, but we cannot do anything to fix the volume or technology challenges. • If you need assistance, call 855-267-1515. • The certification process is beginning to work now.
Getting set up to market on the HIMs Four step process: • Register at the CMS Enterprise Portal (Part 1) • Complete your certification at The Health Insurance Marketplace website • Register to accept applications in the HIMs (Part 2) • Complete the BCBSTX required certification
https://www.regtap.info/uploads/library/AB_slides_092713_5CR_092613.pdfhttps://www.regtap.info/uploads/library/AB_slides_092713_5CR_092613.pdf
Certify https://marketplace.medicarelearningnetworklms.com
Step 3 - Setting Up Your FFM Account • You create your FFM UID (Federally Funded Marketplace User ID) when you create your account on the CMS Enterprise Portal during the agent/broker registration process. • If you forget your FFM User ID or password information, click on the "Forgot my User ID/Password" link on the CMS Enterprise Portal log-in web page at https://portal.cms.gov/.
www.bcbstx.com/producer Step 4: Get certified with The Blues
The message is simple: Right now, nothing is required by Federal law for you to own. On January 1, 2014, that changes. You will then be required by law to own a qualified health insurance. If you cannot afford a QHP, you will be subsidized. If you choose not to own a QHP, you will be penalized. If you need help, I will help you.
Marketing tips • Know how to calculate subsidies • Know how to complete a HIM application • Hint: no health questions, more qualification questions • Find the Health Insurance Marketplace applications for a QHP at www.TheBrokerageinc.com in the HCR Resources section • Know how to calculate Health Insurance Tax Credits for groups of 2-25 Use HITCs to prospect small groups of 2-25 lives
Who are the 50M uninsured? And how do I get quotes and sign them up?
Individuals Eligible for a Premium Tax Credit, by Employment Status
Subsidies are based on the 70% Actuarial Value Plan or “The Silver Plan” • 70% AV Plan Premium $11,450 • Minus the subsidies - $ 8,085 • Net premium cost to family = $ 3,365 per year Total Family Premium is $280 per month
60% AV Plan or “The Bronze Plan” • 60% AV plan premium $9,490 • Minus the subsidies - $8,085 • Net premium cost to family = $1,405 per year Total Premium is $117 per month
ACA “MOOP” (Max Out of Pocket) • $6,350 for an individual • $12,700 for a family • Same as the MOOP of an HDHP (high deductible health plan) • Bronze or Silver plans have the same max out of pocket • If you only make $50K per year, how can you pay this MOOP? • Add a supplemental health plan
Sales Idea: “The Combo Plan” “Bronze Plan” and “Active Care” • Bronze Premium $117 • Active Care Premium $153 • Total Family Premium $270 per month $10 less per month than The Silver Plan at $280 per month, but the supplemental health plan helps offset the $12,700 MOOP.
What is Active Care? • New supplemental health product • combines Critical Illness, Cancer, Heart Attack, Stroke, ESRD, and Accident benefits into one product • Simplified underwriting • May be list billed • Agent commission is 50% • Contact Belynda@TheBrokerageInc.com for complete details • Visit http://thebrokerageinc.com/insurance-products/critical-illness/
Let’s review these numbers again… 6% commission is paid by BCBSTX for years 1-3, and 4% level after that.
Which plan is best suited for the family? • The Silver Plan costs $280 per month • The Bronze Plan / Active Care plan costs $270 per month • The Combo Plan saves the family $10 per month in total premium • The Combo Plan offers better protection to the family • The Combo Plan pays the agent 54% more commission!
<250% Federal Poverty Level =CSR or Cost Sharing Reductions • Similar to the Medicare Savings Plan (Low Income Subsidy), a person at or below the 250% FPL is eligible for cost sharing on the Silver Plan • Think of how the “low income subsidies” work within the “Medicare Savings Program” • How might this impact your recommendations? • Should they even consider a supplemental plan(s)? • Or should they consider less of a supplemental benefit plan(s)?
2014 BCBSTX HIM Plans • Rx Benefits • The Gold Plan On Exchange & The Gold Plan Off Exchange • The Silver Plan On Exchange & The Silver Plan Off Exchange • The Bronze Plan On Exchange & The Bronze Plan Off Exchange
2014 BCBSTX Individual Plans Rx Benefits Structure • Benefit Structures • Drug Card • Coinsurance after Medical Deductible • Formulary • Standard Formulary on PPO Network • Generics Plus formulary on narrow networks • Generics Plus is essentially a leaner version of the standard formulary and includes non-specialty and specialty drugs for all major therapeutic categories • 5-Tier Drug (2-tier Generics) • Drives utilization towards Generic drugs