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It’s Here: The Federal Health Insurance Marketplace in Wisconsin

P resents. It’s Here: The Federal Health Insurance Marketplace in Wisconsin. Public Forum & Professional Conference November 7 - 8, 2013 UW-Fox Valley, Menasha, WI. P resents. It’s Here: The Federal Health Insurance Marketplace in Wisconsin. Public Forum & Professional Conference

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It’s Here: The Federal Health Insurance Marketplace in Wisconsin

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  1. Presents It’s Here: The Federal HealthInsurance Marketplacein Wisconsin Public Forum & Professional Conference November 7 - 8, 2013 UW-Fox Valley, Menasha, WI

  2. Presents It’s Here: The Federal HealthInsurance Marketplacein Wisconsin Public Forum & Professional Conference November 7 - 8, 2013 UW-Fox Valley, Menasha, WI

  3. How theAffordable Care Actaffects your small business

  4. Presentation Overview • Current health care system • ACA changes already in effect • Changes coming with the new marketplace • Making your choice • Employee notification deadline: Oct 1

  5. Current health care system • Premiums have doubled over the past nine years • Small businesses pay 18% more than big businesses • Insurance costs more for women and older workers • Pre-existing conditions = denied coverage or very expensive coverage • Difficult for start-ups and entrepreneurs to get health insurance

  6. ACA changes in effect • Young adults can stay on their parents’ plans until they’re 26 • Children with pre-existing conditions cannot be denied coverage Coming Jan. 1, 2014: + No penalties for women and older workers + Adults can’t be denied coverage for pre-existing conditions + And more…

  7. Cautiously optimistic… • More freedom / security for entrepreneurs • Helps level the playing field for employee recruitment and retention • More options for employers

  8. More options for employers • You don’t have to offer coverage. No penalty if you have fewer than 50 employees. • If you currently offer health insurance, you can keep current insurance or buy coverage in the new SHOP marketplace. • SHOP marketplace is a new option, not a requirement

  9. What is SHOP? • SHOP = Small Business Health Options Program • Online marketplace • Standard coverage at various levels:Platinum – Gold – Silver – Bronze • Allows you to “compare apples to apples”

  10. SHOP Eligibility • Open to employers with fewer than 50 FTEs(full-time-equivalent employees) • Form to determine your FTEs is at WisconsinBusinessAlliance.com/ACA • If you're self-employed with no employees, you can get coverage through the individual Health Insurance Marketplace, but not through SHOP.

  11. SHOP Features • Compare health plans online • You control the coverage you offer • You decide how much to pay toward employee premiums • All plans cover preventive care, prescription drugs, hospitalization, and more • You may qualify for a tax creditworth up to 50% of your premium costs

  12. Tax credits • For-profit businesses • < 25 FTEs (and only for employees) • Pay at least 50% of employees’ premiums • Employees’ annual wages can average no more than $50,000 • Beginning 2014, tax credit is available only for plans purchased through SHOP.

  13. Calculating & claiming your tax credit • Use IRS Form 8941, Credit for Small Employer Health Insurance Premiums • Include the amount as part of the general business credit on your income tax return • Calculator (try different scenarios) WisconsinBusinessAlliance.com/ACA

  14. Deductions Eligible small businesses can claim a business expense deduction for premiums paid in excess of the credit. That’s both a credit and a deduction for employee premium payments.

  15. Enrollment You can enroll either… • Through your broker, or • Directly through the SHOP exchange at healthcare.gov

  16. Payments You can: • Collect employee share of premiums through payroll deduction • Pay SHOP premiums with pre-tax dollars • Get one monthly bill, make one monthly payment to SHOP

  17. Making your choice No magic formula. It’s up to you: • Don’t offer health insurance • Keep offering current coverage • Offer coverage through SHOP

  18. Making your choice • You determine your employees’ deductibles, co-pays, etc. • In general…Lower premiums  Higher out-of-pocketHigher premiums  Lower out-of-pocket • Platinum plans generally have the highest monthly premiums and lowest out-of-pocket costs. • The plan with the lowest premium may not provide you or your employees with the best overall value.

  19. Employee notification You must notify employees of the new Marketplaces (Deadline was October 1) How to notify? Model forms available fromthe U.S. Dept. of Labor or WisconsinBusinessAlliance.com/ACA

  20. Questions? Have questions about the SHOP Marketplace for businesses with 50 or fewer employees? Call 1-800-706-7893 Monday through Friday, 8-4 central time Or visit healthcare.gov/small-business

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