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The ACA Homestretch. This presentation has been designed to assist your ACA marketing efforts, increase your sales, and simplify your administration. February 21, 2014. Homestretch format:. We encourage questions.
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The ACA Homestretch This presentation has been designed to assist your ACA marketing efforts, increase your sales, and simplify your administration. February 21, 2014
Homestretch format: • We encourage questions. • To ask, type your question in the GoToMeeting “Questions” area located in the toolbar on your right side of the screen • The Moderator will answer the questions verbally at the end of the presentation • As a follow up to this webinar, you will receive a copy of the Q&A session • This webinar is being recorded and will be posted at www.TheBrokerageInc.com approximately one hour after completion
A few of the many things we will touch on: • Subsidies • HealthCare.gov • Confusing income tax issues • Household income - what does this mean? • 9.5% Affordability Test • MEC - Minimum Essential Coverage - what is this? • EHB - Essential Health Benefits - how is this different than MEC? • QHP - Qualified Health Plan = EHB • SHOP Exchange • Pay or Play in 2015 • Penalties for not owning a QHP and for Employers (50FTEs+) not offering MEC
Questions from the week of 2-17-14 • Small employer, less than 10 employees. None make over $35000. Am looking at a plan that with employer paying 50% of employee premium puts employee only coverage under the 9.5% max but not if they have dependents. Adding dependent coverage puts them over the 9.5% max. Question: does the 9.5% affordability max apply to only the employee’s premium or the entire family premium the employee pays?
Questions from the week of 2-17-14 What happens to insureds that are also receiving a cost sharing allowance if their income exceeds the amount they estimated, and it puts them back to a higher deductible and out of pocket limit? Does the IRS collect the additional deductible amount if they bought a $0 or $500 deductible plan with the cost-sharing, and it is a silver plan that normally would have a $3,000 or $6,000 deductible and they became ill and used it?
Questions from the week of 2-17-14 Do you have a chart showing the income for Texas allowed for the various family size? (See next slide) “Also please explain why some people don't get a subsidy even when they are below the income thresholds. I have worked with some, for instance, my daughter. She makes $32,000, family size 1, 76712 zip code, but she receives no tax credit because of where we live…” The chart says someone up to $45,960 with family of 1 should be eligible so there must be other factors?? Does her age factor in, she is 28.
Questions from the week of 2-17-14 I understand most of healthcare reform. I have an owner of multiple stores—Client owns 40 stores with different corporations. He is at least a 2% owner in each of the stores. There is an average of 6 employees per stores. In the past, he could write individual groups on each. Question—Under healthcare reform, owner now has to count all stores together. Am I correct?
Questions from the week of 2-17-14 If an employee has the ability to get insurance through an employer (less than 10 employees) but they opt out and go to the exchange, is an employer of this size fined? If an employee in a group of this size has premiums in excess of 9.5% of wages, what happens? Is the employer fined? If there is only one employee in the group that exceeds the 9.5% threshold, can the employer just pay more for that one employee and not for all?
ACA Observations: • Keep in mind, implementing the ACA will continue for several more years • The law has gradually been implemented since March 2010 • The most significant deadlines are between January-April 1, 2014 • The ACA will not be repealed under Obama’s administration • Lawmakers have filed bipartisan bills in December 2013 that, among other things may: • eliminate the penalty for not having a QHP in 2014 • extend the open-enrollment period beyond March 31, 2014 • provide some relief to consumers who have experienced policy cancellations in the past three years
12/20/13 - individual mandate no longer applies to people whose plans were canceled Health insurance plans that were canceled in 2013 will "temporarily" be exempted from the law's individual mandate (HHS Secretary Kathleen Sebelius just delayed the individual mandate for people whose plans have been canceled. ) The individual mandate includes a "hardship exemption." People who qualify can either ignore the individual mandate altogether or purchase a cheap, bare-bones catastrophic insurance plan that's typically only available to people under 30
Texas Health Risk Pool • Terminates at the end of March 2013 • Encouraging the policyholders to try to move to the HIMs ASAP • Sending mailers urging them to use an agent • Pool premium rates are increasing during this extension period • At current rates many Pool enrollees will do better with a new QHP in the exchanges • Subsidies may offset the premium • Any deductibles and other out-of-pockets incurred in 4Q 2013 during the Pool extension period won’t credit to their new plan’s 2014 out-of-pocket cap
Important Dates! • Jan 16 – Feb 15: March 1 Effective dates • Feb 16 – Mar 15: April 1 Effective dates • Mar 16 – Mar 31: May 1 Effective dates • OEP 2015 is Nov 15, 2014 – Jan 15, 2015
Qualifying Events • Similar to a Special Election Period in Medicare • Examples of a QE: • Loss of coverage • Loss of group coverage • Moving • Qualifying for subsidies • Losing subsidies • Gained a dependent due to marriage, birth or adoption
Get a Join.me account to conduct your online Express Link business
Here is a tip or two… • Know how to calculate subsidies • Know how to complete a HIM subsidy application • No health questions • Instead, Personal Identifiable Information (PII) questions • Know how to calculate Health Insurance Tax Credits for groups of 2-25 • Use HITCs to prospect small groups of 2-25 lives
According to a recent analysis by Kaiser Family Foundation (KFF): • An estimated 17 million Americans who are now uninsured or who buy insurance on their own will be eligible for premium tax subsidies in 2014. • Additionally, 29 million people nationally may look to the Marketplaces to purchase health insurance coverage.
The honey hole… • There are about 6.2M uninsured Texans • About 2.2M are <138% FPL • Let the Navigators enroll this population! • That leaves 4,000,000 uninsured Texans • Assume 1 out of 4 enroll • There are about 13,000 BCBSTX appointed agents • Maybe half of them are active – assume 6,500 write a case • 1,000,000 divided by 6,500 is 154 apps per agent • At $500 per app, that could be around $77,000 for the next three years for each broker!
Instant results Family of 4, $60,000 expected income in 2014, Subsidies cover 41% of annual premium
How would you handle this situation? • Salon Manicurist that makes $7.25 per hour, plus tips • Gets paid $217.50 per week (7.25 = x 30 hours) • Gets paid for 52 weeks ($11,310 per year) • Only claims $11,310 • Does not report cash tips • $11,400 is the magic number for one person • $94,200 is the magic number for a family of four • Is this person eligible for Medicaid?
Answer – no Medicaid. Why? • Because Texas did not expand our Medicaid via the ACA, the Manicurist is not eligible for Medicaid • So what can you do to help? • Send her to a local clinic to free provide care • Encourage the person to report more income (cash tips that were not reported) and get the income to at least $11,400
Kaiser Family Foundation Subsidy Calculator $11,310 in 2014 estimated income is not going to generate any subsidies.
Raise the estimated income to above $11,400 Adding an additional $190 of 2014 estimated income now generates a premium subsidy of $2,557 resulting in a $19.17 monthly premium ($230 annually)
Divorced Single Female with one child $35,000 income in 2014, 226% FPL gets 46% of their premiums subsidized
Raise the income to $45,000 Only 12% of the premium is subsidized
Couple, considering retiring, ages 63 and 60 forecasting $40K in 2014 MAGI 258% FPL, 77% of their premiums would be subsidized -$11,053 subsidy
Raise the income to $50,000 Subsidy drops to $9,614, or $1,439 less or $120 more per month to pay in premium.
Raise the income to $55,000… Subsidy went from $9,614 to $9,139, or $475 less
What about this? • Husband, wife and one dependent child • Husband does not pay taxes • Mom files her return and claims a child as a dependent How do you calculate household income, with or without the husbands income?
Tax sniglets • Mom and Dad live in one house. • Dependent child, age 23, now on her own, but has no income to show yet. She works part time, and files her own income tax. • Is she part of the household income calculations? Remember this: the subsidies are based on estimated 2014 income.
<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 the CSRs influence your recommendations? • Would a supplemental plan still make sense? • A reduced supplemental benefit plan may be a better fit for a budget
Regarding the 9.5% affordability test, does this include the dependents and the employee’s cost? • Employer coverage is considered affordable* if employee’s share of the annual premium for self-only coverage is no greater than 9.5% of annual household income * as it relates to the Advanced Premium Tax Credit (APTC) • Starting in 2014, individuals and their dependents offered employer-sponsored coverage that’s affordable and provides minimum value won’t be eligible for a premium tax credit • How will this impact the dependents?
Don’t forget the dependents! • If the employee is offered affordable coverage, the dependents lose their subsidies • Unintended consequence! • Solutions could include: • Give the employees a raise and let them buy health insurance via the exchanges • Drop the group health plan and establish a defined contribution strategy • Requesting an employee only quote, and make the dependents not eligible for coverage
To market plans with subsidies in the HIMs Four step process: • Register at the CMS Enterprise Portal (Part 1) • Complete your certification at the HIM website • Register to enroll people in the HIMs (Part 2) • Complete the BCBSTX required certification
BCBSTX Broker Commissions: Commissions • 6% - Years 1-3 • 4% - Years 4+ • Based on full premium, not subsidized premiums • $25 per app bonus for 1-1-14 effective dates • Snapshot Bonus
Make sure you get paid! • Use the BCBSTX Producer of Record Transfer Form • Send this form with your applications to The Brokerage • Suggestion: take “screen shots” of your agent info from within your Express Link • Be ready to audit your first commission statement!
How do I make sure I get credit for my BCBSTX sales? • Option 1 • Use your Express Link and apply for the subsides via leaving your Express Link, being redirected to the HealthCare.gov website, applying for the subsidies, and being redirected to your Express Link. • WARNING! In February, you will need to scrub your first commission statement very closely to identify any missing commissions, and prepare to prove you are the AOR from your paper apps and screen shots.
How do I make sure I get credit for my BCBSTX sales? • Option 2 – BCBSTX Express Link • Take the app “off-exchange”, forget the subsidies, and submit the app. When it is time settle up with Uncle Sam by April 15, 2015, apply the Premium Tax CREDIT • Example: Premium is $600, client eligible for $200 in monthly subsidies. Client pays the total of $7200 annual premium and collects a tax refund of $2400 in 2015
How do I make sure I get credit for my BCBSTX sales? • Option 3 – Express Link • Use the paper HIM subsidy application and the BCBSTX paper health insurance application • Use the subsidy application to set up the subsidy (mail to the London, KY address) • Submit the health insurance app electronically via Express Link • At the part where you enter your agent info, take a screen shot and print this for future reference
Find valuable tools in our Individual Health section at www.TheBrokerageInc.com
Get started! The message is simple: As of January 1, 2014 you are required by federal law to own a qualified health insurance plan (QHP). 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 can help you.
