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Health Insurance Options for Sole Proprietors

Health Insurance Options for Sole Proprietors. NYS Health Benefit Exchange: Open Enrollment Starts October 2013 What Can Sole Props Get Now? Healthy NY for Sole Props and Small Businesses Potential Group Coverage Options for Sole Props Individual Market Public Health Insurance.

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Health Insurance Options for Sole Proprietors

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  1. Health Insurance Options for Sole Proprietors

  2. NYS Health Benefit Exchange: Open Enrollment Starts October 2013 • What Can Sole Props Get Now? • Healthy NY for Sole Props and Small Businesses • Potential Group Coverage Options for Sole Props • Individual Market • Public Health Insurance Presentation Outline

  3. NYS Health Benefit Exchange: Open Enrollment Starts October 2013

  4. NY Individual ExchangeChanges in 2014 • In 2014, sole proprietors will no longer have access to New York’s small group market • Sole proprietors may get coverage through the New York State Health Benefit Individual Exchange • Exchanges are online marketplaces like “Orbitz” with an interface like “Turbo Tax”

  5. NY Individual ExchangeEnrollment • Initial open enrollment starts October 1, 2013 and ends March 31, 2014 • Coverage begins January 1, 2014 • Special enrollment periods will be available during the year for certain circumstances • Those eligible for Medicaid or Child Health Plus can apply at any time • Annual open enrollment will start on October 15 and end on December 7 for the 2015 benefit period and beyond

  6. NY Individual ExchangeLowering Prices • Insurance works best when healthy people have coverage! • Individual mandate, tax subsidies, and the Exchange work together to drive down prices • Premium prices in the individual market are expected to be reduced by 66% • Exchange mechanisms • Large marketplace to shop for coverage • Big purchasing pool increases buying power and reduces administrative costs • Private insurance plans will compete • Buyers can compare plans apples-to-apples

  7. NY Individual ExchangeTax Subsidies and Annual Out-of-Pocket Maximums • Sole proprietors may be able to receive tax subsidies and cost sharing reductions on Individual Exchange • Tax subsidies available for individuals with income up to 400% of the Federal Poverty Level (FPL) • 400% FPL in 2013 for an individual is $45,960/year • 400% FPL in 2013 for a family of four is $94,200/year • Exchange plans have annual maximum out-of-pocket limits. • Calculate your potential subsidy and maximum costs: • http://healthreform.kff.org/subsidycalculator.aspx

  8. What Can Sole Props Get Now?

  9. Healthy NY for Sole Props and Small Businesses(This program sunsets in 2014)

  10. Healthy New YorkSole Proprietor Eligibility • New York State residence • Ineligible for Medicare • Applicant or spouse employed now or within last year • Employer does not provide health insurance • 12-month wait after voluntarily dropping private coverage • Income below 250% of FPL • $2,327/month (individual) / $3,977/mo (family of 3) • Sole Props can deduct documented business expenses from income

  11. Healthy New YorkSmall Business Eligibility • Business located in NY State • 1-50 eligible employees • At least 30% of employees earn $40K or less • No group health insurance in last 12 months • 50% of the eligible employees will participate • Employer contributes at least 50% of premium • Must be offered to all employees working 20+ hours per week and earning $40K or less

  12. Healthy New YorkBenefits and Cost • High deductible for new enrollees • $1,250 (individual) / $2,500 (family) • Covers most medical services, with copays • Drug Coverage optional • EXCLUSIONS: Mental Health; Substance Abuse; Chiropractor; Hospice; Ambulance; Vision; Dental; DME • Can exclude pre-existing conditions • If applicant uninsured more than 62 days (two months) • $250-$500/month for one person. Prices vary by plan and county.

  13. Healthy New YorkProgram Future • Healthy NY program will conclude for individuals and sole proprietors on December 31, 2013 • January 1, 2014 sole proprietors will be moved to the individual market • Small businesses with 2 – 50 will be transitioned to ACA compliant plans

  14. Potential Group Coverage Options for Sole Props

  15. FreelancersEligibility, Benefits, and Costs • Eligibility: • Independent Workers: freelance, sole prop, contractor, temp • Residency Requirements: NYC Metro Area through North Country, but not Central or Western NY • Work in Eligible Industry: Art, design, financial, etc. • Five different plans offered • Benefits vary by plan • Each plan has some deductible • HD plans have $5k and $10k deductibles • Individual coverage ranges from $225 to $603/month

  16. Lose coverage due to a qualifying event • Lose job, hours reduced, divorce, death, age, etc. • Covered employer • COBRA: 20 or more employees • Mini-COBRA: 2 or more employees • Limited duration • COBRA: 18 months (or 29 or 36 months in some situations) • Mini-COBRA: 36 months • Must make COBRA election within 60 days • Benefits are the same as other members of the plan, including active workers • Cost is 102% of employer’s full premium cost COBRA (Federal) & mini-COBRA (State)Eligibility, Benefits, and Cost

  17. Young AdultsDependent Coverage • New ACA “Age 26” Rule – Federal • Most plans must allow dependents under 26 to stay on parent’s plan, if they allow dependents at all • Must offer same pricing and benefits to all dependents, whether age 5 or age 25 • Can’t discriminate based on age “proxies” like student status, living at home, etc. • State – Age 29 Rule • Dependents under 30 can stay on parent’s plan • Dependent must pay full price of policy, like COBRA

  18. Individual Market

  19. Individual MarketEligibility • Guaranteed Issue • = • Everyone is eligible! • Regardless of age, health, gender, etc. • Some plans only offered in certain regions

  20. Individual MarketBenefits and Costs • Prices and benefits vary by plan and county • Prices do NOT vary by applicant’s age, health • “Community Rating” • No plans under $1,000 in many counties • Prices by plan/county updated monthly at: • www.dfs.ny.gov/insurance/ihmoindx.htm

  21. Individual MarketFinding Coverage • Independent Brokers • Experienced and knowledgeable on plan designs • Enrollment assistance • NYC Health Insurance Link: nyc.gov/hilink • New York City coverage options • Web Interface to compare plans • Contact information to enroll directly with insurers • Healthcare.gov: finder.healthcare.gov • Web interface to compare plans • Contact information to enroll directly with insurers

  22. Public Health Insurance:Medicaid, FHP, CHP, and Medicare

  23. Public Health InsuranceMedicaid, FHP, CHP, and Medicare • Medicaid and Family Health Plus (FHP) • Free health benefits (nearly identical in both programs) for low income individuals and parents • Household income limit for single adults: $931/month • Household income limit for in a family of three: $2,387/month • Child Health Plus (CHP) • All kids are eligible! • Free coverage for low-income children • Sliding scale premium for higher incomes • Medicare • Coverage for individuals 65+ years old • Coverage for disabled individuals

  24. Public Health InsuranceMedicaid, FHP, CHP, and Medicare • To find out more about public health insurance: • Call Community Health Advocates!! • 1-888-614-5400

  25. Help For All New YorkersAssistance for Small Businesses and Consumers

  26. More Resources • NY State Health Benefit Exchange: www.healthcarereform.ny.gov • Community Health Advocates: www.communityhealthadvocates.org • Hotline: (888)614-5400 • HHS Information: www.healthcare.gov • Health Care For All New York: www.hcfany.org • Congressional Budget Office: http://www.cbo.gov/publications/collections/health.cfm • Kaiser Family Foundation: http://healthreform.kff.org/ • Community Catalyst: http://www.communitycatalyst.org/ • ACA: www.healthcare.gov/law/full/index.html

  27. The End / Questions

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