© 2013 Michael Chapman, GroupBenefitsAdvisors.com
What You Need to Know NOW& How to prepare for 2014
• What You Need to Know• What You Need to Decide• When You Need to Act• Plus, How It Affects You, Your
Job, and Your Employer
What?When?
Why?
Healthcare Options for 2013And how to prepare for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Disclaimer:
• The information presented is subject to change, and will likely change in the future.
• Subscribe to TheMedicalInsuranceExchange.com newsletter or contact us for latestupdates.
• The information presented should not to be construed as offering legal or tax advice; consult with a lawyer or tax professional.
• Some state variations may occur, the information presented is based on the laws of Texas.
What?When?
Why?
Healthcare Options for 2013
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
My Qualifications:
• Former CEO• Since 2003, Frequent Public Speaker on Healthcare and Insurance.• Employee Benefits Broker for Companies and Individuals.• Published Author, Blogger.• Helpful, pro bono resource to thousands of individuals and companies in
DFW with benefits-related questions and concerns.
• Mike Chapman, [email protected]• Linkedin.com/in/michaelchapman (14,000+)• 214-764-6315 tel, 214-732-3691 cell
Healthcare Options for 2013
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
My Dilemma
Healthcare Options for 2013
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Door # 2:• Plunge head first
towards opportunities created from PPACA
• Mike Chapman, [email protected]• Linkedin.com/in/michaelchapman• 214-764-6315 tel., 214-732-3691 cell
Healthcare Options for 2013
Healthcare Options for 2013
Best Healthcare Advice for Anyone:
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Best Healthcare Advice for Anyone:
• Stay Healthy• Don’t Get Injured
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
2nd-Best Healthcare Advice for Anyone:
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
2nd-Best Healthcare Advice for Anyone:
• Die Quickly• Die In Your Sleep!
• Over 80% of lifetime healthcare expenses occur in last 18 months of life.
• Medical is Leading Cause of Bankruptcies© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
We Don’t Get to Choose If, When,
or How
We Get Sick, Injured or Die
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
The Choices We MakeDetermines How Much We
Have to Spend
If and When We Get Sick, Injured or Die
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
A Healthy, “Hazard-Free ‘Lifestyle
Reduces How Much We’ll Eventually Pay When We Get Sick, Injured and Die, and Increases the
Length and Quality of Life
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Insurance pools the $$ Risk of
Sickness Accident, and
Death
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Healthcare is Expensive• 30-35% of US GDP• For many families, #1 or 2 budget item.• For many Businesses, #2 Overhead item
after salaries • High, uncontrollable inflation.
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Pre-2014 Options:• COBRA• Private Insurance• “Risk Pool”• VA/Tricare (Veterans/Active Duty)• Medicare (65+)• Medicaid/CHIP (Children)• Self-Insure
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Pre-2014 Options:• COBRA/State Continuation• Same plan, same $ as employer• 18 months/6 months• No exclusion of health conditions• Must elect within 60 days
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Pre-2014 Options:• Private Insurance• Can exclude conditions,
increase rates based on health conditions during underwriting.
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Underwriting:• Evaluation of Risk of claims• Conditions• Age• Gender• Residence
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Pre-2014 Options:
• Group Insurance• Guaranteed Issue• Same cost for every employee
• Individual Insurance• Individually Underwritten
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Pre-2014 Options:
• Individual Insurance• Individually Underwritten• Insuring a healthy, younger, male with
no health conditions is less risk of a claim, so they will pay less for insurance.
• Can reduce cost vs. COBRA by up to 60%
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Pre-2014 Options:
• Individual Insurance• Short term plans• 0-6 months of coverage.• Easy, short application.
• “Permanent” plans• Stay in force as long as you pay premium.• Lengthy application/underwriting.
• Short term and permanent are both major medical plans.
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Pre-2014 Options:
• “Risk Pool”• Option after COBRA and if either spouse
is not eligible for group plan.• Covers individuals who are ineligible or
excluded individual insurance because of health condition.
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Pre-2014 Options:• Medicare• Guaranteed issue coverage at age 65, can
apply at 64 ½• A+B+D plus medicare supplement or
Medicare Advantage (HMO) plan in some areas.
• Limitation of healthcare providers who accept.
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Pre-2014 Options:• Medicaid/CHIP (Children)• Children 0-18• Income/Asset qualify• Waiting list• HMO• Affordable
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Healthcare Options for 2013
Pre-2014 Options:• Self-Insure• You assume risk of sickness/injury• Includes public health programs such
as Parkland and John Peter Smith in DFW
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Whether you yet know it or not……ACA Impacts EVERYTHING
• Every American faces healthcare decisions Beginning 10/1/2013 for 2014.
• Every Business faces similar decisions in 2014
What?
Why?
What?When?
Why?
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
When Must I Make A Decision?• Huge Advertising Campaign.
• Exchanges Open October 1, 2013
• ACA Coverage Begins January 1.
• Best Time To Make A Decision is NOW!
What?When? Why?
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
The Obamacare Clock Is Ticking..
…The Sooner You Know WHAT to Do…The Longer You’ll Have to Adjust!
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Change = Opportunities
Use Knowledge of Obamacare as Your Secret
Advantage.
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Brief Overview of What it Is• Coverage Differences• How You Buy It• What It Costs You• Consequences to You and Employer
What?When? Why?
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Your Health Plan will be Different
2013 2014
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
98% of Today’s Health Plans Will
Be Replaced
Just Kidding!
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Some of the Big Plan Differences:• Different Deductibles – • Max $2,000 Deductible.• $3,500 Max Out of Pocket.
• “Guaranteed Issue,” Regardless of Your Health.• More Coverage, Examples:• Maternity Coverage, Dental Checkups to Age 6
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
More Big Plan Differences:• Guaranteed issue, No “Rate Ups” for Risk or Conditions• Except May Charge 50% More for Smoking• May Offer Discount for Wellness Plan Participation• 3 vs. 6 Age Bands• Community Rating.
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Buzz Word: Essential Benefits
• Ambulatory patient services• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance use disorder services,
including behavioral health treatment• Prescription drugs
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Essential Benefits, continued:
• Rehabilitative and habilitative services and devices• Laboratory services• Preventive and wellness services; chronic disease
management• Pediatric services, including oral and vision care
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Essential Benefits, continued:
• Items or services that have an ‘A’ or ‘B’ rating• Immunizations for routine use in children,
adolescents, & adults• Evidence‐informed preventive care and screenings• No cost sharing for preventive care services (in‐
network)
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Buzz Word: Actuarial Value
• Bronze plans = 60% of minimum of cost of healthcare
• Silver plans = 70% of minimum of cost of healthcare
• Gold plans = 80% of minimum of cost of healthcare
• Platinum plans = 90% of minimum of cost of healthcare
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Your Premiums Will Be Different:
2013:$$$
2014:???
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Anybody Want to Guess the Biggest Factor Whether You’ll Pay More or Less?
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
How Much You Earn!
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Eligibility for Government SubsidyFamily of 4
Income LevelPercent of
Poverty LevelIndividual Can Get
Coverage In:Government
Subsidies
Above $88,200 Above 400% Federal or State Health Ins Exchange
No
$88,200 400% Federal or State Health Ins Exchange
Yes
$29,327$22,050
$0
133%100%0%
Medicaid Yes
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
1. How Do Find Out if I Qualify for a Subsidy for Obamacare?
2. Am I Sure I Really Want a Subsidy?
3. What’s The Penalty If Uninsured?
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Tax Credit or Subsidy• Subsidies Only Available through Public and Private
Exchanges.• Employee+ Dependents NOT ELIGIBLE for a Subsidy If:
• The employer offers at least the actuarial equivalent of the Bronze Plan (60%)
• The employee cost share is not more than 9.5% of their annual income (W‐2 Employee) (AGI)
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Tax Credit or Subsidy• If employer offers health insurance for employees,
employee cannot apply for subsidy for themselves or for their dependents.
• This means employee must purchase high cost, unsubsidized insurance for dependents or pay a tax penalty if they are uninsured.
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Subsidy Calculator:
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Go to: http://TheMedicalInsuranceExchange.com/obamacare-subsidy-calculator/
or http://goo.gl/LbldeU
For Subsidy Estimates
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Go to: http://themedicalinsuranceexchange.com/apply-here-for-obamacare-subsidy-and-health-insurance/
or http://goo.gl/7QAx5y
For Final Draft Copy of ACA Paper Applications
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
If your Adjusted Gross Income ends up exceeding your estimate, the IRS will assess and take back your subsidy.
The IRS Giveth and Taketh Away:
Examples:
• Job Seekers
• Y.E. Bonus
• Unexpected Income
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Where You’ll Buy:Employer
Private
Exchange
• Employer• Federal or State Exchanges
(Federal Only in TX)• Private Exchanges• 2015: SHOP for small biz (< 25)
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Public Insurance Exchanges:
• State Run (23 states + DC)
• Federal Exchange (26 states, including Texas)
Healthcare Options for 2014
“Pre-2014” Health Insurance Transaction
When?
Healthcare Costs© 2013 Michael Chapman, GroupBenefitsAdvisors.com
You and/or Your
Employer
Insurance Company
Insurance Policy
$$,Health
Information
Healthcare Options for 2014
2014 Exchange Transaction
What?
Why?
Healthcare Costs© 2013 Michael Chapman, GroupBenefitsAdvisors.com
You and/or Your
Employer
Insurance Company
Healthcare Options for 2014
2014 Exchange Transaction
What?
Why?
Healthcare Costs© 2013 Michael Chapman, GroupBenefitsAdvisors.com
You and/or Your
Employer
Insurance Company
Inco
me In
form
ation,
Health In
form
ation
Subsidy
Approva
l,
Taxe
s
Healthcare Options for 2014
2014 Exchange Transaction
What?
Why?
Healthcare Costs© 2013 Michael Chapman, GroupBenefitsAdvisors.com
You and/or Your
Employer
Insurance Company
Inco
me In
form
ation,
Health In
form
ation
$$ Policy Subsidy,
Taxes
Subsidy
Approva
l,
Taxe
s
Information
$$ Premium Payment
Health Insurance Policy
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Where:
Marketplace.CMS.Gov
Healthcare Options for 2014
Downside of Public Exchanges:
• Self-serve, with little to no
support
• Expect LONGGGGGG
Wait Times,
• WRONGGGGG Answers.
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Downside of Public Exchanges:
• Inexperienced, minimally trained
“Navigators” and “Assistors”
• Navigator grant money awarded to
organizations favoring Administration
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Downside of “Public Exchanges”
• Do you really want to share
your personal health & tax
information?
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Downside of “Public Exchanges”
• No support or assistance
after purchase.
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
What is a “Private Exchange”?
• Multiple carrier venue for insurance policies
• Not just health insurance
• Run by Experienced, Trained, Licensed Agents
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Example ofPrivate Exchange:
TheMedicalInsuranceExchange.com
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
• Out of pocket max greater than $3,500.• You don’t have guaranteed issue or maternity
coverage now.• You’re younger than age 35 (approx.)• You live in an area with high healthcare utilization.• Your employer decreases contribution or drops group
plan.
You May Pay More in Premiums If in 2013:
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
You May Pay Less in Premiums If in 2013:
• Out of pocket max now less than $3,500.• You have guaranteed issue coverage (Risk Pool).• You’re older than age 50 (approx.)• You live in an area with low healthcare utilization.• Your employer maintains/increases health plan
contribution or improves health plan.
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
• 2014: $95 per Adult, $47.50 per Child up to $285 per family or 1% of income.
Individual Tax Penalty If Uninsured:
• 2015: $325 per Adult, $162.50 per Child up to $975 per family or 2% of income.
• 2016: $695 per Adult, $347.50 per Child up to $2085 per family or 2.5% of income.
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Your Choices:
COBRA
Private/Public Exchange Insurance
Short-term plan + Tax Penalty
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Whatever You Choose, You’ll Pay More:
Taxes
Goods & ServicesNew Federal Tax on Insurer Premiums, 3.8% Tax on Unearned Income, dividend taxes.
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Impact On Seniors:
• Harder to find doctors who accept Medicare (25% pay cut)
• Gradual Closing of Donut Hole• Reduction In Medicare Budget• Likely: Medicare Premiums Based
on Assets and Income
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Employer Impact
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Employer Penalties (delayed):
• $2,000 per Employee over 30 FTEs if Group Ins. or if no Essential Benefits
• $3,000 per Employee that does not enroll in Employer’s plan because it costs employee more than 9.5% of income or plan does not meet Bronze level.
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Certain Industry Sectors Will Get Hammered:• Staffing• Seasonal• Hospitality• Retail
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Employer Impact
Healthcare Options for 2014
• Increased cost, taxes and regulations/red tape for all businesses.
• Employer tax penalties delayed until 2015 (50+ full time employees)
• Uncertainty impacting permanent, full-time employment.
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Employer Impact
Healthcare Options for 2014
• Increase in part-time employment.• Fewer employers will offer health insurance as an
employee benefit.• Fewer employees will want an employer to offer
health insurance so they can qualify for a subsidy for their whole family.
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
In Many Cases, It Benefits Employer to Drop Group Health Ins. Coverage
Healthcare Options for 2014
• Cost of Tax Penalty for 50+ Employees Is Less than Health Insurance and is a Fixed Cost.
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
In Many Cases, It Benefits Employee for Employer to Drop Group Health Ins. Coverage
Healthcare Options for 2014
• Subsidized Cost of Health Insurance for Employee + Dependents May Be Less for Employee than Employee Cost of Health Insurance for Employee Only
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
In Many Cases, It Benefits Employee for Employer to Drop Group Health Ins. Coverage
Healthcare Options for 2014
• For Lower Wage Employees, Its Like Getting Dependents’ Insurance for FREE!
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
At This Point, Which Are You?Dazed & Confused Bored Zombie
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
My Unique Solutions:
• Education, Expertise, Year-Round Service.• TheMedicalInsuranceExchange.com, a Private Health
Insurance Exchange• Employer consultation• Partially Self-Funded Plans for employers
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
The Obamacare Clock Is Ticking..
• Advertising for Fed. Exchanges Has Begun
• Open Enrollment begins October, go to TheMedicalInsuranceExchange.com
• You need to educate others what to do.
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Decision-making Is Like Constipation
Taxes, Penalties,Higher Expenses, STRESS, Etc.
…The Longer You Wait, the Worse It
Gets
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
How I Help Employers• Consulting expertise• Rapid assessment of options & impact• Educate top management• Develop plan of action• Employee education is critical for success.
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
ACA Open Enrollment Preparation:“Black Tuesday”: October 1st, 61 Days Away
• Schedule an appointment now for beginning October 1st.• Write down your Family SS #s, Dates of Birth.• If Insured, Make Copy of Your Insurance Card and Bill.• Go to http
://TheMedicalInsuranceExchange.com/obamacare-subsidy-calculator or http://goo.gl/LbldeU; Print out an estimate of your subsidy.
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
ACA Open Enrollment Preparation:
• Subscribe to http://www.TheMedicalInsuranceExchange.com for updates and information as it becomes available.
• Find a good PCP ASAP!
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
If You’re An Employer or Work for One:• Whether or not your employer offers health ins.,
An Employer Has An Obligation and Opportunity to Communicate ACA to Employees.
• Schedule Me for an Employee Group Meeting
• Schedule Me to Visit with Owner/CFO/CEO
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
How You Can Help Me• Refer me to companies that need
advice.
• What Business Leadership Groups Could Use a Subject Matter Expert Speaker?
• Bookmark/Share:TheMedicalInsuranceExchange.com
How You Can Help Yourself & Your Company
• Share This Information ASAP
• ACT on This Information ASAP
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Remember:
Use Your New Knowledge of Obamacare as Your
Healthcare Advantage.
(Know enough to raise the questions, then, “I know a guy…”
Healthcare Options for 2014
© 2013 Michael Chapman, GroupBenefitsAdvisors.com
Please Comment/ForwardShare/Like:
• http://TheMedicalInsuranceExchange.com • Facebook:• YouTube Channel: ObamacareInformation• LinkedIn.com/in/michaelchapman
• Subscribe, Sign Up for Updates, Upcoming Presentation Schedule and Webinars!
Healthcare Options for 2014