obamacare 411 for employees

Countdown to Action 2013

Obamacare 411

What?

When?

Healthcare Costs

© 2013 Michael Chapman, GroupBenefitsAdvisors.com

Obamacare 411


Countdown to Action 2013:

What every Employee Needs to Know NOW

• What You Need to Know

• What You Need to Decide

• When You Need to Act

• Plus, How It Affects Your Job or Job Search

What?

When?

Obamacare 411


Obamacare 411

My Qualifications:

• Since 2003, Frequent Public Speaker on Healthcare and Insurance.

• Successful Employee Benefits Broker for Companies and Individuals.

• Published Author, Blogger.

• Helpful, pro bono resource to thousands of individuals and companies in DFW with personal questions and concerns.

• Malcolm Gladwell, “Outliers 10,000 Hours” qualification on the subject.

• Mike Chapman, [email protected]

• Linkedin.com/in/michaelchapman (14,000+)

• 214-764-6315 tel, 214-732-3691 cell


mailto:[email protected]

Obamacare 411

My Dilemma:

• 66% of a benefits broker’s subject matter expertise won’t matter in 2014.

• 80+% of a benefits broker’s income will disappear in 2014.

• I’m uniquely qualified to serve the DFW community by providing simple to follow information that people and companies can use to make healthcare decisions and to move on.



• 214-764-6315 tel, 214-732-3691 cell



Obamacare 411

Here’s How You Can Help Me



• 214-764-6315 tel, 214-732-3691 cell


I Am Committed to Serve


Countdown to Action 2013:

Other Presentations For Following Groups:

• What Every President / CFO Needs to Know NOW

• What Every HR Professional Needs to Know NOW

• What Every Business Owner Needs to Know NOW

What?

Obamacare 411

What?

When?


…Do You Know A Business Group Above That Needs a Speaker?

Obamacare 411

About Me:

• Search Candidate for position of President / COO / CEO for small to mid-size businesses.

• Accomplished CEO/President/CEO/US Managing Director for International Companies.

• Experience in Internet/Ecommerce/Manufacturing/Fin. Services/BtoC/BtoB Companies.

• Startup and Operational Turnaround Experience, both domestic and international.

• Twice earned Employee of the Year for well-known Fortune 100 company voted “Most Admired Company” in US by Forbes Magazine. Average US Home owns 4.5 products that I developed and brought to market.

• Since 2003, small business owner in employee benefits field.


• Linkedin.com/in/michaelchapman

• 214-764-6315 tel., 214-732-3691 cell



Obamacare 411

About Me:

• I’m Available, who do you know?• Business Owner or Ownership, in need of a new

leader.• International company, needs a US managing

director or president.


• Linkedin.com/in/michaelchapman

• 214-764-6315 tel., 214-732-3691 cell



Obamacare 411

Opinions Are Like This:

…Unless you’re a Supermodel, keep it to yourself!

--Everybody Has One…

…It’s the LAW of the LAND.

…Quit Your Whining, Listen to what you

need to know! © 2013 Michael Chapman, GroupBenefitsAdvisors.com

Obamacare 411

Why Obamacare?

• Runaway Healthcare Inflation

• Major Segment of Americans

priced out of Health Insurance.

• THE WHY DOESN’T

MATTER, THE MAJORITY HAS

VOTED! © 2013 Michael Chapman, GroupBenefitsAdvisors.com

What?

When

?

Obamacare 411

Secy. HHS Sebelius:

Health and Human Services (HHS) Secretary Kathleen Sebelius.

• Second Most Powerful Person in US.• Not An Elected Position.• The phrase “secretary shall” appears 858 times in HR 3509

(2,409 pages) and 24 times in HR 4872 (1,037 pages)© 2013 Michael Chapman, GroupBenefitsAdvisors.com

Obamacare 411

Disclaimers:“Health and Human Services (HHS) Secretary Kathleen Sebelius said Monday

April 8, 2013 that she did not anticipate how complicated implementing the president’s signature healthcare law would be.”

• Due to the constant changes in the interpretation and application of Obamacare, this presentation is guaranteed NOT to be 100% accurate. Information covered in this presentation is guaranteed to change. You must do your own due diligence.

• This presentation should not be construed as offering legal, insurance, or tax advice, nor is it providing ACA Exchange Navigator advice. This presentation is for Texas only. © 2013 Michael Chapman, GroupBenefitsAdvisors.com

Obamacare 411

WHAT: PPACA, ACA, or Obamacare

• Social Legislation

• Redistribution of Wealth and Income

• Redistribution of HealthCare

• Regulation of Healthcare Providers and

Industry

• Funds Technology to Reduce Waste and

Programs for Public Health.


What?

When

?

Obamacare 411


Emancipation of HealthCare:

• From Who Can Write a Check For It…

• …To a Basic Right of Citizenship.


Obamacare 411


Market-Based vs. Regulated

• From Free Market Pricing &

Availability.

• To Government Control of Pricing &

Availability Healthcare


Obamacare 411

Take a Deep Breath…

• Impact on You and Your Family

It’s Time to Adapt to the

New Order!

• Impact On Your Budget

• Impact On Your Job and Your Employer© 2013 Michael Chapman, GroupBenefitsAdvisors.com

Obamacare 411

When Must I Make A Decision?

• Exchanges Open October 1, 2013

• Obamacare Plans Begin January 1.

• Best Time To Make A Decision is NOW!


What?

When

?

The Obamacare Clock

Is Ticking..

…The Sooner You Know

WHAT to Do


Obamacare 411

…The Longer You’ll Have

to Adjust!

Constipated

Decision-making

=


Obamacare 411

More Taxes,

Penalties,

More Expenses,

Anxiety, Etc.

Change =

Opportunities


Obamacare 411

Use Knowledge of

Obamacare as a

Competitive Advantage.

Obamacare 411

Nobody is An

Expert…

Be the Expert!

“Health and Human Services (HHS) Secretary Kathleen Sebelius said Monday April 8, 2013 that she did not anticipate how complicated implementing the president’s signature healthcare law would be.”


Obamacare 411

Brief Overview of What it Is

• Coverage Differences

• How You Buy It

• What It Costs You

• Consequences to You and Employer


What?

When

?

Obamacare 411

Your Health Plan will be Different


2013 2014

Obamacare 411


98% of Today’s

Health Plans Will

Be Replaced

Just Kidding!

Obamacare 411

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

Obamacare 411

More Big Plan Differences:


• 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.

Obamacare 411

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

Obamacare 411

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

Obamacare 411

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)

Obamacare 411

Your Premiums Will Be Different:


2013:

$$$

2014:

???

Obamacare 411


• 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:

Obamacare 411

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.

Obamacare 411

Anybody Want to

Guess the Biggest

Factor Whether

You’ll Pay More or

Less?


Obamacare 411

How Much You Make

How Much You Own


Obamacare 411

Your Choices:


Pay

Play

Delay

Obamacare 411

Your Choices:


Pay:

Play

Delay

A Penalty for No Insurance

Purchase

Private, Group, Medicare, Excha

nge Insurance

Renew / Change Plan in Nov ‘13

Obamacare 411

Whatever You Choose, You’ll Pay More:


Taxes

Goods & Services

New Federal Tax on Insurer Premiums, 3.8%

Tax on Unearned Income.

Obamacare 411

Your Employer Will Pay More:


+ 2% Payroll Taxes

Compliance

Insurance Premiums

Obamacare 411

Impact On Seniors:


• Reduction In Medicare Budget

• Likely To Pay More Based on

Assets and Income

• Review Boards / Ration Care

• Chronic Illness Management

Where You’ll Buy:


Employer

Exchange

• Employer

• Private Insurance (Broker)

• Medicare/Tricare/Govt. Jobs.

• Online Exchanges

• Private Exchanges

• Federal or State Exchanges

(Federal Only in TX)

• 2015: SHOP for small biz (< 25)

Obamacare 411

Obamacare 411

Where:


Medicare.Gov

Obamacare 411

Where:


Healthcare.Gov

Obamacare 411

Where:


Marketplace.CMS.Gov

Obamacare 411

Where:


YouTube.CMS.Gov

Obamacare 411

TX Employer Impact


Obamacare 411

WHO: All Businesses, 50 Full Time

Employees*


30 Hr. Part-Time Employees

*(Unless Received a Waiver)

Seasonal Employees

Obamacare 411

Fact: 78% of US Businesses are Family

Owned, 2-99 Employees


• 2005: 47% offered health insurance

• 2012: 40% offered health Insurance

• (Fewer offer in Texas)

• Recession: cut-backs, closings

• Premium Inflation

Why?

Obamacare 411

Employer Penalties:


1) If ACA-Mandated Employer doesn’t offer a MEC plan covering 95% of FTEs, they will be assessed a $2,000 TAX Penalty per

employee for every FTE over 30 employees.

Example:

• Employer with 100 FTEs (full time equivalent employees) pays

penalty of $2,000 per employee in taxes for 70 FTEs, or $140,000

more in taxes.

Obamacare 411

Employer Penalties:


2) If ACA-Mandated Employer offers a MEC plan covering 95% of

FTEs, but if the employee cost share is greater than 9.5% of lowest

wage employee’s AGI (W-2), Employer they will be assessed a $2,000 TAX Penalty for every FTE over 30 employees.

Example:

• Employer with 100 FTEs has one full-time janitor who is paid

minimum wage.

• Janitor’s premium share of MEC is 10% of his or her wages.• Employer will be assessed a Tax Penalty of $140,000.

Obamacare 411

Employer Penalties:


3) If ACA-Mandated Employer offers a MEC plan covering 95% of FTEs, they will be $3,000 TAX Penalty per employee for Every

FTE who applies for Insurance through a State or Federal Exchange

and receives a subsidy.

Example:

• Employer with 100 FTEs (full time equivalent employees) will pay a

penalty of $6,000 if two employees apply for insurance through a

State or Federal Exchange.

• (Suggestion: Don’t be “That Guy.”)

Obamacare 411

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?

Obamacare 411

Tax Credit or Subsidy

Congressional Budget Office Estimated that 127M People

Potentially Qualify for Subsidies.

• CBO Estimated that Only 18 Million Will Participate.

• The Subsidy Application Is estimated to be 62 pages!


Obamacare 411

Tax Credit or Subsidy

• Subsidies Only Available through Federal/State Exchanges.

• An Employee Is 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)

Obamacare 411

Eligibility for Government Subsidy

Family of 4

Income Level

Percent of

Poverty Level

Individual 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


Obamacare 411

• 2014: $95 per Adult, $47.50 per Child up to $285 per family or 1% of income.


What’s The 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.

Obamacare 411

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

Obamacare 411

If you qualify for Medicaid and your

Adjusted Gross Income ends up

exceeding your estimate, the IRS

will assess and take back

your subsidy and could

attach assets.


The IRS Giveth and

Taketh Away:

Examples:

• Job Seekers

• Y.E. Bonus

• Unexpected Income

Obamacare 411

Business Pay or Play Calculator


Obamacare 411

For Companies, Business Owners,

Presidents, CFO’s, HR Directors:

• Whole new level of fiduciary responsibility.

• Increased complexity with major

P&L, Tax, HR, and hiring consequences.


Obamacare 411

For individuals or organizations with multiple

ownership, you can’t escape the 50+ FTE Rule

• PEOs

• Staffing Firms

• Private Equity Groups

• Multiple Franchise Owners


IRS To Look back to 6/1/13 for FTEs

Obamacare 411

Certain Industry Sectors Will Get Hammered:

• Staffing

• Seasonal

• Hospitality

• Retail


IRS To Look back to 6/1/13 for FTEs


Obamacare 411

Remember:

Use Your New Knowledge

of Obamacare as a

Competitive Advantage.

Obamacare 411

If You Know

This

Much, You’re

Now

An Expert!

• As of Today, Very Few Businesses, Upper Management and Employees Know This Much About Obamacare.

• Even Fewer have made decisions on what they should do.


Obamacare 411

• To Learn More:

• http://Obamacare411.co• Facebook:• YouTube Channel: ObamacareInformation• Twitter:


• Subscribe and Sign Up for Updates,

upcoming presentations and webinars:

Obamacare 411

Please Comment/Forward

Share/Like:

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Presentation Schedule and Webinars!

Obamacare 411

How You Can Help Me

• Who Do You Know That

Needs Executive Leadership?

• What Leadership Groups

Could Use a Subject Matter

Expert Speaker?


How You Can Help

Yourself and DFW

• Share This Information

ASAP

• ACT on This Information

ASAP

Obamacare 411


Countdown to Action 2013

Obamacare 411

What?

When?

Healthcare Costs


Obamacare 411


obamacare 411 for employees

Documents