Presented by John F Austin, CFPCA Lic. 0C10853

June 2013

Phone: (800) 987-1475Website: http://www.a-ains.com5890 Stoneridge Drive, Ste. #209Pleasanton, CA 94588

Serving The Real Estate Community Since 1988

PPACAWe’ll be talking about the Patient Protections and

Affordable Care Act (PPACA).

Areas To Be CoveredWhat is the PPACA?Time deadlinesWhat’s availableTaxes levied against people who are required to, but

don’t get health insurance.

What is the PPACA?The PPACA is the national health insurance program

that was passed in March 2010. Covered California is the agency that will administer the PPACA in California. The PPACA sets guidelines such as:

Guaranteed ApprovalGuaranteed approval for eligible people – pretty

much everyone who is here legally is eligible.

Effective Dates of CoverageFor a January 1st, 2014 effective date on a PPACA plan,

applications need to be in by December 15th, 2013.If you are on a group plan, that plan should continue

as is until your next renewal – check with your plan administrator for details.

The Bay East Association of REALTORS® Kaiser plan’s open enrollment is November for December 1st , 2013 effective dates.

CarriersThe carriers:1. Kaiser Permanente2. Blue Cross3. Blue Shield4.Health Net5. Western Health Advantage

Plus various other small region carriers.

Metal TiersThe plans (metal plans); Bronze, Silver, Gold and Platinum.

Each has a set level of benefits.

Federal Poverty Guidelines Household 

Size 100%  133%  150% 200%   300% 400% 

1 $11,490 $15,282 $17,235 $22,980 $34,470 $45,960

2 15,510 20,628 23,265 31,020 46,530 62,040

3 19,530 25,975 29,295 39,060 58,590 78,120

4 23,550 31,322 35,325 47,100 70,650 94,200

5 27,570 36,668 41,355 55,140 82,710 110,280

6 31,590 42,015 47,385 63,180 94,770 126,360

7 35,610 47,361 53,415 71,220 106,830 142,440

8 39,630 52,708 59,445 79,260 118,890 158,520

For each additional

person, add$4,020 $5,347 $6,030 $8,040 $12,060 $16,080

Assistance Levels Based on MAGI**Modified AGI = AGI plus or minus various items, see next pageIncome Level Maximum % of Income Paid as 

Premium

Up to 133% of the Federal Poverty Level 2% of income

133 – 150% of the Federal Poverty Level 3% - 4% of income

150 – 200% of the Federal Poverty Level 4% - 6.3% of income

200 – 250% of the Federal Poverty Level 6.3% - 8.05% of income

250 – 300% of the Federal Poverty Level 8.05% - 9.5% of income

300 – 400% of the Federal Poverty Level 9.5% of income

• Any premium payment that surpasses the maximum % of income paid as premium is the subsidy.

• Cost-Sharing Reductions are available for Silver plans for people who are below 250% of the FPL.

• Premium Assistance is available for anyone under 400% of the FPL.

What is considered in MAGI?

Examples of SubsidiesNumber of Family Members

Income (Annual) FPL% Premium Cost Before Subsidy

Payment After Subsidy

1 $22,980.00 – Annual $1,915.00 – Monthly

200% $3,600.00 – Annual$300.00 – Monthly

$1,447.74 – Annual$120.65 – Monthly

2 $62,040.00 – Annual$5,170.00 – Monthly

400% $5,800.00 – Annual$483.33 – Monthly

$5,800.00 –Annual$483.33 – Monthly

3 $58,590.00 – Annual$4,882.50 – Monthly

300% $6,720.00 – Annual$560.00 – Monthly

$5,556.05 – Annual$463.00 - Monthly

4 $35,325.00 – Annual $2,943.75 – Monthly

150% $10,800.00 – Annual$900.00 – Monthly

$1,413.00 – Annual$117.75 – Monthly

Taxes for those who don’t participateTax levies for those who are required to, but don’t

actually acquire health insurance – can be a group or individual plan inside or outside the exchange.

Either income or a fixed penalty is used each year, depending on which is greater.

Year 2014 2015 2016

Taxable Income 1.00% 2.00% 2.50%

Penalty Per Adult & Per Child

$95 / Adult$47.50 / Child

$325 / Adult$162.50 / Child

$695 / Adult$347.50 / Child

Maximum Penalty Per Family

$285.00 $975.00 $2,085.00

Who isn’t required to participate?Everyone, with a few exceptions, is required to acquire health insurance:1.You are part of a religion opposed to acceptance of benefits from a health insurance policy2.You are incarcerated.3.You are a member of an Indian Tribe.4.Your family income is below the threshold for filing a tax return (10,000 for Ind. / 20,000 for Family)5.You would have to pay more than 8% of your income to have health insurance.

Grandfathered PlansThe PPACA plans become effective January 1st, 2014. If you

have been on the same individual plan since March 24, 2010, your plan can be grandfathered – check with your carrier.

If you are an individual plan that is not grandfathered, and do nothing, your carrier, if participating in the PPACA, will move you to one of their “metal” plans.

Some carriers have opted to discontinue offering plans, and have sent notices as required to their participants. If that is the case for you or you don’t have coverage, you are required to obtain health insurance coverage by January 1st, 2014 or be subject to a tax.

The Bay East Association of Realtors® Kaiser Group PlanThe Bay East Kaiser plans will not change for the

12/01/2013 to 11/30/2014 period, and the rates are expected to increase less than 3% from the current rates. Open enrollment for the Bay East Kaiser plans is November, for a December 1st effective date. Those rates will be available the first week of November and will be on our website http://www.a-ains.com

From feedback we’ve been getting, I expect the Kaiser individual rates to increase much more than for your Bay East Kaiser group plan.

Other PlansOther plans outside of Covered California are also

available. An example is Anthem Blue Cross’ individual plans – for which enrollment is expected to be available starting November 11th, 2013.

What do I do?My recommendation to you is to check out all of your

options, your current plan’s offering effective 01/01/2014, the Bay East Kaiser plan for 12/01/2013 – 11/30/2014, and plans inside and outside of the PPACA.

You can try to go it alone, or work with a Covered California Certified Insurance Agent – which we are.

Presented by John F Austin, CFPCA Lic. 0C10853

June 2013

Phone: (800) 987-1475Website: http://www.a-ains.com5890 Stoneridge Drive, Ste. #209Pleasanton, CA 94588

Serving The Real Estate Community Since 1988