HCR Support Specialist Training Module II

Transcription

1 HCR Support Specialist Training Module II The ACA and the Individual Market Your Trainer Today: Constance Starkey

2 Individual Mandate What is the mandate? What are the exceptions? What is the penalty for non-compliance? 2

3 Penalty For the purpose of calculating the penalty, the IRS considers only those household members listed as dependents on the individual s tax return. 3

4 Minimum Essential Coverage (MEC) Medicare, Medicaid (Medi-Cal) or the Children s Health Insurance Program (CHIP), TRICARE (for service members, retirees and their families), The veteran s health program, A plan offered by an employer, Insurance purchased in the Individual market that is at least at the Bronze level, or A grandfathered health plan 4

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6 Exceptions Exceptions include: those with qualifying religious exemptions, those in a health care sharing ministry, individuals not lawfully present in the United States, and incarcerated individuals 6

7 Exceptions Also, no penalty will be imposed on: those without coverage for less than three months members of Indian tribes individuals required to pay more than 8% of household income Qualifying individuals residing outside of the United States, bona fide residents of any possession of the United States 7

8 Penalty The annual penalty for not having minimum essential coverage will be the greater of a flat dollar amount per individual or a percentage of the individual s taxable income. For any dependent under the age 18, the penalty is one half of the individual amount. 8

9 Flat Dollar Penalty Per Individual 2014 = $ = $ = $ After 2016 = Indexed to Inflation The Flat Dollar Penalty is capped at 300% of the Flat Dollar Amount Per Dependent Under Age 18: ½ of Per Individual Penalty 9

10 Flat Dollar Amount A family of three (two parents and one child under 18) would have a flat dollar penalty of $1,737 in 2016 $695 $695 $347 $1,737 10

11 Flat Dollar Amount A family of four (two parents and two children over 18) would have a flat dollar penalty of $2,085 in 2016, due to the 300% cap. $695 $695 $695 $695 $2,780 $695 X 300% = $2,085 11

12 Percentage of Taxable Income If an individual has a household income of $50,000, the percentage would be 1% of the difference between $50,000 and the tax threshold (which we will assume will be $10,000 for an individual in 2014). This individual would need to calculate the percentage penalty to determine if it would be greater than the flat dollar penalty for

13 Percentage of Taxable Income 13 Household income: $50,000 Tax threshold for 2014: $10,000 Difference between income and threshold: $40,000 $40,000 X 1%: $400 Flat dollar penalty: $95 This individual would be subject to a percentage penalty of $400, because this percentage penalty is greater than the flat dollar penalty for 2014, which is $95.

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15 The Exchange

16 The Exchange In order to be eligible to enroll in the Exchange, an individual must be either: a US citizen or, a non-citizen who is lawfully present in the US 16

17 The Exchange Premium Tax Credits are available to individuals: with household incomes between 138% - 400% of the Federal Poverty Level (FPL) or, are eligible for employer sponsored coverage that is below 60% actuarial value or, if premiums exceed 9.5% of their income Cost-sharing Subsidies are available to individuals: enrolled in a Silver plan through the Exchange Shop and Compare Tool 17

18 The Role of the Agent Certified Insurance Agents bring a depth of experience to Covered California by: Serving as trusted licensed advisors Maintaining deep customer relationships Providing valued service (not just enrollment but ongoing support) Offering solutions within and outside of Covered California Health Plans Being savvy marketers Acting as experts in both individual and group markets 18

19 Enrollment Shop and Compare Tool

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21 21 Consumers can then look at all the plans available in each of the metal tiers and compare benefits and premium rates.

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24 Designating an Agent Once the Consumer has logged-in, Click the link Find Help Near You to locate Assistance: 24

25 Designating an Agent Click Find Agent on the page: 25

26 Designating an Agent Enter search information or just click search button for all agents (note: only certified agents will display on this page) Search by location Search by name 26

27 Designating an Agent Certified Agents are displayed, click on the agent s name to select agent: 27

28 Designating an Agent Agent information is displayed, click the Continue button to select the agent: 28

29 Designating an Agent Attestation Page must be completed by the consumer by checking the boxes, typing their name and clicking on Confirm : 29

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31 31 Designating an Agent

32 Appointment and Commissions For the individual market: Commissions are paid by each health insurance company according to their active commission schedule at the time of enrollment Certified Insurance Agents must be directly appointed by each of the health insurance companies in Covered California to receive commission from the health insurance company The commission rate is the same rate as non-exchange business Commissions are based on the gross premium and not the net. This means that if an applicant is eligible for subsidies, it will not negatively impact commission rates 32

33 Appointment and Commissions For the individual market: Health insurance company premium rates are the same for business sold with or without a Certified Insurance Agent There are no steering bonuses (Agents are required to be fair and objective when recommending plans, and not base recommendations on bonuses or higher commissions) Originally, Certified Insurance Agents could not be compensated for Medi-Cal enrollment. Now compensation will be $25.00 per enrollment. 33

34 Agent Commissions More Questions 34 Does Covered California take a percentage of commissions? No. Covered California will pay 100% of commissions owed to Certified Insurance Agents. Are Agents paid commissions based on gross premium or net premium? Currently, commissions will be based on gross premium. What is the difference in commissions between agent/brokers and assisters or navigators? Agents are paid commission based on a % of premium. Certified Enrollment Counselors are paid a fee per enrollee ($58 fee per enrollee + $25 fee at annual renewal).

35 Questions Please submit questions to: Constance Starkey Constance Starkey is an analyst in Public Relations, Public Affairs and Policy at LISI, received her certification through NAHU as a Health Care Reform Professional, and is a Certified Educator for the Broker Certification Program for Covered California. She is also a member in good standing of NAHU, CAHU and serves on the Board of Directors for LAAHU.

36 End Of: HCR Support Specialist Training Module II Thanks for your attention!