AFFORDABLE CARE ACT (ACA)

Transcription

1 AFFORDABLE CARE ACT (ACA) Presented By ANDREW H. HOOK, CELA, CFP, AEP 295 Bendix Road, Suite 170, Virginia Beach, VA Harbour View Blvd., Suite 203, Suffolk, VA Tel: Fax:

2 PURPOSE Increase number of people with HI Increase Standards Of Coverage Tax Credits Subsidies Penalties Complex 2

3 MECHANISM Expansion Of Medicaid, i.e., 11 Million $138 FPL Marketplaces (previously Exchanges) Individual Mandate Employer Mandate Small Employer Large Employer 3

4 MINIMUM ESSENTIAL COVERAGE (MEC) Medicare Part A Medicaid CHIP TRICARE VA Plan Peace Corp Employer-Sponsored Plan Offered In State Market Grandfathered Plan Other HHS Approved 4

5 HI Marketplaces State State/Federal Federal Assistance - Individuals & Small Groups Comparison Shop 5

6 ESSENTIAL HEALTH BENEFITS (EHB) Ambulatory Services Emergency Services Hospitalization Maternity/Newborn Care Mental Health/Substance Abuse Prescription Drugs Rehabilitative & Habilitative Laboratory Preventive & Wellness Chronic Disease Management Pediatric Including Oral & Vision 6

7 ESSENTIAL HEALTH BENEFITS (EHB) con t Required Through Exchanges Not Required Outside Exchanges No Specific Benefits Within Categories State-by-State Basis Cost Sharing 2013 Deductibles, Co-Pays, etc. $12,500 Family $ 6,250 Individual 7

8 COVERAGE LEVELS Metal Tiers Platinum - 90% Gold - 80% Silver - 70% Bronze - 60% Catastrophic Plans 8

9 ELIGIBILITY FOR VARIOUS PROGRAMS Are Individuals Eligible To Apply? Eligible For Affordable Employer HI, Medicaid, CHIP Or Other Government Programs? Qualify For Premium Assistance Credit Or Cost-Sharing Reduction? 9

10 PREMIUM ASSISTANCE Low & Moderate Income 100% 400% FBL Exchange Only Tax Credit Can Be Applied Toward Premiums Inapplicable to Employer and Union Plans 10

11 SUBSITY: METAL TIERS Silver Plan - 30% Household Income Increase AV From % FPL 94% Over % FPL 87% Over % FPL 73% HHS Pays Insurer The Difference 11

12 OPEN ENROLLMENT October 1, 2013 to March 31, 2014 December 15, 2014 = Coverage 1-1 After December 15 th First Day of 1 st or 2 nd Month, then, October 15, 2013 to December 7,

13 INDIVIDUAL MANDATE: WHO MUST BE COVERED & ASSISTANCE Everyone Except: Religious Exemption Non-US Citizens or Nationals & Illegal Immigrants Incarcerated Individuals Assistance Subsidy Tax Credits Exchanges Only 13

14 INDIVIDUAL MANDATE: PENALTY The Lesser of: Flat $ - OR - % of Income Flat $ Monthly - Individual $ $ $ % (for 2014)of Household Income over a threshold gross amount 14

15 SMALL EMPLOYER 49 or Fewer Employees No Penalty 2-Year Tax Credit 15

16 SMALL EMPLOYER: TAX CREDIT Two Years Only Full Credit Up To 50% 10 or Fewer Employees $25,000 Average Wage Phase Out Employees Average Wage Of $25,000 - $50,000 Exchange Policies Only 16

17 DEDUCTIBLE $4,000 Family $2,000 Individual Applies To Small Group Plan Does Not Apply To Large Group Plan 17

18 LARGE EMPLOYER 50+ FTE Minimum Essential Coverage (Not EHB) Affordable 9.5% Household Income - Individual Coverage Cover FTE (30 hrs) + Dependents Penalty 18

19 LARGE EMPLOYER: PENALTY Failure to offer Minimum Essential Coverage (MEC) Employee-Enrolled Individual Coverage In Exchange Premium Assistance Credit Or Cost-Sharing Subsidy $2,000 For Each Employee Over 30 Threshold Example: Employers In Medicaid, CHIP, Or Other Government Programs 19

20 LARGE EMPLOYER: PENALTY UNAFFORDABLE COVERAGE $3,000 Per Year, Per Employee Per FTE, Enrolled In QHF Through Exchange Cap Cannot Exceed Penalty For Failure To Provide Minimum Essential Coverage (MEC) 20

21 PROVISIONS APPLICABLE TO ALL PLANS 21

22 MEDICAL LOSS RATIO Adjusted Premiums Large Group 85% Claims & Quality Improvement 15% Overhead Small Group & Individuals 80% Claims & Quality Improvement 20% Overhead 22

23 CAPS Group Plans Only No Lifetime Caps No Annual Caps Restrictions On Number Of Visits & Treatments 23

24 MISCELLANEOUS Waiting Period - 90 Days Maximum PRE-EXISTING CONDITIONS No Rescission Except Fraud Preventive Coverage No Co-Pay Choice of Primary Care Provider Medical Deductible - 10% AGI Coverage Child Under 26-Years-Old 24

25 CONCLUSION ACA Evolving Pre-Existing Conditions Future Medicals Coverage 25

26 Thank You! 295 Bendix Road, Suite 170, Virginia Beach, VA Harbour View Blvd., Suite 203, Suffolk, VA Tel: Fax: Estate Planning Asset Protection Planning Life Care Planning Long-term Care Planning Veterans Benefits Financial Planning and Advice regarding Investments, Insurance, Annuities, Reverse Mortgages, and Equity Lines Tax Planning Guardianships and Conservatorships Estate and Trust Administration Special Needs Trusts Care Management Services Business Planning and Succession Planning 26