The Affordable Care Act requirements are different for individuals and small and large businesses. How do I know what is required of me?
Our national health care policy is changing. Yes, that means everyone will be affected in some way, shape or form by the Affordable Care Act. It most important that you find a health insurance consultant that you trust to help you navigate through the process and determine what the best option is for you and your family. Here are a few reasons why:
No Cost. Health Insurance brokers/consultants are paid the by the carriers and the state exchange to help businesses and individuals find the best health insurance solutions for employees and families. There is no cost difference in your premium whether or not you get assistance from a licensed consultant.
Subsidies. There are 26 million Americans that will be eligible for subsidies from the government to help pay the premium for coverage. Do you qualify for a subsidy?
The uninsured. If you currently do not have insurance (which is never a good idea!), it is time to start thinking about it. If you do not have insurance in 2014 you will pay a penalty. You may be eligible for a subsidy through the state exchange to assist with the premium. For example, if you are a 35 year old earning $40,000 per year, you are eligible for a subsidy. You also have an option of whether to purchase insurance inside of the state exchange or outside of the exchange on the individual market.
Individuals. If you currently hold an individual policy, it will be changing at the end of the year. New plans will be in place for January 2014 and may or may not be similar to what you hold today. You will have options inside and outside the exchange for a new plan. And similar to the uninsured, you may qualify for a subsidy inside the exchange.
Small businesses. Starting in October, small businesses will have the opportunity to purchase insurance through the exchange. If you are a small business owner, you may also be eligible for a tax credit if you purchase insurance through the exchange. If you are currently offering benefits to your employees now, you can continue to operate in the same manner that you are now by offering benefits via a carrier outside of the exchange, however a few of the plan requirements will change based on reform such as eligibility – must be offered to employees no more than 90 days after of employment. You also have a few required documents that will need to be provided to your employees.
Large businesses. If you are a large business owner of 50 or more full time equivalent employees (FTEs), you will now be required to provide a basic level of insurance to these employees. There are calculations to determine how many FTEs you have, calculations to determine if you should “pay or play”, measuring periods if you have part-time seasonal employees, calculators to determine if your plan meets the minimim requirement for essential benefits, requirements of how long you need to offer the part-time employees benefits based on your waiting periods. You should be keeping extremely accurate data on hours now for your employees as the information you are collecting now matters in 2014. Similar to small businesses, you will also have changes in eligibility requirements and required documents to provide to your employees.
Insurance Pool (OMIP, FMIP). Because underwriting goes away in 2014 and all Americans are eligible to have insurance, there will no longer be state high risk pools. If you are in one of the pools now, you will be able to choose a new plan in or out of the exchange for 2014.
Plan Ahead. We already know what carriers will be in the exchange. We can already start calculating to see if the individuals or small businesses qualify for subsidies or tax credits. We don’t have all the rate information and all the regulations are not finalized, but now is the time to get a better understanding of what the changes may mean to you.