Transcript The Affordable Care Act

The Affordable Care Act
Presented by
Brad Knerr
Account Executive
[email protected]
(805)503-4719
www.vanbeurden.com
Agenda
– The Affordable Care Act (ACA)
– A look back – major health reform changes since 2010
– On the horizon – What you should know about 2014
changes
– Analysis
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Affordable Care Act
•
•
The Affordable Care Act (ACA) was signed into law on March 23, 2010 to
improve the quality of health care and increase access to care for individuals
and businesses.
California has been a leader in supporting the Affordable Care Act. It passed
legislation to conform with the law, and was one of the first states to establish
its own health insurance exchange.
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A quick look back
2010 to present
Timeline
2010
2011
2012
2013
Changes to appeal Process
Annual rate review process
Medical Loss Ratio rebates
Flexible Spending Account
contributions cap ($2,500) limit
Elimination of lifetime limits
on Essential benefits
Health premium regulation,
Medical Loss Ratio (MLR)
Patient-centered Outcomes
Research Institute (PCORI) fee
Medicare tax increase for high
earners
Expanded coverage for
early retirees
Increased penalty for nonqualified HSA withdrawals,
including over the counter drugs
Expanded Regulatory
Compliance imposed on
employers now offering group
benefits. Non-compliance
could result in fines.
No deduction for retiree drug
subsidy
Women’s extended preventive
services with no cost-sharing
W-2 reporting on value of
employer sponsored plans
Extending coverage to
young adults up to age 26
Grandfather status
New rescission rules
Non-discrimination rules
No pre-existing conditions for
enrollees under age 19
Preventive care at no
additional cost
Regulating annual limits on
essential benefits
Small business tax credits
No prior authorization for
emergency services
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As a result of the ACA, many people have benefitted from
expanded coverage and cost savings. Since the law was passed,
many provisions have been enacted creating a foundation for
the 2014 market.
What’s ahead for 2014?
The Individual/ Family Market
Individual/Family Plans
Grandfathered vs. Non-Grandfathered• If you purchased your plan prior March 23,2010 and did not make any significant
plan changes your plan is grandfathered.
• If your plan was purchased after March 23, 2010 or if you made any changes to your
plan after March 23, 2010 then your plan is non-grandfathered
• Grandfathered Plans
• Plans and networks do not change on January 1, 2014
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Individual/Family Plans
ACA Compliant Plans
Platinum Plan = 90% Actuarial Value*
Plan pays 90% of health costs
Enrollee pays 10%
Gold Plan = 80% Actuarial Value*
Plan pays 80% of health costs
Enrollee pays 20%
Silver Plan = 70% Actuarial Value*
Plan pays 70% of health costs
Enrollee pays 30%
Bronze Plan = 60% Actuarial Value*
Plan pays 60% of health costs
Enrollee pays 40%
Each plan in every metal level must cover the same set of essential health benefits. While the range of benefits
will be very similar among the plans, the coverage will vary across these levels, based on the amount of costsharing required.
*Note that the actuarial values must fall into a 4 percentage point range of their category, so the
plan and member plan percentages may vary.
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Individual/Family Plans
• Deductibles: Plan design deductibles Silver and above may not exceed $2,000 (single) or $4,000 (family)..
• Limits on Cost-Sharing: All cost-sharing (including copayments) for Essential Health Benefits services must
count toward the out-of-pocket maximum. In addition, cost-sharing (deductibles, coinsurance, copayment,
or similar charges) will be limited to the dollar amounts in effect that year for HSA-eligible high deductible
health plans.
Essential Health Benefits include:
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Ambulatory Patient
Services
Emergency Services
Hospitalization
Maternity & Newborn
Care
Mental Health and
Substance Abuse Services
Prescription Drugs
Rehabilitative Services
and Devices
Laboratory Services
Preventative and wellness
services
Pediatric Services
The Exchanges- Covered CA
Individual/Family Plans
Individual/Family Plans
Individual Mandate- any individuals without government approved coverage are
subject to a tax/penalty. Each tax/penalty applies to each individual, up to a max of
three household members.
Health Insurance Penalty Phase-In Schedule
Pay the greater of the two amounts
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Year
Percentage of income
above tax-filing
threshold
Set dollar amount
2014
1.0%
$95
2015
2.0%
$395
2016
2.5%
$695
Individual/Family Plans
Elimination of Pre-existing Conditions and Medical Underwriting- all plans will
become guaranteed issue, no longer will carriers be able to decline or “rate-up” an
applicant due to medical history.
Open Enrollment- Because plans will be Guaranteed issue there will be an open
enrollment period.
2014- 10/1/2013-3/31/2014
2015 and subsequent years- 10/1-12/7
Enrollment and Changes can only be made during those times unless a qualifying
event happens ie marriage, birth of a child, adoption, etc.
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The Exchanges
Beginning in 2014, all Americans must purchase health insurance or pay a tax. To
facilitate purchasing, states are setting up health insurance exchanges for individuals
and small businesses to purchase coverage.
California’s Exchange will have two parts:
•Covered California- Individual & family plans
•SHOP – Small Business Health Options Program
Enrollment thru the Exchanges starts on October 1, 2013- 3/31/2014
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The Exchanges: Covered CA
Individual/Family Plans
Tax Credits/Subsidies – if you fall between 138% and 400% of the Federal
Poverty Line and purchase your insurance inside the exchange (Covered CA)
you could be eligible for a government subsidy, in the form of an advanced
premium tax credit.
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# of people Household
138% FPL
400% FPL
1
$1,300
$3,723
2
$1,761
$5,043
3
$2,222
$6,363
4
$2,682
$7,683
5
$3,143
$9,003
6
$3,604
$10,323
The Exchanges- Covered CA
Individual/Family Plans
• Covered CA- Individual Health Insurance Exchange
o Online marketplace to view the standardized plans across the
different carriers in your region.
– 13 carriers participating across the state
The Exchanges- Covered CA
Individual/Family Plans
Analysis
• At Van Beurden Insurance we will analyze your
circumstances, assess your situation, and
present all appropriate options.
Need More Information?
Brad Knerr
(805)528-1484 x 4719
[email protected]