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Presented by Sandra W Moody, LUTCF CLTC, CPIA Dehan Enterprises Insurance & Financial Services LLC ObamaCare and Your Bottom Line.

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Presentation on theme: "Presented by Sandra W Moody, LUTCF CLTC, CPIA Dehan Enterprises Insurance & Financial Services LLC ObamaCare and Your Bottom Line."— Presentation transcript:

1 Presented by Sandra W Moody, LUTCF CLTC, CPIA Dehan Enterprises Insurance & Financial Services LLC ObamaCare and Your Bottom Line

2 How We Got Here Total US HC Spend is more than $2.8 trillion HC Expenses now represents 17.6% of GDP 72% of HC Spend on 6% of Population Nearly 75% of HC Spend on Big 4 Diseases 87 Mil Americans Uninsured at Some Point 80% of the Uninsured from Working Families Approx 15% of African Americas including 1 mil Children Uninsured Dehan Enterprises Insurance & Financial Services

3 How We Got Here Dehan Enterprises Insurance & Financial Services Ohio ranks 8 th in total Uninsured 1.3 mil Ohioans Uninsured Number of Employer Plans Declining Since 2000 Premiums have Risen 4 Times Wages 61% of adults are overweight Obesity Rate in Children Tripled Since 1980 77% of all Rx taken by those over age 50 46% of Ohios Small Businesses offer Health Insurance

4 Patient Protection and Affordable Care Act Establishes Individual Mandate Establishes Employer Mandates Expands Medicaid Eligibility to 133% of FPL Establishes Healthcare Exchange Marketplaces Eliminates Lifetime Maximums & Adds Free Wellness Dependent Coverage Extended to Age 26 Eliminates Pre-existing condition Requirements Closes the Medicare Donut Hole by 2020 Dehan Enterprises Insurance & Financial Services PPACA, Affordable Care Act, ACA or ObamaCare Enacted March, 2010 By President Obama

5 Patient Protection and Affordable Care Act 71 mil Kids and Adults have Received no Cost Preventive Care 3.1 mil Young Adults Obtained Coverage thru Parents Plan (2012) $1.1 Bil in Rebates to 12.8 Mil Americans $6.1 Bil Saved on Rx by Seniors (since 2010) Dehan Enterprises Insurance & Financial Services LLC

6 2011 Average Annual Group Premiums Dehan Enterprises Insurance & Financial Services SingleFamily PPOs $5,584$15,404 HMO $5,350$15,288 HSAs $4,793$13,704

7 Individual Mandates Requires everyone to have health insurance. Those who are not insured in 2014 will be subject to an annual health tax penalty starting at $95 or 1% of taxable income whichever is greater and rising to $695 or 2.5% of income in 2016. Dehan Enterprises Insurance & Financial Services LLC

8 Open Enrollment Period - Individual Initial Open Enrollment October 1 st, 2013 Open Enrollment closes March 31, 2014 for all individual medical plans! Future Annual Open Enrollment October 15 th until December 7 th Coverage Effective Date January 1 st, 2014 Dehan Enterprises Insurance & Financial Services

9 Health Insurance Marketplaces Special Enrollment Period Qualifying Events Loss of Minimum Essential Coverage Material Contract Violations by Marketplace Insurance Carrier Gaining or Becoming a Dependent Gaining or Losing Eligible Premium Tax Credits of Cost Sharing Reductions Relocation Resulting in New or Different Qualified Health Plan Gaining Lawful Presence Enrollment Errors by the Marketplace Exceptional Circumstances Dehan Enterprises Insurance & Financial Services LLC

10 Health Insurance Marketplaces Premium Subsidies for 133% to 400% of FPL Subsidies only available for individuals purchasing through exchange Cost sharing which lowers Out of Pocket for incomes below 250% of FPL People with essential benefits and affordable group coverage cannot obtain subsidies Those eligible for Medicaid cannot obtain subsidies If employer has coverage thru SHOP employees are not eligible for subsidies Dehan Enterprises Insurance & Financial Services LLC

11 Health Insurance Marketplaces Provides another avenue to obtain insurance coverage Ohios Federally Facilitated Marketplace (FFM) 12 Insurance Companies Approx 170 Plans in 17 rating areas Online Portal www.healthcare.gov 26 FFM – 16 State Based – 8 Partnerships Dehan Enterprises Insurance & Financial Services LLC

12 Determining Premium Your age, where you live, family composition and whether you smoke, will determine your premium! Dehan Enterprises Insurance & Financial Services LLC

13 Ohio Geographic Rating Areas Dehan Enterprises Insurance & Financial Services LLC

14 Essential Health Benefits Qualified Health Plans Include at Least These 10 Benefits Ambulatory Patient ServicesPrescription Services Emergency ServicesRehabilitative and Habilitative Services and Devices HospitalizationLaboratory Services Maternity and New Born CarePreventive and Wellness Services and Chronic Disease Management Mental Health and Substance Abuse Disorder Services Including Behavioral Health Services Pediatric Services, including oral and Vision Dehan Enterprises Insurance & Financial Services LLC

15 Metal Levels of Care Level of CoveragePlan Pays on Average Enrollees Pay on Average (In addition to the monthly premium) Bronze60%40% Silver70%30% Gold80%20% Platinum90%10% Dehan Enterprises Insurance & Financial Services LLC

16 Individual Carriers In the Marketplaces Buckeye Community Health Plan Anthem Blue Cross & Blue Shield AultCare CareSource HealthAmerica One HealthSpan Humana Health Plans Kaiser Foundation Health Plan of Ohio Med Mutual Molina Paramount SummaCare Dehan Enterprises Insurance & Financial Services LLC

17 Health Insurance Marketplaces Dehan Enterprises Insurance & Financial Services LLC

18 Health Insurance Marketplaces Dehan Enterprises Insurance & Financial Services LLC

19 Health Insurance Marketplaces Enrollment Assistance Website Portal Toll free Call Center Insurance Navigators Enrollment Counselors In Person Assisters Community Based Organizations Agents and Brokers (each states decision) Dehan Enterprises Insurance & Financial Services LLC

20 2013 Federal Poverty Level Number of Persons In Household 100% FPL400% FPL 1 $11,490$45,590 2 $15,510$62,040 3 $19,530$78,120 4 $23,550$94,120 5 $27,530$110,280 6 $31,590$126,360 Dehan Enterprises Insurance & Financial Services LLC

21 Maximum Annual Premium Paid by Those Eligible for Subsidies in Health Care Exchanges % of FPLMax Prem % 1 Person Family 2 Person Family 3 Person Family 4 Person Family 100%2%$230$310$391$471 133%2%$306$413$520$626 133.1%3%$456$619$780$940 150%4%$689$931$1,172$1,413 200%6.3%$1,448$1,954$2,461$2,967 250%8.05%$2,312$3,114$3,921$4,728 300%9.5%$3,275$4,420$5,566$6,713 350%9.5%$3,820$5,157$6,494$7,830 400%9.5%$4,366$5,894$7,421$8,949 Dehan Enterprises Insurance & Financial Services LLC

22 Medicaid Expansion Increases income eligibility to 138% of the federal poverty level. For a single person, $15,856 Family of four, $32,499 Single adults without children eligible 24 States Moving Forward 22 States Not Implementing 4 States Debating (Ohio is one) Dehan Enterprises Insurance & Financial Services LLC

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24 SHOP Exchange Small Business Health Options Program Ohios FF-SHOP Employers with l ess than 50 employees from 2014 through 2016. After 2017 may allow businesses with more than 100 employees to access coverage here. Dehan Enterprises Insurance & Financial Services

25 Small Business Tax Credits Dehan Enterprises Insurance & Financial Services The credit equals 35% of the employer share of the premium. Business must pay at least 50 percent of the full premium and have fewer than 25 employees with less than a $50,000 average salaries. Owners are excluded. To continue receiving the credit after 2013, business must purchase group coverage through the Exchange. Credit increases to a maximum of 50% in January, 2014.

26 Determining FTE Eligibility Employers choses a look-back period of between 3 and 12 months to measure if an employee has worked an average of 30 hours per week. If meets the 30 hour threshold, during the look-back period, considered FTE for the stability period of at least the next six months, regardless of how many hours the employee works Employer must provide FTE with health insurance or pay a tax penalty. Guidance pending on seasonal and temporary workers Dehan Enterprises Insurance & Financial Services LLC

27 Pay or Play Employer Tax Penalty Employers will face tax penalties if the coverage offered is unaffordable or does meet minimum essential benefits value and an employee receives a subsidy from the Exchange for coverage. Penalty excludes first 30 FTE. Affordability - Employees share of the employee only premium cannot exceed 9.5% of W-2 income. Delayed until January, 2015 Dehan Enterprises Insurance & Financial Services LLC

28 Pay or Plan Employer Tax Penalty Penalty for No Coverage Large employer that does not offer coverage and at least 1 employee receives premium subsidy from the exchange, will incur a penalty of $2000 per FTE. Penalty for Unaffordable Coverage Large employers who do offer coverage and at least 1 employee receives premium subsidy from exchange, will pay lesser of $3,000 for each receiving the subsidy or $2,000 for each FTE. Dehan Enterprises Insurance & Financial Services

29 Large Employer Requirements By 2014, employers with more than 200 employees, requires automatic enrollment into employer health plan. By 2015, mandatory reporting for large employers, health insurance issuers and government agencies. Dehan Enterprises Insurance & Financial Services

30 ObamaCare and Its Your Bottom Line Employer Reporting W-2s required to include cost of employer provided health insurance. Summary of benefit to all eligible employees Fair Standards Labor Act – Healthcare Exchange Notification Dehan Enterprises Insurance & Financial Services LLC

31 ObamaCare and Your Bottom Line Health Savings Accounts (HSAs) – tax on non- qualified medical expenses increases from 10% to 20% Over the counter drugs no longer reimbursable under HSAs, HRAs, FSAs FSAs contributions decreases from $5,000 to $2,500 Itemized federal deduction threshold increases from 7.5% to 10% of AGI Dehan Enterprises Insurance & Financial Services LLC

32 32 Long Term Care Insurance... An Extension of Your Medical Insurance Feds Encourage LTC Health & Welfare Reform of 1996 Deficit Reduction Act of 2005 TAX-DEDUCTIBLE premiums & TAX-FREE benefits Increased look back period to 5 years State Partnership Programs Medicaid spend down protection Affordable Care Act - CLASS Act Voluntary Government LTCi Plan (repealed Jan 2013)

33 Long Term Care Insurance... An Extension of Your Medical Insurance Skilled Care Medically needed Intermediate Care Less frequent skilled care Custodial Care Help with ADLs or memory 1st 60 DaysNext 40 DaysAfter 100 Days CoveredNot Covered Covered Not Covered The gaps in your traditional medical insurance!

34 Long Term Care Insurance... An Extension of Your Medical Insurance What Is Long Term Care? It is the delivery of medical and personal care, other than hospital care to persons with chronic medical conditions resulting from illness or frailty. Post Retirement Disability Dehan Enterprises Insurance & Financial Services LLC

35 Long Term Care Insurance…An Extension of Your Medical Insurance IT CAN HAPPEN TO ANYONE AT ANY TIME AUTO INJURIES CANCER INJURIES FROM ACTIVITIES DIABETES STROKE & HEART ATTACK ARTHRITIS & OSTEOPOROSIS

36 Long Term Care Insurance... An Extension of Your Medical Insurance Activities of Daily Living Bathing Dressing Transferring Toileting Continence Eating or Severe Cognitive Impairment Dehan Enterprises Insurance & Financial Services LLC

37 Long Term Care Insurance... An Extension of Your Medical Insurance LTCi Provides Services For... Home Health Care Personal & Homemaker Care Assisted Living Facilities Adult Day Care Facilities Alzheimer Facilities Nursing Homes Hospice Facilities Dehan Enterprises Insurance & Financial Services LLC

38 Long Term Care Insurance... An Extension of Your Medical Insurance Average Annual Cost of Care In Ohio 2012 $81,213Private Room In a Nursing Home $73,000Semi-Private Room in Nursing Home $44,550Assisted Living Facility (private, one bedroom) $43,197Medicare Certified Home Health Aid (50 hrs per week) $42,328Homemaker Services (50 hrs per week) Dehan Enterprises Insurance & Financial Services LLC

39 Long Term Care Insurance... An Extension of Your Medical Insurance Working Caregivers Are Costing Your Business Lost Productivity Employers lose an estimated $33.6 billion a year on productivity due to employee caregiving. Health Insurance Utilization Working caregivers consume 8% or $13.4 billion more in healthcare services per year. Dehan Enterprises Insurance & Financial Services LLC

40 ObamaCare and Your Bottom Line Now What? Continue to Get Informed Engage Accounting and Benefits Professionals Educate Your Employees and Family Members Explore Adding Ancillary Benefits Institute a Culture of Wellness Use Current Insurance Carriers & Agent Websites Buy Medical and Long Term Care Insurance Now Get Healthy, Stay Healthy Dehan Enterprises Insurance & Financial Services LLC

41 Resources www.dehaninsurance.com www.Healthcare.gov www.barackobama.com/health-care www.medicare.gov Kaiser Foundation – Health Care Reform kff.org/health-reform kff.org/health-reform www.longtermcare.gov www.marketplace.cms.gov www.moodyLTC.com SBA, IRS, HHS, Dept of Labor Your Current Health Carrier and Insurance Broker Dehan Enterprises Insurance & Financial Services LLC

42 ObamaCare and Your Bottom Line Dehan Works on Your Behalf Dehan Enterprises Insurance & Financial Services LLC Helping You in the Creation, Accumulation, and Protection of Wealth! 614 238-3520 smoody@dehaninsurance.com www.dehaninsurance.com www.moodyltc.com Individual & Group Medical Plans Commercial/Business Insurance Employee Benefits & Exec Benefits Long Term Care Insurance Plans Personal Financial Planning Personal Auto/Home/Motorcycle Voluntary Payroll Deduction Plans Surety, Fidelity & Contract Bonds Financial Education Training


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