Presentation on theme: "Making Hay in the ACA what is in it for me? Call 1-866-309-0557 Access Code *1291180*"— Presentation transcript:
Making Hay in the ACA what is in it for me? Call Access Code * *
During a live webinar For the courtesy of all participants, please: Place your phone on mute Either press *6* Or press the mute button on your phone device To unmute, press *6* or the unmute button on your phone device Do not place you phone on hold at anytime Either remain on mute or hang up if you need a break
Agenda Important resources to help you and your prospects Health Insurance Marketplace Certification BCBSTX Certification 2014 BCBSTX ACA plans & agent commissions Using tax subsidies to prospect and grow your clientele
Agenda Continued SHOP Exchange Update Small Group Health Insurance Tax Credits (HITCs) Using HITCs to get more small group health insurance Early renewal strategies Marketing tips
Disclaimer This presentation is tailored for independent health insurance agents in the state of Texas that intend to write BCBSTX in the HIMs
Valuable ACA Resources All located in our Health Care Reform section at
Scroll down to Health Care Reform, where ACA related resources may be found.
https://www.healthcare.gov/https://www.healthcare.gov/ (available in Spanish)
Hola? : The Spanish version of will not be able to accept new HIM enrollments for a few weekswww.healthcare.gov : Spanish online enrollment is not going to happen…this year An estimated 10 million Latinos are eligible for coverage, and 4 million of them speak Spanish primarily. The state of Texas is 40%+ Latino
Use for YouTube video learningwww.CMS.gov
Registration Process for Agents / Brokers Note: the agent distribution channel did not create the problems…but we must deal with them. Know that we would like to help you register, but we cannot do anything to fix the volume or technology challenges. If you need assistance, call The certification process is beginning to work now.
Getting set up to market on the HIMs Four step process: 1.Register at the CMS Enterprise Portal (Part 1) 2.Complete your certification at The Health Insurance Marketplace website 3.Register to accept applications in the HIMs (Part 2) 4.Complete the BCBSTX required certification
Step One: Register to certify
https://marketplace.medicarelearningnetworklms. com Certify
Step 3: Register to enroll people in the HIMs
Step 3 - Setting Up Your FFM Account You create your FFM UID (Federally Funded Marketplace User ID) when you create your account on the CMS Enterprise Portal during the agent/broker registration process. If you forget your FFM User ID or password information, click on the "Forgot my User ID/Password" link on the CMS Enterprise Portal log- in web page at https://portal.cms.gov/. https://portal.cms.gov/
er Step 4: Get certified with The Blues
The message is simple: Right now, nothing is required by Federal law for you to own. On January 1, 2014, that changes. You will then be required by law to own a qualified health insurance. If you cannot afford a QHP, you will be subsidized. If you choose not to own a QHP, you will be penalized. If you need help, I will help you.
Simplify the message – use the Government sources!
Marketing tips Know how to calculate subsidies Know how to complete a HIM application Hint: no health questions, more qualification questions Find the Health Insurance Marketplace applications for a QHP at in the HCR Resources section Know how to calculate Health Insurance Tax Credits for groups of 2-25 Use HITCs to prospect small groups of 2-25 lives
Health Insurance Marketplace (Short Form)
HIM (Short Form)
Who are the 50M uninsured? And how do I get quotes and sign them up?
Individuals Eligible for Premium Tax Credit, by Income
Individuals Eligible for a Premium Tax Credit, by Employment Status
Individuals Eligible for a Premium Tax Credit, by Age
How do you get a health insurance quote?
You will end up at the Kaiser website
– Subsidy Calculator
Enter demographic info & click submit
Subsidies are based on the 70% Actuarial Value Plan or The Silver Plan 70% AV Plan Premium $11,450 Minus the subsidies- $ 8,085 Net premium cost to family= $ 3,365 per year Total Family Premium is $280 per month
60% AV Plan or The Bronze Plan 60% AV plan premium $9,490 Minus the subsidies - $8,085 Net premium cost to family= $1,405 per year Total Premium is $117 per month
ACA MOOP (Max Out of Pocket) $6,350 for an individual $12,700 for a family Same as the MOOP of an HDHP (high deductible health plan) Bronze or Silver plans have the same max out of pocket If you only make $50K per year, how can you pay this MOOP? Add a supplemental health plan
Sales Idea: The Combo Plan Bronze Plan and Active Care Bronze Premium$117 Active Care Premium$153 Total Family Premium$270 per month $10 less per month than The Silver Plan at $280 per month, but the supplemental health plan helps offset the $12,700 MOOP.
What is Active Care? New supplemental health product combines Critical Illness, Cancer, Heart Attack, Stroke, ESRD, and Accident benefits into one product Simplified underwriting May be list billed Agent commission is 50% Contact for complete Visit
Lets review these numbers again… HIM PlanAmount paid by family Subsidized Amount Total PremiumCommission 70% value (Silver)$3,365$8,085$11,4506% = $687 60% value (Bronze)$1,405$8,085$9,4906% = $569 Active Care+ $1,836 =$1, % = $918 $3,241$11,320 = $1,487 6% commission is paid by BCBSTX for years 1-3, and 4% level after that.
Which plan is best suited for the family? The Silver Plan costs $280 per month The Bronze Plan / Active Care plan costs $270 per month The Combo Plan saves the family $10 per month in total premium The Combo Plan offers better protection to the family The Combo Plan pays the agent 54% more commission!
<250% Federal Poverty Level = CSR or Cost Sharing Reductions Similar to the Medicare Savings Plan (Low Income Subsidy), a person at or below the 250% FPL is eligible for cost sharing on the Silver Plan Think of how the low income subsidies work within the Medicare Savings Program How might this impact your recommendations? Should they even consider a supplemental plan(s)? Or should they consider less of a supplemental benefit plan(s)?
2014 BCBSTX HIM Plans Rx Benefits The Gold Plan On Exchange & The Gold Plan Off Exchange The Silver Plan On Exchange & The Silver Plan Off Exchange The Bronze Plan On Exchange & The Bronze Plan Off Exchange
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION BCBSTX Individual Plans Rx Benefits Structure Benefit Structures Drug Card Coinsurance after Medical Deductible Formulary Standard Formulary on PPO Network Generics Plus formulary on narrow networks Generics Plus is essentially a leaner version of the standard formulary and includes non-specialty and specialty drugs for all major therapeutic categories 5-Tier Drug (2-tier Generics) Drives utilization towards Generic drugs 47
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. On Exchange – Gold 48
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. On Exchange – Silver 49
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. On Exchange – Bronze 50
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. Rating Characteristics 51 Age Bands Age 0-20 is one age band Age have single year age bands Age 64+ is one age band Family Demographics The maximum number of dependents (age 0-20) that will be rated on a family plan is capped at 3 Dependents age 21+ do not count toward the cap Under age 20 or younger count toward the cap Benefit Design Metallic Level & Actuarial Value Cost Sharing Network
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. Rating Characteristics Tobacco Use 6 month look back to qualify for non-tobacco BCBSTX tobacco rates are 10-33% higher than the non-tobacco rates (permitted to rate up to 50% higher) Rates are subject to the 3:1 rating ratio Geographic Rating Areas Geographic rating will be by county, not Zip Code Based on the address of the Primary Insured - Even if any member on a policy has a different address than the Primary Insured Texas has 26 defined rating areas
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. BCBSTX Agent Compensation Commissions 6% - Years 1-3 4% - Years 4+ Based on full premium, not subsidized premiums $25 per app bonus for effective dates
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. Utilize the Retail Shopping Cart and ExpressLink If multiple applications are received, the agent on the last application received, prior to the 15 th of the month, will be assigned as the AOR (on and off exchange) Applications with incomplete or missing broker information will be processed as direct Getting paid: Points to Remember
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION. Training & Certification You must obtain CMS Certification You must submit your Marketplace ID to BCBSTX You must complete the BCBSTX Product Training module On Exchange (Public) You must complete the BCBSTX Product Training module Off Exchange (Private)
The Small Business Health Options Program The SHOP Exchange
Health Insurance Tax Credits (HITCs) How can you use HITCs (Health Insurance Tax Credits) to prospect for more business? How many CPAs understand HITCs? Where do you get info to see if your clients will qualify? How do you get employer HITC calculations? Or are they called health premium tax credits?
HITC calculator at
Small group HITCs at
Get used to referencing
IRS Tax Tips: The Small Business Health Care Tax Credit
Early renewal strategies New policy effective date in December 2013 will push the ACA requirements back by one calendar year, delaying the move to a plan that may be more expensive Creates a new health plan year from through What may happen in December 2014 Convert to an ACA compliant product Convert to a defined contribution strategy Drop your health plan How could this impact calendar year Section 125 plans?
Wrap up…go sell ! The Brokerage is proud to be a BCBS General Agent in: Texas New Mexico* Oklahoma* Illinois* You will be able to sell in the: Public Exchanges Private Exchanges SHOP Exchanges *Medicare related products only
Your time is now! Get appointed with BCBSTX through The Brokerage Get certified For help getting started, call The Brokerage Toll free Direct lines: Belynda DiCiaccio Cristin Hopkin-Bishop Dana Ragsdale Click here to meet our staff online
Dont forget 6,200,000 uninsured Texans About 2.2M are 138% FPL or below – let the Navigators enroll this population That leaves 4,000,000 uninsured Texans Say 1 out of 4 enroll There are about 13,000 BCBSTX appointed agents 1,000,000 divided by 13,000 is 77 apps per agent Go forth and prosper!
During the Q & A session Typing a question in the GoToMeeting box is best Keep your phone on mute: Either press *6* Or press the mute button on your phone device To ask a question, please unmute your phone To unmute, press *6* or the unmute button on your phone device Reminder: do not place your phone on hold at anytime Any background music playing while on hold ruins the event for all participants and may result in a session terminating prematurely Either remain on mute or hang up if you need a break
Thank you for your participation! This presentation has been recorded and will be posted in the HCR Resources section at