HEALTH CARE REFORM FOR SMALL BUSINESSES AND SOLE PROPRIETORS Artists Health Insurance Resource Center A program of The Actors Fund Renata Marinaro, Health Services Director, Eastern Region

What is The Actors Fund? The Actors Fund is a nationwide human services organization that helps all professionals in performing arts and entertainment. The Fund is a safety net, providing programs and services for those who are in need, crisis or transition.

Our services  Social Services  Housing  Employment and Training Services  Health Services

Words to know Co-pay Co-insurance Deductible Premium Out-of-pocket maximum HMO & POS/PPO Federal Poverty Level Marketplace Advanced Premium Tax Credit (aka subsidy)

 Children under age 19 with pre-existing conditions can’t be denied coverage.  Young adults up to age 26 (in NY, through age 29) can stay on or enroll in their parents’ coverage. Note: special rules apply for coverage from age  Insurers can’t retroactively cancel the policies of people who get sick. What has health care reform done for me so far?

 All new plans must cover certain preventive services for free. These include: certain breast, colon and cervical cancer screenings; blood pressure, diabetes and cholesterol tests; vaccines, immunizations, and flu shots; and HIV & STD testing.  Insurers can’t impose annual or lifetime dollar limits on medical benefits.  Insurers must spend at least 80% of a consumer’s premium dollars on actual medical care. What has health care reform done for me so far?

 Insurers can’t refuse coverage to anyone, or exclude pre- existing conditions  Most people will be mandated to have coverage or pay a penalty. In 2014, the penalty is $95 or 1% of your income. It goes up to $695 or 2.5% of income in  Medicaid eligibility will be expanded to people with incomes up to 138% of FPL (approx $15,856/yr) What happens in 2014?

 New insurance marketplaces, called Marketplaces, will offer insurance to those who don’t get it through their employer or Medicaid.  Subsidies will be available to people who buy insurance through a Marketplace with income less than 400% of the Federal Poverty Level. ($45,960)  Enrollment in Marketplaces will begin Oct 1, 2013 and end March 31, What happens in 2014?

Employers

 2014: Employers do not have to offer coverage.  Starting in 2015, those with 50 or more employees will have to pay a penalty if they don’t. 2015: Mandate applies only for employers with 50 or more full time equivalent employees (FTEs) - FTEs calculated on a 30 hour work week Will employers be required to offer insurance?

 If you choose to opt out of your employer’s coverage, you will still have to be insured or pay a penalty.  Employees who are offered coverage and choose not to take it will not be eligible for subsidies to pay for coverage through the Marketplace, unless the employer’s plan fails to meet certain benefit guidelines.  Guidelines: Policy must cover at least 60% of medical costs and cannot cost more than 9.5% of employee’s income Does an employee have to accept an employer’s insurance?

 You can continue to provide the same coverage you do now.  You can choose to buy:  Directly from an insurer  Through a broker or agent  On the SHOP Marketplace (with or without the help of a broker or navigator) Where will an employer buy insurance?

What is the SHOP Marketplace? The SHOP Marketplace will sell and administer insurance plans for small businesses online You can select one or a variety of health plans for employees to choose from You can set a fixed contribution to employees’ coverage Administrative simplicity—one monthly invoice, one monthly bill, and help throughout the process!

Who can buy on the SHOP Marketplace? To participate, employers must: Have 50 or fewer employees Be a valid business Offer coverage to all full-time employees* Have a business address or a primary employee worksite in New York State * Employer can define FT, but must be at least 20 hrs/wk

What do I need to enroll on the SHOP Marketplace? Employer: EIN or TIN Gender, DOB, Social Security Number Number of FT and FTE employees Average annual wage (excl. owner and family) Employee roster, incl. dates of birth of employees and dependents

When can I enroll? Initial open enrollment begins October 1, 2013, for coverage beginning January 1, If you apply between 1 st -15 th of the month, coverage begins the first of the following month If you apply between the 16 th and last day of month, coverage begins the first of the second following month Annual Open enrollment occurs on the policy anniversary date.

In the SHOP, employers can…. Choose whether to offer all, some or only one plan in the Marketplace to their employees Choose how much they want to contribute towards employees premiums. They can pay all, some or none of the employee’s premiums There is no minimum contribution, but in order to get a tax credit you have to pay at least 50% of the employee’s premium

Tax Credits for Non-Profit Small Businesses Small businesses (2-49 employees) aren’t required to offer coverage; however… Businesses can receive tax credits for doing so if they buy coverage on the SHOP Marketplace The credit is refundable for a tax-exempt employer

Which employers are eligible? Fewer than 25 full-time (equivalent) employees Two half-time employees count as one full-time employee Average annual wages less than $50,000 Not counting wages of the owner or her family Employer pays at least 50% of premium cost

How to claim the credit Claim credit using IRS Form 8941, available at Non-profits also use Form 990T to claim credit Credit can be claimed for 2 consecutive taxable years Tax credit calculator calculator/ Tax credit calculator Talk to your accountant!

Individuals

 If you don’t get it through your job or a public program, you can buy it through the Marketplace.  Marketplace: a competitive, private insurance marketplace. Shop for plans and buy coverage on the Marketplace website. Marketplaces will also administer new subsidies.  For individuals and families, there will be 4 Tiers of benefits on the Marketplace – Bronze, Silver, Gold, and Platinum - and 1 catastrophic plan (for those under age 30). Where will I buy insurance?

 Name as it appears on your legal documents or identification card  Social Security Number (if you have one)  Date of birth (for all household members)  Tax filing status  The name and address of your current employer(s)  Income information (It might be helpful to bring last’s year tax returns for everyone in the household, paystubs, W2 forms, or if you are self- employed, a record of last three months earnings and expenses)  Information about any other health insurance you or other family member may have  If applicable, immigration (“Alien”) number for immigrant family members  Information about disability status What do I need to bring with me to enroll?

Considerations when picking a plan Cost of Care Premium Deductible Out of Pocket Max PCP Specialist Hospitalization Access to Care Network Doctors Hospitals Benefits Consider your health status/needs! Quality of Care Independent ratings Opinions from family and friends Feedback from doctors/providers Personal experience

Tier% of costs covered by insurer DeductibleConsumer’s max out of pockets costs Bronze60%$3,300$6,350 Silver70%$2,000$5,500 Gold80%$600$4,000 Platinum90%$0$2,000 What will the plans look like in NY?

What benefits do plans on the Marketplace offer? Hospitalization Office visits (PCP & Specialist) Emergency Room Ambulance Mental Health treatment Substance Abuse treatment Medications Diagnostic and lab work Preventive Screenings (free) Maternity care Chiropraxis Gym reimbursement!

Will there be dental coverage? Only for children. For discounted dental services visit:  NYU & Columbia dental schools  New York City Technical College  Dental hygiene clinic: Provides cleaning, fluoride treatment, and x-rays;  Hospital-based low-cost dental care  html html  Negotiate with your dentist!

 If a company offers coverage to an employee, the company must also offer coverage to children (but not spouses).  The employer must make insurance affordable to the employee (less than 9.5% of the employee’s income) but does not have to offer affordable family coverage.  All children in New York are eligible for the Children's Health Insurance Program (CHIP). What about family coverage?

 Under age 30: high-deductible plan option. Deductible is $6,350. Prevention benefits and 3 primary care visits are exempt from deductible.  Under age 26: can stay on/enroll in parents’ plan, regardless of living situation, marital status, student status, or financial dependence.. In NY, adults age can stay on their parents coverage, but special rules apply: you must be unmarried, live or work in NY, and have a policy that was issued in NY. Are there special programs for people under 30?

 You can buy insurance as an individual on the Marketplace. This increases your options and will reduce premiums for those with lower incomes. You may also qualify for the APTC (premium subsidy).  You can’t buy on the SHOP Marketplace.  You may qualify for Medicaid if your income is under $15,856 (single). I’m self-employed. How will this affect me?

 If your income is $11,490 - $45,960 (single), you will receive a subsidy to buy insurance through the Marketplace.  Subsidies will cap the amount you spend on premiums in relation to your total income.  Some people will also be eligible for subsidies that cap your deductible and annual out-of-pocket medical costs. How Will I Afford Insurance?

 Use your HOUSEHOLD modified adjusted gross income:  Adjusted Gross Income (line 37 of Form 1040)  +  Non-taxable social security benefits  Tax Exempt Interest  Foreign Earned income For Medicaid eligibility, you can exclude from your income: scholarships, awards and grants (for education only), and certain lump sum one-time payments How do I calculate my income?

FPL 2013Annual income range Annual percent of income Annual premium contribution %$11, , %$229-$ %$17, , %$ 689-$1, %$22, , %$1447-$ %$28, , %$2312-$ %$34, , %$3274-$4366 Subsidy Chart

 Example: Susan is single and makes $22,000/yr. She will have her premiums capped at 6.3% of her income (approx $130/mo) and her annual out-of-pocket medical costs will be limited to under $4000/yr (excluding premiums).  Calculate your potential subsidy here:  ator ator Example

More info:  Navigating the ACA for small businesses  First Tuesday of every month  5:30-7pm  th Avenue, 11 th floor  Rsvp:  Navigating the ACA for individuals  Every Thursday  12:30-1:30pm  th Avenue, 10 th floor  Rsvp: Small Business Seminar - monthlyIndividual seminar - weekly

For All New Yorkers Assistance for Small Businesses and Consumers