Health Care Reform: The Top 10 Things You Need to Know

Health Care Reform: The Top 10 Things You Need to Know

1. The Individual Mandate applies to YOU:

Beginning 1/1/2014, most Americans (citizens and residents) must have health insurance or pay a penalty.

WHY?

One of the main objectives of Health Care Reform is to provide access to insurance to individuals with pre-existing medical conditions.

To make this happen, the “risk” of insurance must be spread:• old and young• healthy and sick• nationwide

The Individual Mandate applies to YOU, continued:

Some people are exempt from the mandate:

- If you are uninsured for 3 months or less

- If coverage costs more than 8% of your income

- If you are not required to file a tax return because your income is low

- If you would qualify for Medicaid, but your state has chosen not to expand Medicaid eligibility

- If you are a member of a federally recognized Indian Tribe

- If you participate in a health care sharing ministry

- If you are a member of a recognized religious sect with religious objections to health insurance

- If you receive a special exemption

The Individual Mandate applies to YOU, continued:

The Good News: The APC Medical Plans fulfill your requirement under the Individual Mandate.

You are eligible for the plan if you are regularly scheduled to

work 20 hours per week or more.

The Individual Mandate applies to YOU, continued:

If you do not participate in the APC medical plan, you have other options to satisfy the individual mandate, including:

• Another employer plan (for example, your spouse’s employer)

• Medicare or Medicaid

• Individual Coverage

The Individual Mandate applies to YOU, continued:

If you do not have coverage:

• For most people, the penalty in 2014 will be 1% of household income.

• You are required to report this on your federal tax return each year.

• The penalty increases each year, and in 2016, the fee is the higher of $695 per adult or 2.5% of household income.

2. The APC Plan is Affordable

Health Care Reform defines “affordable” coverage as employee-only coverage with a contribution less than 9.5% of your wages.

For example, if you earn $2,000 per month, your employee-only contributions could be $190 per month and be considered affordable.

The employee-only contribution for the HMO is currently $0 for full time employees.

The APC Plan is Affordable, continued

If you are Part-Time….

The APC medical plan is affordable for most, if not all, part-time employees.

There may be some limited circumstances in which a part time employee does not have affordable coverage.

3. The APC Plan Offers Minimum Value

Health Care Reform defines “Minimum Value,” as a medical plan that pays, on average 60% or more of health care costs across all covered lives.

Keep in mind that your personal medical claims may result in higher or lower levels of coverage.

Affordable Coverage and Minimum Value become important as we introduce The Marketplace.

4. Coverage in the Marketplace is NOT Free

Health Care Reform creates an insurance Marketplace (also

called Exchange) where individuals can purchase coverage on

an individual basis, with no pre-existing condition exclusions.

Some people, will get help paying for the cost of this coverage

(more on this in a minute…)

Coverage in the Marketplace is NOT Free, continued

Because you are eligible for the APC medical plan, you are most

likely not eligible for any financial assistance because you

already have access to Affordable and Minimum Value Coverage.

This means, to buy coverage on the Marketplace – you will

likely have to pay the ENTIRE monthly premium.

Coverage in the Marketplace is NOT Free, continued:

If you are part time and coverage with APC is not affordable, you

may be eligible for some financial assistance in the Marketplace.

The Marketplace will make all determinations about financial

assistance eligibility.

5. Financial Assistance (Subsidies) in the Marketplace are Tax CreditsThere are two ways to get financial assistance in the

Marketplace:

1. Premium Subsidies that lower your monthly cost to purchase

insurance, and

2. Cost Sharing Subsidies that lower your plan costs, such as

deductibles.

Both methods of subsidy are Tax Credits. The amount you

receive will be measured against your actual household

income when you file your taxes.

Just like your regular income taxes – you have to pay

overages back to the government.

6. Coverage in the Marketplace is NOT Tax Deductible

Whether you pay the full premium, or if you are receiving

financial assistance, any portion of the monthly premium you

pay is with after-tax dollars.

The contributions you pay via payroll deductions for the APC

medical plan are pre-tax.

7. www.healthcare.gov

7. www.healthcare.gov

Why go to www.healthcare.gov?

1.If you want to know what plans are available on the individual

market and how much they cost.

2.If you want to know more about Health Care Reform in

general.

3.If you are part time and the APC medical plan is not

affordable

8. Medicaid

Health Care Reform provides for the expansion of Medicaid to

anyone earning up to 133% of the Federal Poverty Level.

• $15,282 for a single person, in 2014

• $31,322 for a family of four, in 2014.

Currently, Medicaid eligibility is defined state-by-state, and often excludes able bodied adults, regardless of income.

The Supreme Court struck down the mandatory expansion of

Medicaid and has left each state to decide

www.medicaid.gov has the most recent updates.

9. Pick a Primary Care Physician Now

The Congressional Budget Office estimates that up to 15 million

people will acquire health insurance next year – through the

Marketplace and through Medicaid.

Who is going to provide the care for these new patients?

Physician offices often close to new patients when their patient

rolls get to certain, pre-established levels.

10. Fast Facts

1. COBRA is still available after qualifying events

2. Medicare is unchanged

3. Exchange Notices

4. APC is a large employer under the rules of Health Care

Reform

• The Employer Mandate is to “Pay or Play” - 2015

• Employers have new taxes

5. If you have general questions about Health Care Reform:

• The Kaiser Family Foundation Website: www.kff.org

Thank you!