The medicalinsuranceexchange.com Obamacare Update 11,05,13

ACA: The Great Equalizer for Small to Mid-Size Businesses (SMBs)

…Stuff your benefits consultant or broker doesn’t know or doesn’t want you to know!

New Strategies On How to Use ACA to: • Benefit your Business

• Benefit Your Employees

• Disadvantage Your (Bigger) Competitors.

• And how to keep more of what you make!

ACA: The Great Equalizer for Small to Mid-Size Businesses (SMBs)

…Stuff your benefits consultant or broker doesn’t know or doesn’t want you to know!

Find some ACA “Easter” Eggs for your biz!

US History Lesson

1935: Social Security and Disability Created1965: Medicare Created1985: COBRA Created2003: Medicare Prescription Drug “Part D” Created2010: ACA (Obamacare) Created

Each of Above was Controversial ● Each Required Education and Adjustment by Americans ● Each Bas Been Modified Through Legislation ● None Has Ever Been Repealed ● Each Quickly Became a “Right of Citizenship”

2014: ACA “Guaranteed Issue” Health Plans

– History Repeats Itself!

“The Good Ship ‘Guaranteed Issue’ Has Sailed”

• ACA can’t be defunded without Senate vote to change ACA from a Mandatory to Discretionary Spending budget item.

• Future changes likely, but “Guaranteed Issue” is here to stay

ACA Individual Plans:“Better” than Group Plans

• Comprehensive, Essential Health Benefits in all ACA Plans:

• Preventative, Wellness• Maternity, Child Dental, Vision• Serious mental, emotional, drug/alcohol

abuse, tobacco cessation, obesity counseling.

Under Healthcare Reform, Are Benefits Still Beneficial?

Why many employees will seek jobs that do NOT offer group health

insurance starting in 2014, and how SMBs can benefit…


Under ACA, Bigger ≠ Better

• 2015 Employer Tax Penalties• More Compliance• More Legal, Administrative

In Fact, Being Smaller May Be Better, More Profitable!


“Benefit” of Getting Bigger:

• Self-Insure = Lower Cost under ACA• Less Mandates, Taxes• No Community Rating• More Control Over Employee Health

• 100+ (Healthy) Employees

A:

Why are they called “Benefits”?

Because They Benefit the Employee.

Four ways:

1. Employer Contribution – Nobody else is going to pay for their health insurance

2. Tax Free – Receive benefits tax free, pay their portion of premium tax free through 125 plan

3. Guaranteed Issue – Employees and dependents cannot be denied coverage or charged more due to medical conditions (big deal in Texas)

4. Mandated Benefits – Group plans cover services not covered by individual plans (i.e. maternity – although these benefits do drive up the costs)

Most of the “Benefits” are Gone

The “Benefits” of a Group Health Plan Are Gone in 2014.

1. Employer Contribution – This now penalizes most employees (More about this later)

2. Tax Free – Receive benefits tax free, pay their portion of premiums tax free through 125 Cafeteria plan.

3. Guaranteed issue – Employees and dependents can no longer be denied coverage or charged more due to medical conditions with individual ACA plans

4. Mandated Benefits – Group plans cover services now covered by individual plans (i.e. maternity).

1. Size of Business (# of Employees)2. Average Income of Employees3. Costs – Group Premium Vs. Penalty etc…

Factors will be:

WHAT ARE BIG EMPLOYERS DOING ABOUT ACA?

Reducing workforce

Reducing hours to <30hrs/week

Dropping coverage

WHAT ARE BIG EMPLOYERS DOING ABOUT ACA?

Cutbacks = not a place you want to work

Part-time/revolving door = mistakes & lost productivity

Cost increases passed on to customers

Who Wants to Work at a BIG Company?

Losing Advantage of Size and Scale

Employer of Last Resort + No loyalty

Lower profits, Customer satisfaction.

ACA advantages to SMBs

SMBs can become an employer of choice

Stable, personal SMB = customer, employee loyalty

Lower employee cost, lower turnover, more talent

• ACA Plan N. TX Premiums:• Lowest cost PPO (Bronze) Plan for 40/50/60 yo:

• $239.70/$354.22/$539.68• Lowest cost PPO (Silver) Plan for 40/50/60 yo: • $341.04/$488.51/$736.04• Lowest cost PPO (Gold) Plan for 40/50/60 yo: • $412.26/$590.52/$889.75• Lowest Cost HMO (Bronze) Plan for 40/50/60 yo: • $189.72/$271.82/$409.46

ACA Plan Rates:

IRS Tax Subsidies are SMBs New Best Friend.

How Dropping Group Health Benefits Helps “Most” Employees under ACA

(& Employees’ New Best Friend.)

• Household Size ~ Household Income ~ Annual Subsidy

Here’s The Link to Subsidy Calculator:

http://themedicalinsuranceexchange.com/obamacare-subsidy-calculator/



For “Most” Employees, An Employer Health Plan is NOT a

Benefit under ACA!One Example:

• Median for HH Family of 4: $60,000

– Employer Pays 50% of Employee Only Premium, $250 per month, $3,000/yr.

– Est. Cost to Insure Family = $11,500/yr.

– IRS Premium Tax Credit: $6,700

Dropping Group Health Benefits Helps “Most” Employees under ACA

Big ACA “GOTCHA”:• If Either Spouse’s Employer

Offers a Group Health Plan for Employees…

• Then Entire Household is Disqualified from IRS Premium Tax Credit!

Big ACA “GOTCHA”:• The $ from the IRS

Premium Subsidy Likely More than What Employer Contributes for Health Insurance!

This Is Why Unions Are So Mad!

No Tax Subsidies if a Group Health Plan Available

Your Company Key Employees

“Experienced” Employees

• Big Companies with Big, Self-Insured Health Plans Will Continue to Shed Older, Wiser Employees

• BIG OPPORTUNITY FOR SMBs to pick up valuable talent without risk of medical claims hurting company’s benefits.

What about your #1, AndMost Valuable Employee?

?

What about your #1,Most Valuable Employee?

• If Dropping Group Health Insurance Saves Your Employees $$ and gives them better coverage options…

• …What could dropping Group Health do to Benefit Your Business and Benefit YOU?

YOU!

Founder/CEO


How Dropping Group Health Ins. Can Benefit Your Business:• Reduces administrative

time + red tape.• Eliminates your

company’s biggest budget inflation item.

• Frees up $$ for other uses in the business.

YOU!

Founder/CEO


How Dropping Group Health Ins. Can Benefit YOU:• Increase profitability &

business valuation.• Fund a Max.

Retirement /Profit Sharing Contribution

• Fund ESOP to get your equity out of business.

YOU!

Founder/CEO

Do the Math: Employer

• SMB with 40 employees spends minimum of $120,000/yr. on group health insurance premiums

• IF SMB makes 5% after tax profit, it takes $2,400,000 in extra sales just to pay for group health insurance.

Do the Math: Employee

• SMB pays $3,000 towards per employee with avg. annual wages of $50,000.

• Est. IRS Premium Subsidy of $6,500 for employee with family of 4.

• The $3,500 extra from premium subsidy is an extra six weeks wages.

Do the Math: Self-Employed

• Deductions reduce how much you pay in IRS Taxes.

• Deductions could also increase your IRS Insurance Subsidy.

• Premiums are deductible if self-employed.

• By opting to pay full premiums, you increase deductions, and increase IRS Tax Credit Alternative (Silver Plan or Better)

If Group Health Insurance Is No Longer a Benefit, Then What is??

• Taxable Benefits:– Pay Increase– Bonuses

• Tax-Favored Benefits:– Profit Sharing Plan– 401K Contribution– Dental, vision, other ins.– ESOP

Other Ways to Attract & Retain Employees:

Here’s How I Help Your SMB:• Adjust Your Employee Benefits to ACA

Realities & Opportunities• Educate Your Employees About The New

ACA Realities & About Your New Benefits• Enroll Your Employees In New Benefits,

Including Individual ACA Health Plans

My Value Proposition

3 Simple Steps for Employer:

Revise Benefits Plan

Employee Group Meeting

One on One Enrollment

Apply for Subsidy

Shop for Health Insurance

Employee Pays The Difference

3 Simple Steps for Employee:

Business Advantages

Helps You Attract and Retain Great Employees

Offer flexible and affordable benefit plans that all of your employees qualify for

Reduces Benefits Inflation & Admin Cost

A Private Health Insurance Exchange

How can I learn more about ACA?

IMPORTANT:Don’t Procrastinate!• Get familiar with rates, networks, etc.• Decide on best plan now.• If no subsidy, apply now• If subsidy-eligible, decide now, apply

asap Healthcare.gov is fixed.


Deadlines:1. 11/15/13: Last date for “pre-

ACA” plan (both individual and Group) for 12/1/13 coverage.

• Underwritten, no IRS subsidy• Rates fixed until 12/1/14• At that point, only (higher cost)

ACA plans available


Deadlines:2. 12/15/13: Last date for ACA

plan (both individual and Group) for 1/1/14 coverage

• Guaranteed Issue• Higher Cost• But May Qualify for IRS

Subsidy.


Deadlines:3. 3/31/14: Last date for ACA

plan (both individual and Group.) for 5/1/14 coverage

• Guaranteed Issue• Higher Cost• But May Qualify for IRS

Subsidy.


Healthcare.gov Issues• No Fix Until 11/30 (maybe)

• No Subsidy until fixed• Decide on Health Plan Now• Narrow Window to apply by

12/15 for 1/1/14 coverage.


Seek Professional Advice• No cost to work with a broker.• Saves Time, Better Decisions,

avoid costly mistakes.• Help throughout the year

with claims, insurance issues.


Want an Obamacare Quote?1. Go to:

www.TheMedicalInsuranceExchange.com

2. Click on “Quotes” button on Left Hand Side.

3. Go to Subsidy Calculator for Subsidy Estimate.

http://www.themedicalinsuranceexchange.com/

http://www.themedicalinsuranceexchange.com/



Call/Email Me to Discuss/Enroll

– [email protected]– (214) 764-6315• Put “Obamacare Request” in subject line.• Will send documents you need to enroll,

along with updates.• Will follow up with request for appointment

a few days later.

mailto:[email protected]


What you’ll get now:

• 11 page ACA FAQ Guide• Subsidy Chart

• Pre-enrollment Checklist

• TX Rate and Plan Guide

• Updates

How You’ll Benefit

What you’ll get:

• Cutting Edge Advice

• Expertise in ACA and other insurance/benefits

• Keep more of what you earn

• Support throughout the year.

A Stress-Free ACA Enrollment

• Save you, employees $$

• Pre-education, guidance

• Smooth, hassle-free enrollment

• Year-round support

Value-Based No Cost Services

What this costs you:

• Absolutely no additional cost to enroll through a broker.

• Costs you $$$ in missed opportunities or extra medical expenses from poor decisions.

• Saves valuable time working with an expert, so you can focus on your business.

Value-Based No Cost Services

What this costs you:

• Absolutely no additional cost to enroll through a broker.

• Costs you $$$ in missed opportunities or extra medical expenses from poor decisions.

• Saves valuable time working with an expert, so you can focus on your business.

Next Steps

• Schedule Appointment• Formulate Plan• Communicate Plan• Implement/Enroll• >December 15th

• Quarterly Updates


Call/Email Me to Discuss/Enroll

– [email protected]– (214) 764-6315• Put “Obamacare Request” in subject line.• Will send documents you need to enroll,

along with updates.• Will follow up with request for appointment

a few days later.

mailto:[email protected]

Economy & Finance

The medicalinsuranceexchange.com Obamacare Update 11,05,13