Presentation on the Affordable Care Act given by Lori Compas, Executive Director of the Wisconsin Business Alliance and its sister foundation to De Pere Area Chamber of Commerce on 9/11/13.
3. Presentation Overview
• Current health care system
• ACA changes already in effect
• Changes coming with the new exchanges
• Making your choice
• Employee notification deadline: Oct 1
4. Current health care system
• High cost: Premiums have doubled over the
past nine years
• Small businesses pay 18% more than big
businesses
• Insurance costs more for women and older
workers
• Pre-existing conditions = denied coverage
or very expensive coverage
• Difficult to compare insurance plans
5. ACA changes already in effect
• No penalties for women and older workers
• Children with pre-existing conditions cannot
be denied coverage
• Plan costs and benefits are standardized and
easy to compare
• Young adults can stay on their parents’
plans until they’re 26
6. The new health care exchanges
• You don’t have to offer coverage. No penalty if
you have fewer than 50 employees.
• Health care exchanges are an option,
not a requirement
• If you want to offer coverage, you can choose
to buy coverage on the SHOP
marketplace.
7. SHOP Marketplace
• Standard coverage at various levels:
Platinum – Gold – Silver – Bronze
• Allow you to “compare apples to apples”
• ALL SHOP plans fully cover…
– Preventive care
– Immunizations
– Well child check-ups
– and more
8. SHOP Eligibility
• Open to employers with 50 or fewer FTEs
(full-time-equivalent employees)
• If you're self-employed with no employees,
you can get coverage through the individual
Health Insurance Marketplace,
but not through SHOP.
9. SHOP Features
• Compare health plans online
• You control the coverage you offer
• You decide how much to pay
toward employee premiums
• All plans offer preventive care,
immunizations, well-child check-ups, etc.
• You may qualify for a tax credit
worth up to 50% of your premium costs
10. Tax credits
• For-profit businesses
• < 25 FTEs (and only for employees)
• Pay at least 50% of employees’ premiums
• Employees’ annual salaries can average
no more than $50,000
• Beginning 2014, tax credit is
available only for plans purchased
through SHOP.
11. Calculating & claiming your tax credit
• Use IRS Form 8941, Credit for Small
Employer Health Insurance Premiums
• Include the amount as part of the general
business credit on your income tax return
• Calculator (try different scenarios)
WisconsinBusinessAlliance.com
/ACA
12. Deductions
Since the amount of the health insurance
premium payments is more than the total credit,
eligible small businesses can still claim a
business expense deduction for the premiums
in excess of the credit.
That’s both a credit and a deduction for
employee premium payments.
14. Payments
You can choose to…
• Collect employee share of premiums through
payroll deduction
• Make premium contributions to SHOP with
pre-tax dollars
• Get one monthly bill, make one monthly
payment to SHOP
15. Making your choice
• You determine your employees’ deductible,
co-pays, and out-of-pocket
• In general…
Lower premiums Higher out-of-pocket
Higher premiums Lower out-of-pocket
• Platinum plans generally have the highest
monthly premiums and lowest out-of-pocket
costs.
• The plan with the lowest premium
may not provide you or your employees
with the best overall value.
16. Employee notification
You must notify employees of the new
exchanges by October 1, 2013
How to notify? Model forms available from
the U.S. Dept. of Labor or
WisconsinBusinessAlliance.com/ACA
17. Questions?
Have questions about the SHOP Marketplace
for businesses with 50 or fewer employees?
Call 1-800-706-7893
Monday through Friday, 8-4 central time
Or visit healthcare.gov/small-business
Notas del editor
Source: SBA
Metal levels have nothing to do with QUALITY.The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace, and all Medicaid state plans must cover these services by 2014.
You are probably wondering: what IS an FTE? Basically, two half-time workers count as one FTE. That means 20 half-time employees are equivalent to 10 FTEs, which makes the number of FTEs 10, not 20.(Changing to 100 FTEs in 2016)
Employers can receive a tax credit for up to 35% of what they spend on coverage for employees (25% for nonprofits). On Jan. 1, 2014, this tax credit increases to 50% (35% for nonprofits).Business owners and their families are not eligible for the tax credit.Average annual wages. Say you pay total wages of $200,000 and have 10 FTEs. To figure average annual wages you divide $200,000 by 10 — the number of FTEs — and the result is your average annual wage. The average annual wage would be $20,000.The maximum tax credit is available to employers with 10 or fewer full-time equivalent employees and average annual wages of less than $25,000
Employers can receive a tax credit for up to 35% of what they spend on coverage for employees (25% for nonprofits). On Jan. 1, 2014, this tax credit increases to 50% (35% for nonprofits).Business owners and their families are not eligible for the tax credit.
Employees’ deductible payments and copays – and the total amount they spend out-of-pocket for the year if they need a lot of care – depends on which plan category you choose.As with all health plans, you and your employees will pay a monthly premium. You can decide up front how much you can afford to contribute toward your employees’ premium costs, so you have more control over your company's health coverage spending.For example, with a Bronze plan, the premiums will be lower than a Gold plan. But your employees will probably pay more when they go to the doctor.