Presented by Sandra W Moody, LUTCF CLTC, CPIA Dehan Enterprises Insurance & Financial Services LLC ObamaCare and Your Bottom Line.

Presented by

Sandra W Moody, LUTCF CLTC, CPIA

Dehan Enterprises Insurance & Financial Services LLC

ObamaCare and Your Bottom Line

How We Got Here

• Total US HC Spend is more than $2.8 trillion• HC Expenses now represents 17.6% of GDP• 72% of HC Spend on 6% of Population• Nearly 75% of HC Spend on Big 4 Diseases• 87 Mil Americans Uninsured at Some Point• 80% of the Uninsured from Working Families• Approx 15% of African Americas including 1 mil

Children Uninsured

Dehan Enterprises Insurance & Financial Services

How We Got Here


• Ohio ranks 8th in total Uninsured• 1.3 mil Ohioans Uninsured• Number of Employer Plans Declining Since 2000• Premiums have Risen 4 Times Wages• 61% of adults are overweight• Obesity Rate in Children Tripled Since 1980• 77% of all Rx taken by those over age 50• 46% of Ohio’s Small Businesses offer Health Insurance

Patient Protection and Affordable Care Act

• Establishes Individual Mandate • Establishes Employer Mandates• Expands Medicaid Eligibility to 133% of

FPL• Establishes Healthcare Exchange

Marketplaces• Eliminates Lifetime Maximums & Adds

Free Wellness• Dependent Coverage Extended to Age 26• Eliminates Pre-existing condition

Requirements• Closes the Medicare Donut Hole by 2020


PPACA, Affordable Care

Act, ACA or ObamaCare

Enacted March, 2010

By President

Obama

Patient Protection and Affordable Care Act

71 mil Kids and Adults have Received no Cost Preventive Care

3.1 mil Young Adults Obtained Coverage thru Parents Plan (2012)

$1.1 Bil in Rebates to 12.8 Mil Americans

$6.1 Bil Saved on Rx by Seniors (since 2010)


2011 Average Annual Group Premiums


Single Family

PPOs $5,584 $15,404

HMO $5,350 $15,288

HSAs $4,793 $13,704

Individual Mandates

Requires everyone to have health insurance. Those who are not insured in 2014 will be

subject to an annual health tax penalty starting at $95 or 1% of taxable income

whichever is greater and rising to $695 or 2.5% of income in 2016.


Open Enrollment Period - Individual

• Initial Open Enrollment October 1st, 2013• Open Enrollment closes March 31, 2014

for all individual medical plans!• Future Annual Open Enrollment October

15th until December 7th

• Coverage Effective Date January 1st, 2014


Health Insurance Marketplaces

Special Enrollment Period Qualifying Events

Loss of Minimum Essential Coverage

Material Contract Violations by Marketplace Insurance

CarrierGaining or Becoming a

DependentGaining or Losing Eligible

Premium Tax Credits of Cost Sharing Reductions

Relocation Resulting in New or Different Qualified Health Plan

Gaining Lawful Presence

Enrollment Errors by the Marketplace

Exceptional Circumstances



• Premium Subsidies for 133% to 400% of FPL• Subsidies only available for individuals purchasing

through exchange• Cost sharing which lowers Out of Pocket for incomes

below 250% of FPL• People with “essential benefits” and “affordable”

group coverage cannot obtain subsidies• Those eligible for Medicaid cannot obtain subsidies• If employer has coverage thru SHOP employees are

not eligible for subsidies



Provides another avenue to obtain insurance coverage

Ohio’s Federally Facilitated Marketplace (FFM)12 Insurance Companies

Approx 170 Plans in 17 rating areas

Online Portalwww.healthcare.gov

26 FFM – 16 State Based – 8 Partnerships


http://www.healthcare.gov/

Determining Premium

Your age, where you live, family composition and

whether you smoke, will determine your premium!


Ohio Geographic Rating Areas


Essential Health Benefits

Qualified Health Plans Include at Least These 10 Benefits

Ambulatory Patient Services Prescription Services

Emergency Services Rehabilitative and Habilitative Services and Devices

Hospitalization Laboratory Services

Maternity and New Born Care Preventive and Wellness Services and Chronic Disease Management

Mental Health and Substance Abuse Disorder Services Including Behavioral Health Services

Pediatric Services, including oral and Vision


Metal Levels of Care

Level of Coverage Plan Pays on Average

Enrollees Pay on Average(In addition to the monthly premium)

Bronze 60% 40%

Silver 70% 30%

Gold 80% 20%

Platinum 90% 10%


Individual Carriers In the Marketplaces

• Buckeye Community Health Plan

• Anthem Blue Cross & Blue Shield

• AultCare• CareSource• HealthAmerica One• HealthSpan

• Humana Health Plans• Kaiser Foundation

Health Plan of Ohio• Med Mutual• Molina • Paramount• SummaCare







Enrollment Assistance

• Website Portal• Toll free Call Center• Insurance Navigators• Enrollment Counselors• In Person Assisters• Community Based Organizations• Agents and Brokers (each state’s decision)


2013 Federal Poverty Level

Number of Persons In Household

100% FPL 400% FPL

1 $11,490 $45,590

2 $15,510 $62,040

3 $19,530 $78,120

4 $23,550 $94,120

5 $27,530 $110,280

6 $31,590 $126,360Dehan Enterprises Insurance & Financial

Services LLC

Maximum Annual Premium Paid by Those Eligible for

Subsidies in Health Care Exchanges% of FPL Max Prem

%1 PersonFamily

2 PersonFamily

3 PersonFamily

4 PersonFamily

100% 2% $230 $310 $391 $471

133% 2% $306 $413 $520 $626

133.1% 3% $456 $619 $780 $940

150% 4% $689 $931 $1,172 $1,413

200% 6.3% $1,448 $1,954 $2,461 $2,967

250% 8.05% $2,312 $3,114 $3,921 $4,728

300% 9.5% $3,275 $4,420 $5,566 $6,713

350% 9.5% $3,820 $5,157 $6,494 $7,830

400% 9.5% $4,366 $5,894 $7,421 $8,949Dehan Enterprises Insurance & Financial

Services LLC

Medicaid Expansion

Increases income eligibility to 138% of the federal poverty level.

For a single person, $15,856 Family of four, $32,499

Single adults without children eligible

24 States Moving Forward22 States Not Implementing

4 States Debating (Ohio is one)Dehan Enterprises Insurance & Financial

Services LLC


SHOP ExchangeSmall Business Health Options Program

Ohio’s FF-SHOPEmployers with less than 50 employees from 2014 through 2016. After 2017 may allow businesses with more than 100 employees to access coverage here.


Small Business Tax Credits


The credit equals 35% of the employer share of the premium. Business must pay at least 50 percent of the full

premium and have fewer than 25 employees with less than a $50,000 average salaries. Owners are excluded.

To continue receiving the credit after 2013, business must purchase group coverage through the Exchange.

Credit increases to a maximum of 50% in January, 2014.

Determining FTE Eligibility

• Employers choses a “look-back” period of between 3 and 12 months to measure if an employee has worked an average of 30 hours per week.

• If meets the 30 hour threshold, during the look-back period, considered FTE for the “stability period” of at least the next six months, regardless of how many hours the employee works

• Employer must provide FTE with health insurance or pay a tax penalty.

• Guidance pending on seasonal and temporary workers


Pay or Play Employer Tax Penalty

Employers will face tax penalties if the coverage offered is unaffordable or does meet minimum essential benefits value and an employee receives a subsidy from the Exchange for coverage.

Penalty excludes first 30 FTE.Affordability - Employee’s share of the employee only premium cannot exceed 9.5% of W-2 income.

Delayed until January, 2015 Dehan Enterprises Insurance & Financial

Services LLC

Pay or Plan Employer Tax Penalty

Penalty for No Coverage

Large employer that does not offer coverage and at least 1 employee receives premium subsidy from the exchange, will incur a penalty of $2000 per FTE.

Penalty for Unaffordable Coverage

Large employers who do offer coverage and at least 1 employee receives premium subsidy from exchange, will pay lesser of $3,000 for each receiving the subsidy or $2,000 for each FTE.


Large Employer Requirements

• By 2014, employers with more than 200 employees, requires automatic enrollment into employer health plan.

• By 2015, mandatory reporting for large employers, health insurance issuers and government agencies.


ObamaCare and Its Your Bottom Line

Employer Reporting

W-2s required to include cost of employer provided health insurance.

Summary of benefit to all eligible employees Fair Standards Labor Act – Healthcare Exchange

Notification



Health Savings Accounts (HSAs) – tax on non-qualified medical expenses increases from 10% to 20%

Over the counter drugs no longer reimbursable under HSAs, HRAs, FSAs

FSAs contributions decreases from $5,000 to $2,500 Itemized federal deduction threshold increases from

7.5% to 10% of AGI


32

Long Term Care Insurance . . . An Extension of Your Medical Insurance

Fed’s Encourage LTC

Health & Welfare Reform of 1996

Deficit Reduction Act of 2005TAX-DEDUCTIBLE premiums & TAX-FREE benefits

Increased look back period to 5 years

State Partnership ProgramsMedicaid spend down protection

Affordable Care Act - CLASS ActVoluntary Government LTCi Plan (repealed Jan 2013)


Skilled CareMedically needed

Intermediate CareLess frequent skilled care

Custodial CareHelp with ADLs or memory

1st 60 Days Next 40 Days After 100 Days

Covered Not Covered

Covered

Not Covered

Not Covered

The gaps in your traditional medical insurance!


What Is Long Term Care?

It is the delivery of medical and personal care, other than hospital care to persons with chronic medical conditions resulting

from illness or frailty.

Post Retirement Disability


Long Term Care Insurance…An Extension of Your Medical Insurance

IT CAN HAPPEN TO ANYONE

AT ANY TIME

AUTO INJURIES

CANCER

INJURIES FROM ACTIVITIES

DIABETES

STROKE &HEART ATTACK

ARTHRITIS &OSTEOPOROSIS


Activities of Daily Living

• Bathing• Dressing• Transferring• Toileting• Continence• Eating or• Severe Cognitive Impairment



LTCi Provides Services For . . .

• Home Health Care• Personal & Homemaker Care• Assisted Living Facilities• Adult Day Care Facilities• Alzheimer Facilities• Nursing Homes• Hospice Facilities



Average Annual Cost of Care In Ohio 2012$81,213 Private Room In a Nursing Home

$73,000 Semi-Private Room in Nursing Home

$44,550 Assisted Living Facility (private, one bedroom)

$43,197 Medicare Certified Home Health Aid (50 hrs per week)

$42,328 Homemaker Services (50 hrs per week)



Working Caregivers Are Costing Your Business

Lost ProductivityEmployers lose an estimated $33.6 billion a

year on productivity due to employee caregiving.

Health Insurance UtilizationWorking caregivers consume 8% or $13.4 billion more in healthcare services per year.



Now What?• Continue to Get Informed• Engage Accounting and Benefits Professionals• Educate Your Employees and Family Members• Explore Adding Ancillary Benefits• Institute a Culture of Wellness• Use Current Insurance Carriers & Agent Websites• Buy Medical and Long Term Care Insurance Now• Get Healthy, Stay Healthy


Resources• www.dehaninsurance.com• www.Healthcare.gov• www.barackobama.com/health-care• www.medicare.gov• Kaiser Foundation – Health Care Reform

kff.org/health-reform• www.longtermcare.gov• www.marketplace.cms.gov• www.moodyLTC.com• SBA, IRS, HHS, Dept of Labor• Your Current Health Carrier and Insurance BrokerDehan Enterprises Insurance & Financial

Services LLC



http://kff.org/health-reform

http://www.longtermcare.gov/

http://www.marketplace.cms.gov/


Dehan Works on Your Behalf


Helping You in the Creation,

Accumulation, and Protection of Wealth!

614 [email protected]

www.dehaninsurance.comwww.moodyltc.com

• Individual & Group Medical Plans• Commercial/Business Insurance• Employee Benefits & Exec Benefits• Long Term Care Insurance Plans• Personal Financial Planning• Personal Auto/Home/Motorcycle• Voluntary Payroll Deduction Plans• Surety, Fidelity & Contract Bonds• Financial Education Training

http://www.dehaninsurance.com/

Presented by Sandra W Moody, LUTCF CLTC, CPIA Dehan Enterprises Insurance & Financial Services LLC ObamaCare and Your Bottom Line.

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