I thought it was called the AFFORDABLE Health Care Act?

Well, when you have to sell a big idea to millions of people, you need to come up with a catchy name and Affordable Health Care Act seemed to fit the bill.  But post - 1/1/14, health insurance is still genuinely affordable for a relatively small number of citizens.

The base rates on new health insurance policies took a pretty good jump as of 1/1/14.  There are multiple reasons for that which include:  low limits on deductibles and out of pocket expenses, new fees being paid by everyone from the insurance companies to the physicians, and additional coverage that is now required that used to be optional.  After all, somebody has to pay for the subsidies being offered through healthcare.gov.

Yes, the subsidies.  That is the financial help (aka: discounts) being offered to those who qualify due to income. And if you meet certain criteria -your coverage may be affordable.  If an individual makes less than 400% of the federal poverty limit, they may be eligible for a subsidy, although, I have found their income must be SUBSTANTIALLY less than that limit to qualify for a meaningful amount.  But be careful.  If your income is under 100% of the fed poverty limit, you make too little to qualify for a subsidy in Florida.  Yes, you read that right - but that's a topic for another post.

The other "test" of affordability is the cost of coverage for those working for businesses with 50+ employees.  To meet federal guidelines (and avoid penalties) the employer must offer a plan that does not cost any employee more that 9.5% of their income for "employee only" coverage.  However, those limits do not typically help with the cost of the employee's dependents.

So, in the end, if you have a solid middle class income (over $60,000 for a couple) you will get no financial help and the coverage you purchase will cost more than it did a year ago - and there are reasons for that.

Does all that that make me a down with reform advocate?  Not exactly.  Some good things have happened - but that's for the next post.

After the 3/31/2014 Deadline

The first open enrollment for ACA healthcare reform policies has closed.  Are you now enrolled in a health insurance plan?

I've had calls asking "is it too late to enroll?"  And the answer is:  generally yes, but sometimes no.  Clear enough for you?

If you have had no insurance and just didn't get around to enrolling - in most cases it's now too late.  You will have to wait until the next open enrollment which is scheduled to begin November 15th.

However, if you lose coverage because you change jobs or your employer discontinues their group plan, that will create a special enrollment period for you - and you can enroll if you do so quickly.

Keep in mind, this is the federal government and with well over 300,000,000 people in the US, the list of rules and exceptions is almost infinite.  If you aren't sure how this will apply to your situation, you may call me or the nice people at healthcare.gov to discuss your situation.


Watch for my next post entitled "I thought it was called the AFFORDABLE health care act?"

Daytona Obedience Club Class Schedule for April 2014

The Obedience Club Of Daytona has obedience courses for April Here is the description of the BASIC course:

Dogs and handlers learn the basic skills for having a good pet. Dogs to walk on a leash without pulling, come, sit, stay and problem solving such as: potty and crate training, behavioral issues. This class prepares dog and handler to take the AKC recognized "Canine Good Citizen" test. 

Click For More Information on the April 2014 Obedience Class Schedule

Self Insured Plans for Small Busiensses

Health Care Reform is changing the look of health insurance throughout the nation.  As I have mentioned earlier, it is also causing some old ideas to resurface.  One of those is self insured plans for small groups.

First, one clarification.  Virtually no employer, regardless of size, truly self-insures for the entire risk of covering their employees and dependents with health insurance.  Instead, the employer agrees to pay up to a certain amount per person, and a larger amount in total claims for all employees.  Then they have special insurance that pays claims that exceed those amounts.

Although self insured plans have been tried with small employer groups from time to time, this has generally been  recommended for businesses with at least several hundred employees or more.  However, thanks to a provision in the health care reform legislation, self-insured coverage is getting another look.  Why?  Because it is largely exempt from the reform rules.

Yes - exempt from the rules.  And this could be good news.  The HCR rules could cause insurance to become so expensive, it may be more difficult than ever to purchase,  A product that gives us more flexibiltiy could be very helpful.

Once again, it's too early to tell.  But, if you are a small employer, be on the lookout for self-insured plans and decide if that's a good move for you.

Small Employer Option to Group Health Insurance

As mentioned in the previous posting - many insurance professionals feel that small employers (fewer than 50 employees) will move away from offering group health insurance when Health Care Reform allows individuals to purchase insurance regardless of health conditions.  However, employers realize that quality employees will still look to their employer to help with the cost of health insurance  What to do?

A premium reimbusement plan may be an option to consider.  In simple terms it works like this:  employer determines how much they are willing to contribute to each employee for health coverage (let's say $300 per month).  The employer sets up a reimbusement plan with a third party administrator and makes the contributions to each employee's account monthly.  The employee can then access that money to pay a portion of their health insurance premium.  If the contribution is more than that employee's premium, they can use the remaining funds for other designated health related expenses.

This concept has been around a long time but was of limited use unless you had a very health group with very healthy dependents.  The new law effective 1/1/14 will make it a more viable option for many.  One warning: there are still significant rules that must be followed in using this arrangement so use professionals  to handle the funds.

Employers with fewer than 50 employees

If your employer has fewer than 50 employees, health care reform doesn't penalize them for not offering health insurance.  In fact, they may qualify for a subsidy if they do.  But - they must qualify with the federal government - and requalify periodically.

In the past, small employers offered health insurance because it was difficult for employees to purchase their own unless they were in excellent health.  Health Care Reform will change that making it possible for anyone to purchase coverage regardless of health conditions. Since they will be free from the burden of being the only potential source of health coverage for many of their staff - will small employers still want to be involved? 

Many of us in the insurance industry feel the answer to that question is "No."  Small employers are likely to take this opportunity to get out from under a time consuming chore that was a headache for them all along.  Only time will tell, but with guaranteed issue individual plans scheduled to arrive by 1/1/2014 - more employees are likely to have to learn to compare and purchase policies for themselves.

Next week - an alternate method for small employers to help employees with their health coverage.

Health Care Reform - I work for a large employer - what should I do?

If you are already covered by your mid to large sized employer (50 employees +) you probably don't have to do anything.  Although the law doesn't force a business to offer health insurance, there will be financial penalties if they don't.  So, those who offer coverage now are likely to continue.  And 50 + employee businesses that don't offer coverage now are being strongly encouraged to do so - again, penalties if they don't comply.  However, stay alert to what is happening at work - some employers are threatening to rebel by refusing to offer or discontinuing benefits and paying the penalty.  That may be all bluster - but make sure your family's security doesn't get caught in the middle.

Next post coming week of May 20th:  What if I work for a company with less that 50 employees?