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Obamacare 411 for employees
1.
Countdown to Action
2013 Obamacare 411 What? When? Healthcare Costs © 2013 Michael Chapman, GroupBenefitsAdvisors.com
2.
Obamacare 411 © 2013
Michael Chapman, GroupBenefitsAdvisors.com
3.
Obamacare 411 © 2013
Michael Chapman, GroupBenefitsAdvisors.com
4.
Countdown to Action
2013: What every Employee Needs to Know NOW • What You Need to Know • What You Need to Decide • When You Need to Act • Plus, How It Affects Your Job or Job Search What? When? Obamacare 411 © 2013 Michael Chapman, GroupBenefitsAdvisors.com
5.
Obamacare 411 My Qualifications: •
Since 2003, Frequent Public Speaker on Healthcare and Insurance. • Successful Employee Benefits Broker for Companies and Individuals. • Published Author, Blogger. • Helpful, pro bono resource to thousands of individuals and companies in DFW with personal questions and concerns. • Malcolm Gladwell, “Outliers 10,000 Hours” qualification on the subject. • Mike Chapman, mtchapman@endeavorgroup.net • Linkedin.com/in/michaelchapman (14,000+) • 214-764-6315 tel, 214-732-3691 cell © 2013 Michael Chapman, GroupBenefitsAdvisors.com
6.
Obamacare 411 My Dilemma: •
66% of a benefits broker’s subject matter expertise won’t matter in 2014. • 80+% of a benefits broker’s income will disappear in 2014. • I’m uniquely qualified to serve the DFW community by providing simple to follow information that people and companies can use to make healthcare decisions and to move on. • Mike Chapman, mtchapman@endeavorgroup.net • Linkedin.com/in/michaelchapman (14,000+) • 214-764-6315 tel, 214-732-3691 cell © 2013 Michael Chapman, GroupBenefitsAdvisors.com
7.
Obamacare 411 Here’s How
You Can Help Me • Mike Chapman, mtchapman@endeavorgroup.net • Linkedin.com/in/michaelchapman (14,000+) • 214-764-6315 tel, 214-732-3691 cell © 2013 Michael Chapman, GroupBenefitsAdvisors.com I Am Committed to Serve
8.
Countdown to Action
2013: Other Presentations For Following Groups: • What Every President / CFO Needs to Know NOW • What Every HR Professional Needs to Know NOW • What Every Business Owner Needs to Know NOW What? Obamacare 411 What? When? © 2013 Michael Chapman, GroupBenefitsAdvisors.com …Do You Know A Business Group Above That Needs a Speaker?
9.
Obamacare 411 About Me: •
Search Candidate for position of President / COO / CEO for small to mid-size businesses. • Accomplished CEO/President/CEO/US Managing Director for International Companies. • Experience in Internet/Ecommerce/Manufacturing/Fin. Services/BtoC/BtoB Companies. • Startup and Operational Turnaround Experience, both domestic and international. • Twice earned Employee of the Year for well-known Fortune 100 company voted “Most Admired Company” in US by Forbes Magazine. Average US Home owns 4.5 products that I developed and brought to market. • Since 2003, small business owner in employee benefits field. • Mike Chapman, mtchapman@endeavorgroup.net • Linkedin.com/in/michaelchapman • 214-764-6315 tel., 214-732-3691 cell © 2013 Michael Chapman, GroupBenefitsAdvisors.com
10.
Obamacare 411 About Me: •
I’m Available, who do you know? • Business Owner or Ownership, in need of a new leader. • International company, needs a US managing director or president. • Mike Chapman, mtchapman@endeavorgroup.net • Linkedin.com/in/michaelchapman • 214-764-6315 tel., 214-732-3691 cell © 2013 Michael Chapman, GroupBenefitsAdvisors.com
11.
Obamacare 411 Opinions Are
Like This: …Unless you’re a Supermodel, keep it to yourself! --Everybody Has One… …It’s the LAW of the LAND. …Quit Your Whining, Listen to what you need to know! © 2013 Michael Chapman, GroupBenefitsAdvisors.com
12.
Obamacare 411 Why Obamacare? •
Runaway Healthcare Inflation • Major Segment of Americans priced out of Health Insurance. • THE WHY DOESN’T MATTER, THE MAJORITY HAS VOTED! © 2013 Michael Chapman, GroupBenefitsAdvisors.com What? When ?
13.
Obamacare 411 Secy. HHS
Sebelius: Health and Human Services (HHS) Secretary Kathleen Sebelius. • Second Most Powerful Person in US. • Not An Elected Position. • The phrase “secretary shall” appears 858 times in HR 3509 (2,409 pages) and 24 times in HR 4872 (1,037 pages) © 2013 Michael Chapman, GroupBenefitsAdvisors.com
14.
Obamacare 411 Disclaimers:“Health and
Human Services (HHS) Secretary Kathleen Sebelius said Monday April 8, 2013 that she did not anticipate how complicated implementing the president’s signature healthcare law would be.” • Due to the constant changes in the interpretation and application of Obamacare, this presentation is guaranteed NOT to be 100% accurate. Information covered in this presentation is guaranteed to change. You must do your own due diligence. • This presentation should not be construed as offering legal, insurance, or tax advice, nor is it providing ACA Exchange Navigator advice. This presentation is for Texas only. © 2013 Michael Chapman, GroupBenefitsAdvisors.com
15.
Obamacare 411 WHAT: PPACA,
ACA, or Obamacare • Social Legislation • Redistribution of Wealth and Income • Redistribution of HealthCare • Regulation of Healthcare Providers and Industry • Funds Technology to Reduce Waste and Programs for Public Health. © 2013 Michael Chapman, GroupBenefitsAdvisors.com What? When ?
16.
Obamacare 411 WHAT: PPACA,
ACA, or Obamacare Emancipation of HealthCare: • From Who Can Write a Check For It… • …To a Basic Right of Citizenship. © 2013 Michael Chapman, GroupBenefitsAdvisors.com
17.
Obamacare 411 WHAT: PPACA,
ACA, or Obamacare Market-Based vs. Regulated • From Free Market Pricing & Availability. • To Government Control of Pricing & Availability Healthcare © 2013 Michael Chapman, GroupBenefitsAdvisors.com
18.
Obamacare 411 Take a
Deep Breath… • Impact on You and Your Family It’s Time to Adapt to the New Order! • Impact On Your Budget • Impact On Your Job and Your Employer© 2013 Michael Chapman, GroupBenefitsAdvisors.com
19.
Obamacare 411 When Must
I Make A Decision? • Exchanges Open October 1, 2013 • Obamacare Plans Begin January 1. • Best Time To Make A Decision is NOW! © 2013 Michael Chapman, GroupBenefitsAdvisors.com What? When ?
20.
The Obamacare Clock Is
Ticking.. …The Sooner You Know WHAT to Do © 2013 Michael Chapman, GroupBenefitsAdvisors.com Obamacare 411 …The Longer You’ll Have to Adjust!
21.
Constipated Decision-making = © 2013 Michael
Chapman, GroupBenefitsAdvisors.com Obamacare 411 More Taxes, Penalties, More Expenses, Anxiety, Etc.
22.
Change = Opportunities © 2013
Michael Chapman, GroupBenefitsAdvisors.com Obamacare 411 Use Knowledge of Obamacare as a Competitive Advantage.
23.
Obamacare 411 Nobody is
An Expert… Be the Expert! “Health and Human Services (HHS) Secretary Kathleen Sebelius said Monday April 8, 2013 that she did not anticipate how complicated implementing the president’s signature healthcare law would be.” © 2013 Michael Chapman, GroupBenefitsAdvisors.com
24.
Obamacare 411 Brief Overview
of What it Is • Coverage Differences • How You Buy It • What It Costs You • Consequences to You and Employer © 2013 Michael Chapman, GroupBenefitsAdvisors.com What? When ?
25.
Obamacare 411 Your Health
Plan will be Different © 2013 Michael Chapman, GroupBenefitsAdvisors.com 2013 2014
26.
Obamacare 411 © 2013
Michael Chapman, GroupBenefitsAdvisors.com 98% of Today’s Health Plans Will Be Replaced Just Kidding!
27.
Obamacare 411 Some of
the Big Plan Differences: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Different Deductibles – • Max $2,000 Deductible. • $3,500 Max Out of Pocket. • “Guaranteed Issue,” Regardless of Your Health. • More Coverage, Examples: • Maternity Coverage, Dental Checkups to Age 6
28.
Obamacare 411 More Big
Plan Differences: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • No “Rate Ups” for Risk or Conditions • Except May Charge 50% More for Smoking • May Offer Discount for Wellness Plan Participation • 3 vs. 6 Age Bands • Community Rating.
29.
Obamacare 411 Buzz Word:
Essential Benefits © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Prescription drugs
30.
Obamacare 411 Essential Benefits,
continued: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services; chronic disease management • Pediatric services, including oral and vision care
31.
Obamacare 411 Essential Benefits,
continued: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Items or services that have an „A‟ or „B‟ rating • Immunizations for routine use in children, adolescents, & adults • Evidence‐informed preventive care and screenings • No cost sharing for preventive care services (in‐network)
32.
Obamacare 411 Your Premiums
Will Be Different: © 2013 Michael Chapman, GroupBenefitsAdvisors.com 2013: $$$ 2014: ???
33.
Obamacare 411 © 2013
Michael Chapman, GroupBenefitsAdvisors.com • Out of pocket max greater than $3,500. • You don’t have guaranteed issue or maternity coverage now. • You’re younger than age 35 (approx.) • You live in an area with high healthcare utilization. • Your employer decreases contribution or drops group plan. You May Pay More in Premiums If in 2013:
34.
Obamacare 411 You May
Pay Less in Premiums If in 2013: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Out of pocket max now less than $3,500. • You have guaranteed issue coverage (Risk Pool). • You’re older than age 50 (approx.) • You live in an area with low healthcare utilization. • Your employer maintains/increases health plan contribution or improves health plan.
35.
Obamacare 411 Anybody Want
to Guess the Biggest Factor Whether You’ll Pay More or Less? © 2013 Michael Chapman, GroupBenefitsAdvisors.com
36.
Obamacare 411 How Much
You Make How Much You Own © 2013 Michael Chapman, GroupBenefitsAdvisors.com
37.
Obamacare 411 Your Choices: ©
2013 Michael Chapman, GroupBenefitsAdvisors.com Pay Play Delay
38.
Obamacare 411 Your Choices: ©
2013 Michael Chapman, GroupBenefitsAdvisors.com Pay: Play Delay A Penalty for No Insurance Purchase Private, Group, Medicare, Excha nge Insurance Renew / Change Plan in Nov ‘13
39.
Obamacare 411 Whatever You
Choose, You’ll Pay More: © 2013 Michael Chapman, GroupBenefitsAdvisors.com Taxes Goods & Services New Federal Tax on Insurer Premiums, 3.8% Tax on Unearned Income.
40.
Obamacare 411 Your Employer
Will Pay More: © 2013 Michael Chapman, GroupBenefitsAdvisors.com + 2% Payroll Taxes Compliance Insurance Premiums
41.
Obamacare 411 Impact On
Seniors: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Reduction In Medicare Budget • Likely To Pay More Based on Assets and Income • Review Boards / Ration Care • Chronic Illness Management
42.
Where You’ll Buy: ©
2013 Michael Chapman, GroupBenefitsAdvisors.com Employer Exchange • Employer • Private Insurance (Broker) • Medicare/Tricare/Govt. Jobs. • Online Exchanges • Private Exchanges • Federal or State Exchanges (Federal Only in TX) • 2015: SHOP for small biz (< 25) Obamacare 411
43.
Obamacare 411 Where: © 2013
Michael Chapman, GroupBenefitsAdvisors.com Medicare.Gov
44.
Obamacare 411 Where: © 2013
Michael Chapman, GroupBenefitsAdvisors.com Healthcare.Gov
45.
Obamacare 411 Where: © 2013
Michael Chapman, GroupBenefitsAdvisors.com Marketplace.CMS.Gov
46.
Obamacare 411 Where: © 2013
Michael Chapman, GroupBenefitsAdvisors.com Marketplace.CMS.Gov
47.
Obamacare 411 Where: © 2013
Michael Chapman, GroupBenefitsAdvisors.com Marketplace.CMS.Gov
48.
Obamacare 411 Where: © 2013
Michael Chapman, GroupBenefitsAdvisors.com Marketplace.CMS.Gov
49.
Obamacare 411 Where: © 2013
Michael Chapman, GroupBenefitsAdvisors.com YouTube.CMS.Gov
50.
Obamacare 411 TX Employer
Impact © 2013 Michael Chapman, GroupBenefitsAdvisors.com
51.
Obamacare 411 WHO: All
Businesses, 50 Full Time Employees* © 2013 Michael Chapman, GroupBenefitsAdvisors.com 30 Hr. Part-Time Employees *(Unless Received a Waiver) Seasonal Employees
52.
Obamacare 411 Fact: 78%
of US Businesses are Family Owned, 2-99 Employees © 2013 Michael Chapman, GroupBenefitsAdvisors.com • 2005: 47% offered health insurance • 2012: 40% offered health Insurance • (Fewer offer in Texas) • Recession: cut-backs, closings • Premium Inflation Why?
53.
Obamacare 411 Employer Penalties: ©
2013 Michael Chapman, GroupBenefitsAdvisors.com 1) If ACA-Mandated Employer doesn’t offer a MEC plan covering 95% of FTEs, they will be assessed a $2,000 TAX Penalty per employee for every FTE over 30 employees. Example: • Employer with 100 FTEs (full time equivalent employees) pays penalty of $2,000 per employee in taxes for 70 FTEs, or $140,000 more in taxes.
54.
Obamacare 411 Employer Penalties: ©
2013 Michael Chapman, GroupBenefitsAdvisors.com 2) If ACA-Mandated Employer offers a MEC plan covering 95% of FTEs, but if the employee cost share is greater than 9.5% of lowest wage employee’s AGI (W-2), Employer they will be assessed a $2,000 TAX Penalty for every FTE over 30 employees. Example: • Employer with 100 FTEs has one full-time janitor who is paid minimum wage. • Janitor’s premium share of MEC is 10% of his or her wages. • Employer will be assessed a Tax Penalty of $140,000.
55.
Obamacare 411 Employer Penalties: ©
2013 Michael Chapman, GroupBenefitsAdvisors.com 3) If ACA-Mandated Employer offers a MEC plan covering 95% of FTEs, they will be $3,000 TAX Penalty per employee for Every FTE who applies for Insurance through a State or Federal Exchange and receives a subsidy. Example: • Employer with 100 FTEs (full time equivalent employees) will pay a penalty of $6,000 if two employees apply for insurance through a State or Federal Exchange. • (Suggestion: Don’t be “That Guy.”)
56.
Obamacare 411 1. How
Do Find Out if I Qualify for a Subsidy for Obamacare? © 2013 Michael Chapman, GroupBenefitsAdvisors.com 2. Am I Sure I Really Want a Subsidy? 3. What’s The Penalty If Uninsured?
57.
Obamacare 411 Tax Credit
or Subsidy Congressional Budget Office Estimated that 127M People Potentially Qualify for Subsidies. • CBO Estimated that Only 18 Million Will Participate. • The Subsidy Application Is estimated to be 62 pages! © 2013 Michael Chapman, GroupBenefitsAdvisors.com
58.
Obamacare 411 Tax Credit
or Subsidy • Subsidies Only Available through Federal/State Exchanges. • An Employee Is NOT Eligible for a Subsidy If: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • The employer offers at least the actuarial equivalent of the Bronze Plan (60%) • The employee cost share is not more than 9.5% of their annual income (W‐2 Employee) (AGI)
59.
Obamacare 411 Eligibility for
Government Subsidy Family of 4 Income Level Percent of Poverty Level Individual Can Get Coverage In: Government Subsidies Above $88,200 Above 400% Federal or State Health Ins Exchange No $88,200 400% Federal or State Health Ins Exchange Yes $29,327 $22,050 $0 133% 100% 0% Medicaid Yes © 2013 Michael Chapman, GroupBenefitsAdvisors.com
60.
Obamacare 411 • 2014:
$95 per Adult, $47.50 per Child up to $285 per family or 1% of income. © 2013 Michael Chapman, GroupBenefitsAdvisors.com What’s The Penalty If Uninsured? • 2015: $325 per Adult, $162.50 per Child up to $975 per family or 2% of income. • 2016: $695 per Adult, $347.50 per Child up to $2085 per family or 2.5% of income.
61.
Obamacare 411 If your
Adjusted Gross Income ends up exceeding your estimate, the IRS will assess and take back your subsidy. © 2013 Michael Chapman, GroupBenefitsAdvisors.com The IRS Giveth and Taketh Away: Examples: • Job Seekers • Y.E. Bonus • Unexpected Income
62.
Obamacare 411 If you
qualify for Medicaid and your Adjusted Gross Income ends up exceeding your estimate, the IRS will assess and take back your subsidy and could attach assets. © 2013 Michael Chapman, GroupBenefitsAdvisors.com The IRS Giveth and Taketh Away: Examples: • Job Seekers • Y.E. Bonus • Unexpected Income
63.
Obamacare 411 Business Pay
or Play Calculator © 2013 Michael Chapman, GroupBenefitsAdvisors.com
64.
Obamacare 411 For Companies,
Business Owners, Presidents, CFO’s, HR Directors: • Whole new level of fiduciary responsibility. • Increased complexity with major P&L, Tax, HR, and hiring consequences. © 2013 Michael Chapman, GroupBenefitsAdvisors.com
65.
Obamacare 411 For individuals
or organizations with multiple ownership, you can’t escape the 50+ FTE Rule • PEOs • Staffing Firms • Private Equity Groups • Multiple Franchise Owners © 2013 Michael Chapman, GroupBenefitsAdvisors.com IRS To Look back to 6/1/13 for FTEs
66.
Obamacare 411 Certain Industry
Sectors Will Get Hammered: • Staffing • Seasonal • Hospitality • Retail © 2013 Michael Chapman, GroupBenefitsAdvisors.com IRS To Look back to 6/1/13 for FTEs
67.
© 2013 Michael
Chapman, GroupBenefitsAdvisors.com Obamacare 411 Remember: Use Your New Knowledge of Obamacare as a Competitive Advantage.
68.
Obamacare 411 If You
Know This Much, You’re Now An Expert! • As of Today, Very Few Businesses, Upper Management and Employees Know This Much About Obamacare. • Even Fewer have made decisions on what they should do. © 2013 Michael Chapman, GroupBenefitsAdvisors.com
69.
Obamacare 411 • To
Learn More: • http://Obamacare411.co • Facebook: • YouTube Channel: ObamacareInformation • Twitter: © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Subscribe and Sign Up for Updates, upcoming presentations and webinars:
70.
Obamacare 411 Please Comment/Forward Share/Like: •
http://Obamacare411.co • Facebook: • YouTube Channel: ObamacareInformation • Twitter: • LinkedIn.com/in/michaelchapman © 2013 Michael Chapman, GroupBenefitsAdvisors.com • Subscribe, Sign Up for Updates, Upcoming Presentation Schedule and Webinars!
71.
Obamacare 411 How You
Can Help Me • Who Do You Know That Needs Executive Leadership? • What Leadership Groups Could Use a Subject Matter Expert Speaker? © 2013 Michael Chapman, GroupBenefitsAdvisors.com How You Can Help Yourself and DFW • Share This Information ASAP • ACT on This Information ASAP
72.
Obamacare 411 © 2013
Michael Chapman, GroupBenefitsAdvisors.com
73.
Countdown to Action
2013 Obamacare 411 What? When? Healthcare Costs © 2013 Michael Chapman, GroupBenefitsAdvisors.com
74.
Obamacare 411 © 2013
Michael Chapman, GroupBenefitsAdvisors.com
75.
Obamacare 411 © 2013
Michael Chapman, GroupBenefitsAdvisors.com
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