health care reform scenarios

"As Health Care Reform implementation ramps up, I'm getting more questions about what people should do.  Basically, it will come down to price and benefits of the different options.  Up til now, there has been very little pricing information, however, over these next few weeks, more pricing information should become available.  

Here are some common health care reform scenarios:

·  Your Employer Offers Insurance If you are full time, you will likely continue getting insurance this way. However, your plan options may change at open enrollment in 2014.

·  You Sponsor a Small Group Health Plan Employers will continue to be able to sponsor a group plan through either a government subsidized 'SHOP' Exchange or through conventional small group market plans. Consider taking advantage of your carrier's Early Renewal option for December 1st to lock in current rates and plan designs.

·  You Sponsor a Small Group Health Plan But Have No W-2 Employees "Mom and Pop" groups will be required to terminate their plans at the 2014 renewal and select either an Exchange plan or go to the individual health insurance market. NOTE: To avoid becoming liable for higher than expected deductible payments, these groups should consider switching January 1, 2014 to individual plans.

·  You Have An Individually Issued Private Plan If you do nothing, your plan will change automatically on January 1st, 2014 to a reform compatible plan. You will still be able to choose either a private market plan or an Exchange plan. NOTE: Many existing private high deductible plans do not meet reform guidelines and will be converted to richer benefit - and more expensive - health care reform compliant plans.

·  You Have No Insurance Now You can apply October 1st for an Exchange plan to be effective January 1st which may offer Premium Assistance Tax Credits and/or Cost Sharing Subsidies. All individual plans will be guaranteed issue so no one will be declined for health reasons.

·  If You Do Not Purchase Insurance A tax penalty on your household income will be assessed: 1% in 2014, 2% in 2015, 2.5% in 2016, then inflation adjusted after that. 

I will be helping my clients 'grid out' their options:

·  Private individual plans vs. CoveredCA Exchange/Marketplace plans with subsidies,

·  Private small group plans vs CoveredCA SHOP plans with potential Premium Assistance Tax Credits and Cost Sharing Subsidies,

·  As a business owner, should I terminate my small group plan and let my employees go to the exchanges,

·  As an employee, should I waive my plan at work and get a private plan?

·  How about not having insurance at all?

·  What are the tax incentives or penalties available for each course of action?

Go here for a link to estimate the individual Premium Assistance Tax Credit Calculator. http://www.healthsonoma.com/coveredca.html

Go here for a link to estimate the Small Business Tax Credit for SHOP plans. http://www.healthsonoma.com/shop.html

Go here for a link to the Affordable Care Act Individual Penalty Calculator. http://www.healthsonoma.com/individuals.html

As health care reform moves forward, my agency will be certified to assist consumers navigate the Covered California health insurance exchanges and explore alternatives. Please don't hesitate to contact me at 707-935-6294 x103 or contact me by email.