Happy 2014!!  The Individual Mandate and Small Employer reform provisions of the Affordable Care Act are now in-force.  How have people been impacted?  Take a look at these cases.

Case #1:  Wow!!  This is great.

Small business in the financial services industry with 6 employees.   2013 premium was rated-up due to history of high claims.  2013 benefits = $3000 OOP(out-of-pocket) expense.  Total premium = $4155.  2014 benefits are better with $2000 OOP and premium is lower at $2774.

Case #2:  Whoa!!  So this is the reward for being young and healthy.

Small business in the irrigation industry with 29 employees; mostly younger and male.  2013 premium = $8004 per month.  2014 premium for similar benefits = $12006.

Case #3:  We just can’t do this anymore.

Manufacturer with 55 employees.  The company will be subject to Large Employer rules in 2015 and must pay a fine if they do not provide affordable coverage.  Their group plan premiums are high because of medical conditions.  The rating system does not change for large employers.  Many employees have waived coverage on the group plan because it is too expensive.  But now the employees must enroll in a health insurance plan or pay a penalty.  Company management came to the conclusion that the only affordable path to health insurance for the majority of their employees and families was to eliminate the group plan.  This would give employees eligibility for financial assistance on the Marketplace.  The employer will be paying the fine in 2015.  This decision is one that the company never dreamed it would consider.

Case #4:  Thank you Marketplace!!

Married couple in their early 60’s.  Because of pre-existing health conditions, she was covered under the Nebraska CHIPS program.  Due to the high cost of her premium, he opted to go without health insurance.  Her policy had a $2000 deductible at a cost of $1280/mo.  They qualified for a Premium Tax Credit of $800/mo & purchased a Gold benefit plan that covers both of them for less than $500/mo.

Case #5:  Ouch! This is painful.

Family that includes mom, dad and three college age kids.  The family’s income exceeds the threshold for financial assistance.  2013 benefits = HSA with $5000 OOP expense at $982 monthly premium.  2014 benefits = HSA with $12700 OOP and premium of $1427.  Total increase in premium + OOP expense = more than $13000.

Case #6:  Now what are we supposed to do?

Young family that includes mom, dad and two preschool children.  The Marketplace financial calculator estimates the family will be eligible for the Premium Tax Credit and Cost Share Reduction subsidy.  Their contribution to monthly premium should be about $200 per month. 2013 premium is $850 meaning a savings of $650 per month.  However, the Marketplace determined that the children may be eligible for Medicaid benefits in Nebraska.  That means the family cannot move forward with enrolling in a Marketplace insurance plan until Nebraska DHHS determines whether the children are eligible.  They have decided to continue paying the premium for the 2013 policy for a couple more months and hope that DHHS will be able to process their application quickly.  There are many Nebraska families caught in this situation.

Reminder:  Open Enrollment continues on the Marketplace through March 31, 2014.


by Chris McPike, Vice President, ComPro

402-488-5100

www.comproins.com