Affordable Care Act
Update
Mike Bitters/Steve
Church
We
want to provide you with the information you need to both be in compliance and
make the best possible decisions on health insurance options for the Kentucky
market place.
Individual
Mandate:
·
The
ACA requires everyone to be enrolled in a health plan by March 31, 2014
·
If
you do not have coverage there will be a penalty.
·
The
last enrollment date for individual plans is 3/31 for a 4/15 effective
date.
·
If
you are not enrolled by 3/31/2014 you will have to wait until this fall to
enroll.
The Exchange
Marketplace
Kynect gives you a choice of the following
insurance companies:
o
Anthem/Pathway
o
Kentucky
Health Cooperative
o
Humana
(HMO options only in Louisville, Lexington and Northern Kentucky).
To
be eligible for any subsidy, you must enroll through the Kynect website. Subsides are based on income and family
makeup.
The Off Exchange
Marketplace
The
carriers that are writing individual plans outside of Kynect are :
o
Humana
(PPO & HMO)
o
Anthem/Pathway
o
Assurant.
When
considering which market place is best for you, pay attention to the plan
designs and the provider networks available. Do not assume that your
doctor or hospital is taking the plan you chose simply because it is an Anthem
or Humana plan. They have significantly
changed their provider networks for these products YOU
MAY NOT HAVE ANY COVERAGE IF YOU GO OUT OF STATE.
Don’t
take a chance on this, get with a professional insurance broker (like Logan
Lavelle Hunt) and discuss thoroughly. Only a licensed broker in Kentucky,
under the ACA, can make a recommendation
to a client, so call Logan Lavelle Hunt for sound guidance.
Small
Group Employers (2-50):
January
1, 2014 began the full implementation of health care reform nationwide.
o
Community
Rating is how health insurance rates are set for this size company
o
Carriers
can no longer use health history to set your premiums.
o
Age,
geographic location and smoker/non smoker are only factors used do determine
rates.
Because
of this rating methodology many (a majority) of employers accepted an “early
renewal” for December 1, 2013 to avoid the negative effect this will have on
your premiums. For employers who did not accept this “early renewal” or got
busy and did not pay attention, there have been renewal increases from 30-80%.
Small
Business has not been offered an extension or waiver to put off the effects of
the ACA. This segment of employers is
getting hit the hardest due to ACA.
The
unique benefit of being a member of a Trade Association that has a group
insurance program is that the group medical plan for members avoids these
rating provisions.
o
The
Association Plan is treated as a large
group health plan under the ACA
o
The
Association Plan is able to use medical history to set premiums.
Although
not a perfect fit for every employer, this is a strong option that members need
to look into. Logan Lavelle Hunt, our
agent, has had recent success with a member who received an 80% increase as a
result of community rating and the ACA. Through the Association plan that member only experienced a 9%
increase for the same benefit selection.
Another
delay in ACA implementation was handed down on February 10, 2014 for companies
of this size. If you have a company that
is in this category, you are probably familiar with the “Play or Pay” provision
that is in the law. Basically, “play or
pay” means that you either provide a minimum health insurance plans to all full
time employees (play) OR pay a fine to
the government if you choose not to provide employees the coverage. This has been very problematic for the
administration politically and therefore changes were made for this segment of
companies.
The
changes are as follows:
o
“Play
or Pay" deadline has been pushed back to January 1, 2016
o
Community
Rating (described above) will take effect on January 1, 2016
The
Association group medical plan can be an attractive option today for larger
employers, why wait? Take all of the
guess work out of ACA by joining our program now.
With
all the changes in the individual and group market place using a professional
insurance broker is more important than ever. Remember to contact Logan
Lavelle Hunt, our exclusively endorsed agent, if you want more information on your
Association Group Plan.
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