I’m doing a series on things I think you should know about Obamacare. Here is installment #3…
There’s a major glitch or loophole in the healthcare law that actually allows large employers to avoid health-law penalties by offering stripped down plans that are devoid of any hospital benefits. That’s right. No hospital benefits at all. Obamacare regulators created an online calculator to certify whether plans offered by large self-insured employers that pay their own medical claims meet the Affordable Care Act’s toughest standard. The Obamacare calculator is used to test “minimum value” for adequate benefits. Many, including your 2-Minute Drill author, were surprised to read in a recent Kaiser Health News story that the calculator approves these plans lacking any hospital benefits.
Word is that numerous large, low-wage employers with high turnover that haven’t offered medical coverage in the past — retailers, hoteliers, restaurants and other businesses with high worker turnover and lower pay — are considering driving a truck through this loophole by offering plans without any hospitalization coverage. By doing so, they thus protect themselves from some of the employer mandate penalties that come into play next year. Some of the talking heads in the industry claim the calculator was purposely designed this way by the administration. However, I tend to agree with respected consultant Bob Laszewski. He’s quoted as saying “That’s baloney. Nobody said we’re going to have health plans out there that don’t cover hospitalization. That was never the intention…I think they just screwed up.” Stay tuned for more on this.
Obamacare…Did you know? #1
Obamacare…Did you know? #2
Info for Part-time or Other Employees Currently Without Health Insurance
There’s lots of noise out there related to Obamacare’s individual mandate and the rapidly approaching March 31 open enrollment deadline. Here’s summary information for those part-time or other employees that currently do not have any health insurance:
- The deadline to sign up for individual health insurance is March 31 – less than a week away. This marks the end of the open enrollment period. After March 31, those without coverage will not be able to purchase an individual health plan (on or off the exchange) until the next open enrollment period beginning in November — unless they have a qualifying event such as marriage, birth of a child, loss of employer sponsored health coverage, move out of state, have a significant income change, etc. If that’s the case, then they can enroll during a special enrollment period.
- Extensions may be available based on information released just yesterday. According to latest reports if someone started to apply for coverage through the HealthCare.gov website but could not finish by March 31 or they experienced other glitches in trying to sign up, they will have until about the middle of April to seek an extension. Individuals can qualify for an extension by checking a blue box on the HealthCare.gov website indicating that they’ve tried to enroll before the deadline. The following are links to recent news stories that reported the extension that was officially announced yesterday:
- If someone goes without health coverage after March 31, they may be subject to health reform law’s tax penalty come tax time next April for not having coverage. The penalty this year is $95 or up to 1% of income, whichever is greater.
- Some financial assistance may be available. Individuals and families with incomes between 100 percent and 400 percent of the poverty level (about $11,490 to $45,960 for individuals) may qualify of premium tax credits (also referred to as premium subsidies). Tax credits are based on a percentage of household income and are applied on a sliding scale for those that qualify.
Individuals who want to obtain health care insurance before the March 31 deadline should visit Healthare.gov to begin their application process.
There are many opinions about Medicaid expansion and my post is opinion free.
Employers across all sectors of the economy are likely to have Medicaid eligible employees/dependents in their population. Many do not know they are Medicaid eligible and some may be on the employer plan.
What does this mean?
Like anything, researching it may be the best first step. Simply finding out if this exists in an employer population may make sense.
Some employees will be delighted to know they qualify, some may be upset. Some employers will take advantage of Medicaid expansion to reduce the rolls on the employer-sponsored plan while others may hate the idea and avoid it all together.
We respect all opinions but we also are developing a tool to determine eligibility and — if the employer would like — assist in the enrollment process. We will be launching it next month.
We want to help any employer that wants to know who in their population is eligible for Medicaid and then listen to find out if there is anything the employer would like to do about it.
What is Medicaid?
- Medicaid is funded largely by the federal government but run by the states
- Unlike Medicare, Medicaid eligibility is based on income. The Affordable Care Act expanded medicaid to reach well beyond prior eligibility pools (it will now 133% of poverty level).
- Medicaid operates as nearly 100% coverage for all medical expenses.
- Medicaid networks are more restrictive than Medicare or commercial policy networks
Medicaid used to be accessible only to children and low (really low) income parents with dependent children. Single people did not qualify. Parents with eligible children did not qualify often. Eligibility now is much much wider.
In the next few weeks we will be rolling out a tool to assist any employer/employee evaluate Medicaid eligibility.
3 Employer Take-a-ways
The administration announced late Monday yet another change-up to one of the major focal points embedded in the Affordable Care Act – the employer mandate. Here are the three biggest aspects of the announcement that employers of all sizes need to know:
Employers with 100+ Employees
Employers with 100 or more workers will only have to cover 70% (down from 95%) of eligible employees in 2015 to avoid fines. The original 95% benchmark now goes into effect in 2016 and beyond.
Employers with 50 – 100 Employees
Employers in this category get a reprieve of sorts through 2015 as the mandate is delayed altogether for another year. As things stand today, they must begin offering coverage to eligible employees in 2016 in order to avoid fines associated with the new law.
Employers with fewer than 50 Employees
Under 50 employers (already exempt from the employer mandate to provide coverage) will now be exempt in 2015 and each year going forward from the reporting requirements they were subject to as originally outlined in the new law.
Despite speculation by many, as of yet there have been no changes or reprieves to the individual mandate that went into effect on January 1 of this year. It remains unchanged.
For more detailed information on Monday’s announcement see articles that appeared in the Washington Post and Fiscal Times.
For an expert analysis, read Bob Laszewski’s piece at Health Care Policy and Marketplace Review.
Read More >>>
- Tom Barrett
- February 12, 2014
- analysis, announcement, coverage, delays, expert, Fiscal Times, insurance, latest, mandate, news, Obamacare, questions, Washington Post
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