mandate

As Expected, States Will Have More Control and Greater Flexibility in Regulating Obamacare Starting in 2019

In a CMS press release the Trump Administration announced yesterday, as expected, that beginning in 2019 individual states will have more control and greater flexibility in regulating the individual health insurance market and the Obamacare Marketplace (aka the Exchange). In a summary of the “final 2019 Payment Notice Rule” CMS highlighted provisions that were intended to increase flexibility, improve affordability, and decrease administrative burdens.

 

It’s likely that changes made at the individual state level will ultimately have some impact either directly or indirectly on employer sponsored health coverage, particularly the small group market. We will be monitoring this very closely for our clients and will report back, especially as we get closer to 2019 and more information becomes available.

In the meantime, here’s a sampling of the headlines and links to the respective articles following yesterday’s announcement by CMS:

Here’s a link to the CMS press release:

 

ACA in 2017… Stay Tuned

What do we see?

Our opinion was that if Hillary Clinton had won, ACA would have gotten the heavy lift it would have needed to advance.  The difficult regulations would have been imposed (vs delayed further) and the money would have been allocated from general funds to stabilize the market.

Without the heavy lift, big trouble for ACA would be on the horizon.

The horizon is here.  What we see initially is that the regulations will start to go away (changed or ignored) and cash infusion will not happen.  What remains to be seen is what the party  in power will do to replace the law.  Doing nothing will almost be a replacement, but to what?  The Republicans do have various plans, but which course they will follow remains to be scene.

Our job will be to let you know how this will affect you and your people.  As of today, we just hold the course.  The taxes and reporting requirements are still in place. The plans on the market have not changed.  We will keep you aware as things change. If things hit your radar or you have questions on what you read or hear, please let us know and we will dig in.

For more on the latest:  ACA Compliance Bulletin — Congress Clears Path for ACA Repeal

Definition of Predicament: People Who Don’t Have Access to Employer Coverage, Aren’t Medicare Eligible, and Don’t Qualify for Subsidies

Yes, this is a bit anecdotal. Nevertheless, I think it’s  worth reporting and some may find it interesting.

First, recently our team managed the annual open enrollment process for the group health plan of one of our employer clients. After a quick but thoughtful evaluation of options, one employee who was previously covered by an individual market policy opted to enroll on the employer’s group plan (family coverage) and terminate coverage under the individual market plan. Both the individual plan and the group plan were Qualified Health Plans (QHP) under ACA. The plans had similar benefits. And, they were underwritten by the same large insurance carrier.

Savings?

$600 a month in gross premium. That’s quite a spread.  Add in the employer contribution and the savings to the employee were even greater.

“Who’s Exempt from the ACA Individual Mandate to Have Health Insurance?”

During several recent meetings this question was posed a number of times by curious employees and a few their employers. It seems many folks are still unclear about the exemptions. Many also were unclear on the amount of the penalties.

Below is a summary on exemptions and individual penatlies published recently in a Kaiser Health News article addressing these FAQs:

Who’s Exempt from the Requirement to Have Insurance?

 The list of possible exemptions is a long one. You may be eligible for an exemption if:
• Your income is below the federal income tax filing threshold.
• The lowest priced available plan costs more than 8.05 percent of your income.
• Your income is less than 138 percent of the federal poverty level (about $16,105 for 2015 coverage for an individual) and your state did not expand Medicaid coverage to adults at this income level as permitted under the health law.
• You experienced one of several hardships, including eviction, bankruptcy or domestic violence.
• You are a member of an Indian tribe, health care sharing ministry or a religious group that objects to insurance.
• You are in jail.
• You are an immigrant who is not in the country legally.

Many also asked about the penalties. More from the KHN article:

Penalties: How Much?

For 2016, the penalty will be the greater of $695 or 2.5 percent of income.
Although much of the discussion is often about the flat dollar penalty – $325 in 2015 — many people will be paying substantially more than that. A single person earning more than $26,550 would not qualify for the $325 penalty ($26,550 – $10,300 = $16,250 x 2 percent = $325.) So the 2 percent penalty is the standard that will apply in most cases, say experts. For example, for a single person whose modified adjusted gross income is $35,000, the penalty would be $494 ($35,000 – $10,300 = $24,700 x 2 percent = $494. That same individual would have paid $249 in penalties for 2014.

The penalty is capped at the national average price for a bronze plan, which the IRS announced was $2,484 for an individual and $12,240 for a family of five or more in 2015.

To read about other ObamaCare FAQ’s go to FAQ: What Are The Penalties For Not Getting Insurance?

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