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LIFE Happens has uploaded realLIFEstories | Life Insurance | Boomer Esiason

Boomer Esiason, retired NFL quarterback and current TV analyst, has a passion for life insurance. His mother died when he was just 7, and money was tight growing up because of it.


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Obama administration launches ACA support tool for businesses

A new government website called the Health Care Wizard gives employers customized information about how the Affordable Care Act applies to them based on company location, size and health insurance plans offered. The tool returns formulas for calculating penalties, compliance dates and new regulations. NEW SITE     AMSINSURE.COM

Easy access tool on Health Care Reform for Business

Health Care Changes: A New Tool for Small Business Owners

We're excited to announce a new, streamlined health care tool , housed at Business USA,  to help you find out exactly what you and your employees need to know about the Affordable Care Act. In a few quick steps, you'll understand the essentials of new insurance options and other health care changes.

> Try the new health care tool

Government site to help employers with Health Care Reform

http://business.usa.gov/healthcare

The Obama administration just launched Business.USA.gov/healthcare, which is intended to be a one-stop-shop website that will provide employers of all sizes educational materials on how the Affordable Care Act may affect businesses and help them compete. The site includes a wizard tool that is tailored based on size and location, so businesses can learn how the law helps them provide affordable coverage options to their employees while still meeting their bottom line.

Health Care Changes Wizard | BusinessUSA

business.usa.gov

Health Care Changes Health Care Changes Affordable health care is a top concern for businesses. In a few quick steps, this wizard can help you understand what you need to know about new insurance options and other health care changes as well as find health

realLIFEstories | Life Insurance | Brigette Hunter - Keeping a Family an...

Comedy website looks to make health insurance a laughing matter

Writers for the comedic video website Funny or Die are working on video scripts to encourage the site's audience to enroll in health insurance coverage. The material will not be political and instead will "focus more on the positive stuff and really how it relates to young people who aren't thinking about health care in a serious way," said Mike Farah, president of production. The Hill/Healthwatch blog (7/25)

SHOP tax credits explained

Firms with fewer than 25 employees can get up to a 50% tax credit next year if they join the Small Business Health Options Program, Small Business Administration Senior Policy Adviser Meredith Olafson said during a webcast. Some of the SHOP exchanges will offer only one plan next year, but employers should have multiple plans from which to choose in 2015, Olafson said. Average annual wages at qualified businesses must be $50,000 or lower, excluding owner, partner and family income; and employers must cover a certain percentage of employees' premiums. InvestmentNews (free registration) (

Can an Assisted Living Community Transfer my Mother without my Approval?

 

Question: My question is whether an Assisted Living Facility can transfer my mother to another facility without my approval, her financial and health care Agent. Apparently, Mom, who is 87 years old and has dementia, has been somewhat rowdy recently and apparently because of this behavior/acting out, the Assisted Living Facility has made a unilateral decision (without my input at all) to transfer her to another facility on the other side of town. Can this be done and what is my recourse?

Answer: In Florida, a resident in an assisted living facility has the right to at least 45 days’ notice of relocation or termination of residency unless a physician certifies that the resident requires an emergency relocation to a facility providing a more skilled level of care or the resident engages in a “pattern of conduct that is harmful or offensive to other residents.”. So, in your particular case, if the ALF has provided proper notice, they can transfer her for any reason or no reason. If they have not provided proper notice and it is not an emergency transfer as described above then you may have recourse. I suggest that you contact the Long Term Care Ombudsman Program through the Department of Elder Affairs for more specific guidance in your mother’s case. They can be reached at 1.888.831.04040 or at http://ombudsman.myflorida.com. There is no charge for these services.

- See more at: http://www.eldercarematters.com/eldercareanswers/2013/07/26/todays-qa-can-an-assisted-living-community-transfer-my-mother-without-my-approval/#sthash.3670sl0E.dpuf

Health Insurance Exchanges and how people buy Healt Insurance

Excerpt from a survey where people accessed the Health Insurance Exchanges and how they would purchase health insurance from the Washington Post 7/14/13.
                                                             

Still, the focus on price, including the effect of subsidies, is a constant. Consulting firm Booz & Co.'s pretend exchanges showed that premiums were the most important factor in plan selection, followed by cost-sharing features like deductibles. McKinsey & Co., which tested about 150,000 consumers, found most would opt for smaller arrays of doctors and hospitals to achieve discounts.
 

If you are wondering, then I will tell you that this is no different than how people have shopped for health insurance prior to Health Reform. All the fuss and muss over explaining options to most people has nothing to do with how the will shop and buy health insurance on the exchanges.
 

If this happens then it is my best guess that things won't go well and all insures who have higher prices will eventually cut their prices trying to compete or exit the exchange.

5 compliance considerations for employers

Business owners and health care providers should take steps now to comply with the next phase of the Affordable Care Act, attorney Pepper Crutcher writes. Employers should monitor forthcoming IRS guidance on the penalties and taxes it will and will not collect. Employers with "grandfathered" plans should determine the benefits and drawbacks of staying with those plans or making even small changes and losing grandfathered status, determine whether self-insurance is the best option, and consider offering scaled-back options. American City Business Journals/Birmingham, Ala.

§  The crucial difference between ACA tax credits and subsidies
People with incomes between 100% and 400% of the federal poverty level might qualify for tax credits to offset health insurance premiums, and people with incomes between 100% and 250% of the poverty level may also qualify for subsidies to offset out-of-pocket costs. Consumers can apply in advance for the tax credit based on estimated income, and the funds will be sent to the insurer, but if income was underestimated and too much was paid to the insurer, consumers may owe the difference at tax time. Cost-sharing subsidies are also paid directly to insurers, but they need not be paid back if the consumer's income rises or was underestimated. Kaiser Health News/Capsules blog (7/10)        

Cadalic Plans under Health Care Refom

Cadillac insurance plan - Wikipedia, the free encyclopedia

en.wikipedia.org/wiki/Cadillac_insurance_plan‎

 

 

<sup>Informally, a Cadillac plan is any unusually expensive
health insurance plan, usually arising in discussions of medical-cost
control measures in the United States.[1][2][3][4] The term derives from
the Cadillac automobile, which has represented American luxury
since its introduction in 1902,[1]and as a health care metaphor dates
to the 1970s.[1] The term gained
popularity in the early 1990s during the debate over the
Clinton health care plan of 1993,[1] and was also widespread during
 debate over possible excise taxes on "Cadillac" plans during the
health care reforms proposed during the Obama administration.[1]
(Bills proposed by Clinton and Obama did not use the term
"Cadillac".)

The Patient Protection and Affordable Care Act
(as amended by the
Health Care and Education Reconciliation Act of 2010) imposes an
annual excise tax on plans with premiums exceeding $10,200 for
 individuals or $27,500 for a family (not including vision and dental
benefits) starting in 2018.[4]

Criticisms of these plans generally center on the small or
nonexistent co-pays, deductibles, or caps that encourage the
overuse of medical care, driving the cost up for the uninsured or
those on other plans, which some say necessitates a Cadillac tax.[citation needed]

A study published in Health Affairs in December 2009 found that
high-cost health plans do not provide unusually rich benefits to e
nrollees. The researchers found that only 3.7% of the variation in the
cost of family coverage in employer-sponsored health plans is
attributable to differences in the actuarial value of benefits.

Only 6.1% of the variation is attributable to the combination of
benefit design and plan type (e.g., PPO, HMO, etc.). The employer's
industry and regional variations in health care costs explain part of t
he variation, but most is unexplained. The researchers conclude
"…that analysts should not equate high-cost plans with Cadillac
plans, but that in fact other factors—industry and cost of medical
inputs—are as important in predicting whether a plan is a high-cost
plan. Without appropriate adjustments, a simple cap may exacerbate
rather than ameliorate current inequities."[5]</sup>

Healthcare Reform Update: Employers – Controlled Groups and Related Entities

Healthcare Reform Update: Employers – Controlled Groups and Related Entities

March 06, 2013

The Affordable Care Act (“ACA”) provision also known as Employer Shared Responsibility, mandates that employers who generally employ 50 or more full-time equivalents must offer group health insurance benefits to its full-time employees and their dependents or potentially pay a penalty. Employers can determine whether they meet the 50 or more full-time equivalent threshold for January 1, 2014 by using selected information from 2013. An important note, if two or more companies are “related” then the companies may be combined by the government for purposes of determining if the companies are subject to the Employer Shared Responsibility provisions.
Control group and related entities’ rules can be found in the Internal Revenue Code, including but not limited to, sections 414(b) and 414(c), which generally provide that employees of all companies which are members of a controlled group of entities and employees of trade[s] or business[es] (whether or not incorporated) which are under “common control” are to be treated as employed by a single employer. Companies with as little as 20% of common ownership may be considered part of a control group, while companies with 80% common ownership are usually presumed to be “related”. Another area that needs to be considered is affiliated service groups which provide integrated services to the public, parent-subsidiary, brother-sister entities and “family members” with ownership that may be attributed to a related person’s individual ownership interests. In addition, smaller entities with five or fewer persons which could include trusts are also legal entities which should be considered when deciding on who is part of a “control” group.
Lastly, the IRS has proposed anti-abuse provisions which will penalize employers who attempt to avoid the mandates of ACA. As always, please speak with competent legal and accounting professionals to address your specific circumstances.
http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-Employer-Shared-Responsibility-Provisions-Under-the-Affordable-Care-Act

Obama Administration delays

	Importan Notice, Obama Administration Delays Tax on employers with 50 or more employees as required under ACA.

 

The Washington Post by Sarah Kliff - July 2, 2013: The Obama administration will not penalize businesses that do not provide health insurance in 2014, the Treasury Department announced Tuesday. Instead, it will delay enforcement of a major Affordable Care Act requirement that all employers with more than 50 employees provide coverage to their workers until 2015. The administration said it would postpone the provision after hearing significant concerns from employers about the challenges of implementing it. “We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively,” Mark Mazur, Assistant Secretary for Tax Policy, wrote in a late Tuesday blog post. “We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so.” The Affordable Care Act requires all employers with more than 50 full-time workers provide health insurance or pay steep fines. That policy had raised concerns about companies downsizing their workforce or cutting workers’ hours in order to dodge the new mandate. In delaying the enforcement of that rule, the White House sidesteps those challenges for one year. It is also the second significant interruption for the Affordable Care Act, following a one-year delay on key functions of the small business insurance marketplaces. Together, the moves could draw criticism that the administration will not be able to put into effect its signature legislative accomplishment on schedule.

Individual Penalty Transition Relief for Those Eligible to Enroll in Employer-Sponsored Coverage with a Plan Year That Begins in 2013 and ends in 2014

 

Because many employer-sponsored plans have non-calendar plan years, brokers have questions regarding how to advise clients with employees and/or dependents who waived employer-sponsored coverage but would need to have minimum essential coverage beginning January 1, 2014 in order to avoid the Individual Shared Responsibility Payment (i.e. individual penalty).   IRS Notice 2013-42, issued Wednesday 6/26/2013, addresses these questions and provides an employee, or an individual with a relationship to the employee, who is eligible to enroll in a non-calendar year employer-sponsored plan with a plan year beginning in 2013 and ending in 2014 will not be liable for the individual penalty until the end of the 2013-2014 plan year. Thus, employees and dependents that choose to wait until the 2014-2015 plan year to enroll in coverage will not be subject to the individual penalty for the months in 2014 that are part of the 2013-2014 plan year.

For your easy access, we posted IRS Notice 2013-42 in the Health Reform Updates & News section of our Health Reform Resource Center; where you also will find an abundance of helpful resources like our ACA Calculators http://ca.wordandbrown.com/HRRC/ACANews.aspx.

Employer notice to employees on Health Insurance Market Place

EMPLOYER EXCHANGE NOTICE- Federal regulators have moved back the date in which ALL EMPLOYERS must provide a written notice about the health insurance exchanges , known in CA as “COVERED CALIFORNIA”.  A copy my be obtained from the Department of Labor for Employers WITH and WITHOUT plans and in English and Spainish.  See below for the information contained in the letter.

Form Approved

OMB No.

New Health Insurance Marketplace Coverage

Options and Your Health Coverage

PART A: General Information

When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance
: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.
1

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.

How Can I Get More Information?

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

Retail Clinics Expand Health Care Services

In a move that caught the attention of the American Academy of Family Physicians (AAFP), Walgreens' Take Care ClinicsSM have begun offering assessment, treatment and management for chronic conditions such as hypertension, diabetes, high cholesterol, asthma, and more ... READ MORE

Self–compliance Tools for Health Benefits Laws

Self–compliance Tools for Health Benefits Laws

There’s no denying it — numerous provisions of Health Insurance Portability and Accountability Act (HIPAA) and Affordable Care Act (ACA) are complicated and confusing. To help with this confusion, the Department of Labor (DOL) now provides two tools on its website that group health plans, plan sponsors, plan administrators, and health insurance issuers can use to test their compliance. These tools, or checklists, deal specifically with group health plan requirements (Part 7) of ERISA.

The first checklist focuses on HIPAA portability and other law provisions, such as pre–existing conditions exclusions, certificates of creditable coverage, special enrollment rights, wellness programs, and more. The questions and explanations of applicable statutes and other regulatory/administrative interpretation materials assist those involved in operating a group health plan in understanding the laws and their related responsibilities.

The second checklist focuses on ACA provisions, including a plan’s status as a "grandfathered" plan exempt from some ACA requirements, and such ACA requirements as limitations on rescission and annual and lifetime limits, and more. The various sets of questions and answers allow users to assess their plan's compliance with the ACA provisions that have already taken place, or will take place in the near future

Do you no someone who needs help with buying Health Insurance, let them know that in starting in October they will be to look for help to begin Jan1, 2014!

Two types of financial assistance will available through the Marketplace for individuals: one reduces your monthly insurance premium, and the other helps with out-of-pocket expenses for care. Applicants may qualify for one or both depending on household income. If you qualify, the federal government will pay any financial assistance to Kaiser Permanente on your behalf. Learn more about federal financial help.

Watch a short video from the U.S. Department of Health and Human Services that explains the Marketplaces.

The Facts about the Marketplaces

• Marketplaces are federal or state-run marketplaces where consumers can compare and buy health insurance plans.
• The individual Marketplaces will open on October 1, 2013, with coverage available beginning January 1, 2014.*
• All plans available through the Marketplaces will provide comprehensive benefits – from visits to the doctor or hospital, to prescriptions, to screenings for cancer and other conditions.
• To help consumers compare plans from different insurance companies, several standard levels of coverage will be offered. These include Bronze, Silver, and Gold plans. Platinum plans and high cost share/low premium plans will also be available in some states for some people.
• The Marketplaces will also help determine if consumers are eligible for a reduced premium, lower cost-sharing, or for Medicaid or other publicly subsidized health benefits coverage.

Question: Next year, based on the new Health Care Reform regulations, may our company still require a 90-day waiting period (60 days in California) before new employees become eligible to enroll in the health plan?

Answer: Yes, your company may still impose a waiting period of up to 90 days for new employees entering your group health plan. However, it is important to note that beginning with an employer’s first plan year starting on or after January 1, 2014, an organization may not use a waiting period that exceeds 90 days (60 days in California). This restriction applies to all employers, regardless of size, that sponsor a group health plan, as well as to both grandfathered and non-grandfathered plans. The proposed guidance does not permit the employer to wait to offer benefits until the first of the month following 90 days of employment. (However, many employer advocacy groups have submitted comments asking for the allowance of a “first of the month following 90 days” waiting period, so it is still possible that the federal government may institute a safe harbor to allow this calculation method in its final guidance.) As the proposed regulations currently read, the employer must count all calendar days when calculating the 90-day waiting period (60 days in California), including weekends and holidays. If the 91st day (61st day in California) is a weekend or holiday, the organization may set a policy permitting coverage to be effective earlier than the 91st day of employment, but it may not make the effective date of coverage later than the 91st day (61st day in California). If your current health insurance plan utilizes a longer waiting period, it may need to be adjusted in 2014 in order to comply with the new regulations. These adjustments may include the authorization of mid-month enrollments if your organization opts to use a 90-day waiting period (60 days in California). There are some exceptions to this rule when the employer is unable to determine if a new employee’s average hours will be sufficient to qualify for health plan participation. When this occurs, the plan may take a reasonable period of time to determine whether the employee meets the plan's eligibility requirements, which may include a measurement look-back period of up to 12 months.

Employers that offer Health Coverage need to send a letter regarding the exchanges.

http://www.dol.gov/ebsa/pdf/FLSAwithplans.pdf

New Health Insurance Marketplace Coverage
Options and Your Health Coverage

PART A: General Information
When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment­based health coverage offered by your employer.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer doesnot offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household
income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an aftertax basis.

How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description or contact . The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

Form Approved
OMB No.

Notice to employers that do not provide health coverage

http://www.dol.gov/ebsa/pdf/FLSAwithoutplans.pdf

New Health Insurance Marketplace Coverage
Options and Your Health Coverage

PART A: General Information

When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards.

 If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an aftertax basis.

How Can I Get More Information?

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.  1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

Form Approved
OMB No.

How does the individual subsidy for the purchase of Health Insurnance work and who qualifies.

Subsidies: Who is eligible and how do they work?

June 5, 2013
Starting January 1, 2014, some of your individual clients may be able to get subsidies or tax credits when they buy health coverage. So who can get these subsidies or tax credits, and how do they work? We’ll break it down for you.
Subsidies for individuals
In 2014, people who qualify may be able to get a tax credit from the government to help them buy health coverage and pay their premiums. Or they may qualify for subsidies from the government to help them pay for their out-of-pocket health care costs. And they don’t have to wait until tax time to get it. The tax credit can be used for any individual plan sold on the exchange, or health care marketplace.
Who qualifies

• Tax credit:
  • People who are U.S. citizens or legally live in the U.S.
  • People earning between 100% and 400% of the federal poverty level if they are not eligible for other sources of minimum essential coverage, including government-sponsored programs such as Medicare and Medicaid or Medi-Cal in California.
  • Single people with household modified adjusted gross incomes from 100% to 400% of the federal poverty level would earn from $11,490 to $45,960 each year.
  • A family of four with household modified adjusted gross income from 100% to 400% of the federal poverty level would earn from $23,550 to $94,200 each year.
• Subsidy:
  • People with incomes up to 250% of the federal poverty level may also get an extra subsidy when they buy a silver level plan. These subsidies are lower cost shares for services covered by the silver plan. The federal government subsidizes the higher benefits provided by the insurer.

Who doesn’t qualify

• People who can get Medicare or Medicaid (Medi-Cal in California)
• People who can get a plan of a minimum value at work with premiums that cost less than 9.5% of their earnings

What Small Business with 2 to 50 employees have to know about Health Care Reform?

How is employer size defined?

A large employer is defined as having 50 or more full-time equivalent employees during a testing period that can be from six to 12 months. Full time is defined by the government as 30 hours per week.

The term equivalent is used to account for those who work less than 30 hours per week. For example, if an employer has 30 full-time employees working 30 hours each week and three part-time employees working 20 hours each week, it has 32 full-time equivalent employees. The part-time hours per month are added, then divided by 130 to determine additional full-time equivalent employees.

There is some relief for seasonal workers.

How does PPACA apply to small employers?

The employer penalties are just one piece. All employers are subject to certain rules if providing a health insurance plan, such as:

• Waiting periods for eligibility cannot exceed 90 days, beginning in 2014.
• Continuing to cover dependents of employees until age 26, in most cases.
• Providing a Summary of Benefits and Coverage to each employee at specific events, such as open enrollment.
• Supplying 60-day notification for any plan changes, except at renewal.

What are some other considerations?

If a plan is not grandfathered — hasn’t changed since the law went into effect in 2010 — then it must continue to waive all cost sharing for preventive care services, which includes women’s preventive care for plans renewing on or after Aug. 1, 2012.

Employers also must offer employees information on the public insurance exchange whether providing health coverage or not. The law requires this notice be distributed each March; however, it has been delayed in 2013, pending Department of Labor guidance.

In 2014, all non-grandfathered small group plans will have limits on the deductibles charged in-network. The maximum deductible will be $2,000 per individual and $4,000 per family. There also will be out-of-pocket limits that apply to all non-grandfathered plans. These limits are the same as those for high deductible health plans, which this year is $6,250 for an individual and $12,500 for a family.

How will the pricing methodology change?

The biggest change for small employers will be the pricing methodology applied to group insurance plans. Insurance companies will be unable to use gender, industry, group size or medical history, and therefore are limited to family size, geography, tobacco use and age. The companies can charge the oldest ages no more than three times what they charge the youngest ages. Many insurance companies use a ratio of 7:1 or higher, so this should result in higher rates for younger, healthier groups and better rates for older, less healthy groups. In addition, there will be new taxes and fees passed through to the employer in 2014.

Where do small employers have flexibility?

A small employer, with fewer than 50 full-time employees, has more flexibility in determining how many hours an employee must work to be benefits-eligible. For example, a small employer can establish 37.5 hours as the minimum to be eligible for the company health plan, so employees regularly working less than 37.5 hours aren’t eligible. Those employees most likely are eligible for a subsidy to purchase coverage in the public insurance exchange. But, as a small employer not subject to the employer penalties, there are no financial consequences.

Because of the complexities, employers are encouraged to review their employee count and other pending health care reform legislation with a qualified advisor.

 

 

The high cost of U.S. health care

The cost of hip replacement surgery in the U.S. is up to four times higher than what's paid in Switzerland or France, while charges for cesarean section births were more triple the cost of the same procedure in New Zealand or Britain, according to a Commonwealth Fund report. Meanwhile, colonoscopies alone contribute more than $10 billion in annual costs. This report explores the drivers behind high costs in the U.S. using the colonoscopy example as a case study for understanding why 18% of U.S. gross domestic product goes to spending on health care. The New York Times (tiered subscription model)

Covered California Announces Health Plans & Rates

 

California Broker Magazines Insurance Insider News: Thirteen health insurance plans will offer health care coverage through the Covered California health exchange in 2014. The plans are a mix of large non-profit and commercial plan leaders, along with well-known Medi-Cal and regional plans.

The rates for individual plans through the exchange vary from 2% above to 29% below average 2013 premiums for small employer plans in California’s most populous regions. Additionally, exchange plans limit annual out-of-pocket costs to $6,350. Covered California plans include the largest health insurers in the individual market as well as new entrants, regional plans, and local MediCal plans.

The following health plans will participate in the exchange:
• Health Net
• Kaiser
• Anthem Blue Cross
• Blue Shield
• Alameda Alliance for Health
• Chinese Community Health Plan
• LA Care Health Plan
• Molina Healthcare
• Sharp Health Plan
• Valley Health Plan
• Ventura County Health Care Plan
• Western Health Advantage

Three of the nation’s largest players in the employer-sponsored insurance market – UnitedHealthCare, Cigna, and Aetna – will not be selling plans through the California exchange.
Brokers will be able to sell any plan in the exchange, according to Michael Lujan of Covered California who spoke at the LAAHU conference in Los Angeles last week. He urged brokers to get familiar with the plans in order to be ready for open enrollment in October. Renee Casserly of Blue Shield said that, as a broker, you should maintain contact with your clients and let them know that you are able to help them purchase plans under the exchange. She noted that carriers will begin sending out information about the exchange to individual policyholders in September.
Consumers will have a choice of HMOs, PPOs, and exclusive provider organizations (EPOs). Plans that were chosen for the exchange agreed to reduce profit margins down to 2% and 3% and embrace ACOs and medical homes.

In Los Angeles, Orange, San Bernardino, San Diego and Riverside counties, Health Net expects to offer its new tailored-network HMO exchange product, “CommunityCare,” which will be built around local health care providers. Steve Sell, president of Health Net’s Western Region Health Plan said the company will work to ensure that the medical groups, individual physicians and hospitals are committed to comprehensive care coordination and offer freedom of choice in selecting eligible in-network primary care physicians. Health Net Life expects to offer individuals PPO exchange products in the Northern California counties of Contra Costa, Kern, Marin, Mariposa, Merced, Monterey, Napa, San Benito, San Joaquin, San Francisco, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma, Stanislaus and Tulare.

Molina Healthcare will participate in Los Angeles, San Diego, Riverside, and San Bernardino counties. “Our goal is to work with low-income or uninsured,” said J. Mario Molina, MD, president and chief executive officer for Molina Healthcare.
Kaiser Health news reports that nearly three dozen health plans submitted bids to sell their products in the competitive marketplace, and 13 were selected. Exchange officials rejected bids that were priced too high or failed to have robust networks of doctors and hospitals.

Premiums vary depending on the geographic region, the consumer’s age, and the richness of benefits. For example, a 25-year-old in Los Angeles could choose a Health Net catastrophic plan for $117 a month or choose a Bronze plan for $147 a month from L.A. Care, the nation’s largest public health plan. If the 25-year old earns less than about $45,600 per year, they would qualify for a subsidy to bring the cost of the premium down further.

More than half of Californians will be eligible for federal income tax credits for exchange plans. A 40-year-old in Los Angeles who earns $1,915 a month, or 200% of the federal poverty level, would pay a monthly premium of $90 for a Health Net HMO Silver plan in 2014.
The monthly premium would be $332 to $476 for a Silver plan for a 40-year-old individual in Sacramento. That includes federal subsidies, on a sliding scale, for a man or woman with income up to $45,960. Individuals who are eligible for the highest subsidy ($276 per month) would have out-of-pocket premium costs as low as $56 per month. Californians would receive federal subsidies on a sliding scale, extending to a family of four earning up to $94,200. For more information info@amsinsure.com

What happens when a loved one in a nursing home is not receiving proper care?

Question:  3 months ago my sisters and I reluctantly placed our mother (who is 81 years old) in a local nursing home.  Now she is about 30 pounds thinner, doesn’t speak, smells terribly and has bed sores.  We believe that this is the result of poor care provided by the nursing home.  Is there anyone we can contact to “check out” this nursing home and to help us resolve these quality of care issues?  Several of our friends have suggested that we contact the State Long Term Care Ombudsman’s office.  We are not sure what the role of the Ombudsman’s office is.  Can you please educate us on this elder care agency?

Answer:  The Long Term Care Ombudsman program is administered by the Administration on Aging (AoA), and each state (plus the District of Columbia, Puerto Rico and Guam) has a Long Term Care Ombudsman program. 

Long Term Care Ombudsmen are advocates for the residents of long term care facilities, including nursing homes, board and care homes and assisted living facilities.  They are trained to help residents (and the families of residents) resolve problems that they may be experiencing with long term care facilities.

Long Term Care Ombudsmen can help families address the following long term care concerns:

• Violation of  the resident's rights or dignity
• Physical, verbal or mental abuse
• Poor quality of care
• Inappropriate use of restaints

A Dun & Bradstreet study surveyed more than 12,000 failed businesses to find out why businesses fold.

What they found was that 97.5% of the failures were caused by factors involving the human element including incompetence, inexperience and human frailties such as death. The death of a Key Person can and most often will cause the following: ·         Disruption of management ·         Impairment of credit ·         Loss of profits ·         Loss of company confidence Now is the time to review your businessKey Person coverage or put it in place if they do not already have it. We have a “turn-key” tool kit that will help you identify their need and walk you through the process.

Small Businesses Hold Off On Hiring Due to the ACA

 

Forty-one percent of small business owners say they are holding off on hiring because of the Affordable Care Act, according to a Gallup poll. Thirty-eight percent have pulled back on plans to grow their business; 19% have reduced their number of employees; 18% have cut employee hours; and 24% have thought about eliminating healthcare coverage for employees.

Forty-eight percent say the ACA will be bad for their business, compared to 9% who say it will be good, and 39% who expect no impact. Fifty-two percent say the ACA will lower the quality of healthcare; 13% say it will improve care; and 30% say it will have no impact.

Fifty-five percent of small business owners expect to pay more for healthcare as a result of the ACA. Five percent expect their healthcare costs to decline while 37% say the health law will have no effect on what they pay for healthcare. For more information, visit www.gallup.com.

Life Combo Products See Double-Digit Growth

 

More than 86,000 life combination policies were sold in 2012, an increase of 19% over 2011, according to a LIMRA report. Consumers under 59 held more than half of in-force polices in 2012. Sixty percent of life combination policies are insuring women. Life combination products accounted for 11% of new premium for individual life insurance.
Sales of life combination products continue to grow at a remarkable rate as new carriers enter the market and existing players refine products to remain competitive, said Catherine Ho, LIMRA product actuary. “This segment of the market weathered the storm pretty well during the recession when individual life sales declined significantly. Now that sales growth has returned for individual life, we anticipate life combination products to continue their steady growth,” she said.

All life combination product lines experienced growth in 2012, with whole life (WL) and universal life (UL) combination premium each growing 10% and variable combination premium growing 3%. Whole life combination policy count rose 23%; UL policy count rose 19%; and variable policy count rose 4%.All but one distribution channel experienced double-digit growth in 2012 (independent RIA). Banks and savings institutions posted the largest premium growth, rising 21%; affiliated agents recorded 30% growth in policy count.

Consumers Are Not Prepared for a Critical Illness

 

Ninety percent of middle-income Americans say they are not financially prepared for a critical illness diagnosis, according to a study by the Washington National Institute for Wellness Solutions. The study surveyed 1,001 Americans ages 30 to 66 with annual household incomes of $35,000 to $99,999. The following statistics reveal that many have little, if any, savings to fall back on in the event of a critical illness:
• 75% have less than $20,000.
• 50% have less than $2,000.
• 25% have no savings.
To pay for out-of-pocket critical illness costs, middle-income Americans say they would need to use credit cards (28%) or loans from family/friends (23%) or financial institutions (19%). Another 23% don’t know what resources they could use to pay their expenses. Millennials and Gen Xers anticipate greater reliance on credit cards and loans to pay for critical illness expenses. Thirty-eight percent say they might never recover financially from a battle with cancer and 45% believe they would never recover financially from an Alzheimer’s/dementia diagnosis.
Eighty-eight percent of middle-income Americans have had no conversations with loved ones or advisers about potential care-giving options and 60% have not discussed financial planning for critical illness. Only 12% have explored care-giving options.

Individual Rates to Soar In California

 

Expanded enrollment of a sicker population will drive up rates for individual health plans in 2014, according to a study by Milliman for Covered California, the state’s health exchange. The average premium increase will be an astounding 30.1% for people who make too much to receive the subsidy (more than $93,700 for a family of four or $45,960 for an individual).

However, Californians who will qualify for the highest premium tax credits, due to their income, will see an average drop of 85% in what they pay for health coverage. Depending on the individual’s choice of health plan, this premium tax credit could cover a higher percentage of the premium. There are 1 .6 million people uninsured and eligible for subsidies. Many of them could have 100% of their premiums covered through the Affordable Care Act. Those who make less money will be eligible for larger federal tax credits to make their health care more affordable. Households earning from 138% to 250% of the federal poverty level will likely see an average drop of 85% in what they pay for health coverage. Households earning 250% to 400% of federal poverty level will pay on average 45% less, for more coverage with lower copay and deductibles, than what they would have paid for an individual plan in 2013. The hope is that, in future years, Californians will see decreases in their health care costs as they no longer pay for the burden of the millions of uninsured and benefit from improvements in how care is delivered, according to Covered California.

Do You Have YOUR Income Protected?

http://www.youtube.com/watch?v=LHC2R94i3VI&list=PL2FDFB00D1E5B39D1

Good Health Can Be Fun; Teach Your Children

 

Become the hero of your own health story! Habit Heroes like Agent Dynamo can show you how to practice healthy habits. Eating well, exercising and having a positive attitude can turn you into a Habit Hero too — and Anthem can be your helpful sidekick. Choose one of our wellness programs to help. And be the BEST YOU that you can be!

           

Anthem is proud to bring the message of good health to people of all ages by co-sponsoring the Habit Heroes exhibit in the INNOVENTIONS Attraction at Epcot® in the Walt Disney World® Resort. Promoting healthy habits is the goal. And you do it with healthy foods, exercising, and a positive attitude.

As to Disney artwork/properties: ©Disney.

What bothers patients most when visiting the doctor?

A U.S. survey of 1,000 people found the top complaints of patients included long wait times to see physicians, unclear descriptions of problems, slow test results and billing issues. The Consumer Reports study found women were more bothered than men when physicians used electronic devices to record notes and when conversations were held within earshot of other patients. PhysiciansBriefing.com/HealthDay News

Certified Care Manager answers family's question on ElderCareMatters.com

 

Question: Will my parents’ long term care insurance policies pay for day care for my father. Mom is the primary caregiver and needs this “time off” from dad in order not to become totally exhausted. Please advise.

Answer: Without seeing your parent’s specific policy, it is impossible to know what is or is not covered. Some policies only offer payment for specific services such as a non-medical caregiver in the home, a Geriatric Care Manager or the monthly cost for a facility. In addition, many companies sell riders to the basic policy to cover additional types of services beyond what the basic policy covers. Some of the newer policies pay a flat amount of money each month and allow the insured to determine how the money is spent. I recommend you review your parent’s insurance policy to determine the specific benefits allowed to them under their policy. 

It may also be helpful to talk with the agent directly to ensure you are taking full advantage of the benefits they are entitled to receive.
ElderCareMatters.com – America's National Directory of Elder Care / Senior Care Resources for Families.

ACA Will Test Consumers’ Loyalty to Their Doctors

 

Half of consumers would switch their doctor if they could save a certain amount in annual health care costs, according to a survey by HealthPocket. Thirty-four percent would switch if they could save $500 to $1,000; eight percent would switch if they could save $1,000 to $2,000; and 8% would switch if they could save $3,000 or more.

Consumers and small employers will face an array of new health plan choices in 2014. Other than cost, one of the key factors in consumers’ selection process is whether their doctor participates in a plan’s provider network. Cost pressures are moving insurers to limit their provider networks. They are seeking to negotiate lower rates to healthcare providers in exchange for a larger volume of patients.

HealthPocket is offering a physician search component on its site at http://www.healthpocket.com/doctor-finder. It allows consumers to compare all commercial health plans, Medicare plans and Medicaid programs that their doctor may accept.

Special Needs Trusts for special needs children?

Question: "My wife and I (who are in our 60s) have been encouraged to set up a Special Needs Trust for our disabled adult child. Could you please tell us why this would be necessary? Also, could you please provide us with a little background information on this type of legal instrument?"
Answer: Among the many challenges facing parents of children with special needs is planning for the time when the parents will no longer be around to act as the primary caregivers. Advance planning by parents can make all the difference in the life of the child with special needs, as well as for siblings who may be left with caretaking responsibilities.
A Special Needs Trust for your disabled child should be part of an overall plan for your child. If the parent is the legal guardian for the disabled child, it is essential as part of the planning is to arrange for the orderly transfer of the guardianship to a successor. A Special Needs Trust is a trust created for a chronically disabled beneficiary, which supplements government benefits like Medicaid. Medicaid and other government benefit programs consider the resources and income of an individual for purposes of determining eligibility and the amount of such assistance. With a Special Needs Trust, however, someone may establish a trust for a disabled individual without jeopardizing that individual’s eligibility for government benefits. Special needs trusts allow a disabled beneficiary to receive inheritances, gifts, lawsuit settlements, or other funds and yet not lose his or her eligibility for certain government programs. Such trusts are drafted so that the funds will not be considered to belong to the beneficiary in determining eligibility for public benefits.
Often, special needs trusts are created by a parent or other family member for a child with special needs, even though the child may be an adult by the time the trust is created or funded. Such trusts are set up as a way for an individual to leave assets to a disabled relative. As their name implies, special needs trusts are designed not to provide basic support, but instead to pay for comforts and luxuries that could not be paid for by public assistance funds. These trusts typically pay for things like education, recreation, counseling, and medical attention beyond the simple necessities of life. However, the trustee can use trust funds for food, clothing, and shelter if the trustee decides doing so is in the beneficiary’s best interest despite a possible loss or reduction in public assistance. Special needs can include medical and dental expenses, annual independent check-ups, necessary or desirable equipment training and education, insurance, transportation, and essential dietary needs. If the trust is sufficiently funded, the disabled person can also receive spending money, electronic equipment and appliances, computers, vacations, movies, payments for a companion, and other self-esteem and quality-of-life enhancing expenses.
It is important to plan to ensure that your child receives appropriate therapies and medical treatments. It is essential to take the time necessary to find appropriate caregivers who will carry out your wishes and respect your child's goals, dreams and life expectations. At the same time, Predators are particularly attracted to vulnerable beneficiaries, such as the young and those with limited self-protective capacities. When you plan with trusts, you decide who has access to the information about your children's inheritance. This protects your child and other family members, who may be serving as trustees, from predators.
It is important that special needs trusts not be unnecessarily inflexible and generic. Although an attorney with some knowledge of trusts can protect almost any trust from invalidating the child's public benefits, an attorney without special needs experience may not customize the trust to the particular child's needs, and the child may not receive the benefits that the parent provided when they were alive.


James C. Siebert, Attorney at Law

Is it possible to pay the medical expenses of a parent and deduct on your tax returns?

 

Question: My mother is 87 years old and lives in an assisted living facility, which cost about $4,000 per month. She has no assets to speak of and very little income, i.e. she has a small monthly Social Security check and a very small monthly pension. I have been paying for her care in the assisted living facility. Is there anyway that my husband and I can deduct what we pay for mom's medical care in the assisted living facilty on our individual income tax returns? Please provide your answer as soon as possible because we are about to file our 2012 individual income tax returns.
Answer: Yes, a child can deduct medical expenses that they paid on behalf of their parent (even if the parent doesn't qualify as one of their dependents, doesn't live with them and has a gross income that exceeds $3,800 (for tax year 2012)) if the child provided over half of the parent's total support during the tax year. Assuming that the child paid more than 50% of their parent's total support during this tax year, then the medical expenses paid on the parent's behalf in excess of 7.5% of the child's Adjusted Gross Income (AGI) are deductible on the child's individual income tax returns as itemized deductions.