Healthcare Reform

Important dates for 2018 enrollment:

  • November 1, 2017: Open Enrollment starts — first day you can enroll in a 2016 Marketplace plan
  • January 1, 2018: First date 2018 coverage can start
  • December 15, 2017: 2016 Open Enrollment ends
  • In order to get a 01/01/18 effective date on your plan, you must have your application in by 12/15/2017.
  • HAP and Priority Health have discontinued most of their PPOs if not all of them.  Please contact us after November 1st to shop for your next plan.

If you don’t enroll in a 2018 plan by December 15, 2017, you can’t enroll in a health insurance plan for 2018 unless you qualify for a Special Enrollment Period.  How can I get coverage after open enrollment ends?

Remember… You CANNOT change plans outside of open enrollment.

 

2018 Updates:
  •  The 2018 Out of Pocket Maximum will go to $7,350 per individual and $14,700 per family

Medicaid, CHIP, and SHOP – apply any time

The Medicaid Website is:  http://www.michigan.gov/healthymiplan

The medicaid phone number is 800-642-3195

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If you are searching the marketplace yourself, you MUST enter our Marketplace ID (Mrobinette) and National Producer Number (8950505) in order to utilize the services we provide you at no extra cost.

Health Care Reform

There are a lot of changes coming throughout the years as the Health Care reform takes place.  We would like to keep you updated on these changes and how they will affect you as an individual as well as you as an employer

The SHOP is the marketplace for small businesses.  SHOP certification is not mandatory; however, we have agents who are SHOP certified. There is no additional cost for our services.

Please let your employees who are looking for individual coverage know to contact us, so we can assist them in the Marketplace.

What is the Federally Facilitated Marketplace? The Marketplace is for individuals and the SHOP marketplace is for small groups of 50 or fewer employees.  It is a place where you can go to shop for plans, see if you qualify for a tax credit or subsidy, and apply for coverage.

Do I have to apply for coverage on the Federally Facilitated Marketplace?  No; however, to qualify for financial help (tax credits and/or subsidies) you must apply for coverage through the Marketplace.  There may be additional carriers that do not participate with the Marketplace (so you cannot get a tax credit and/or subsidy with this carrier that is not on the Marketplace).

Will I be charged a fee if I do not have health coverage?

 

What is the fee for not having health insurance in 2018?

The fee is calculated 2 different ways – as a percentage of your household income, and per person. You’ll pay whichever is higher.

Percentage of income

  • 2.5% of the taxpayer’s household income that is above the tax return filing threshold for the taxpayer’s filing status.

Per person

  • $695 per adult
  • $347.50 per child under 18
  • Maximum: $2,085

In order to avoid paying the fee, you must have minimum essential coverage. All Marketplace plans offer minimum essential coverage. Most plans outside the Marketplace qualify as minimum essential coverage too.

How you pay the fee

  • Using the percentage method, only the part of your household income that’s above the yearly tax filing threshold ($10,300 for individuals, $20,600 for couples filing jointly in 2015, the most recent year available) is counted.
  • Using the per-person method, you pay only for people in your household who don’t have insurance coverage.
  • If you have coverage for part of the year, the fee is 1/12 of the annual amount for each month you (or your tax dependents) don’t have coverage. If you’re uncovered only 1 or 2 months, you don’t have to pay the fee at all. Learn about the “short gap” exemption.
  • You pay the fee when you file your federal tax return for the year you don’t have coverage.

Learn more about the individual shared responsibility payment from the Internal Revenue Service.

Plans effective beginning January 1, 2014 and forward (group and individual) must have 10 essential plan benefits: 

  1. Outpatient Care – The care you receive for treatment without being admitted to a hospital
  2. Emergency Room services
  3. Inpatient Care – The care you receive for a treatment in the hospital
  4. Maternity and Newborn – Care before and after your baby is born
  5. Mental Health and Substance use disorder services – Including behavioral health treatment (this includes counseling and psychotherapy)
  6. Prescription Drugs
  7. Rehabilitative and Habilitative service and devices (services and devices to help people with injuries, disabilities, or chronic conditions, or to gain or recover mental and physical skills.  This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation and more
  8. Laboratory tests
  9. Preventative Services – Counseling, screenings and vaccines (things to help keep you healthy like annual physicals)
  10. Pediatric Services for Children under 18 – Dental and vision care

***Please note that short term coverage does not meet the minimum essential coverage, so you will still be penalized for not have coverage

Individual Coverage

For plans effective/renewing January 1, 2014 and forward…

  • New Taxes and Fees will be implemented on all existing and new plans
  • Non-Discrimination Rules – Most health insurance carriers cannot deny or increase your rate for coverage if you have a pre-existing condition; it must be covered from day one of your plan.
  • Individual Mandate fees for those without coverage will be implemented
  • Premium Tax Credits/Subsidies will be available for those people who meet a certain income bracket.  If your employer offers coverage that meets minimum value criteria, you will not qualify for the tax credit/subsidy.
  • Reduced Cost Sharing will be implemented.  This allows for people with lower incomes to have their cost-sharing reduced so that their plan, on average, pays a greater share of covered benefits.
  • Child only policies will be available with certain carriers

Federal Poverty Level (FPL) - The below is a chart acquired from HAP showing the estimated incomes in order to receive a subsidy/tax credit and cost sharing.


A measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits.
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Federal Poverty Level amounts are higher in Alaska and Hawaii. See Alaska and Hawaii FPL information.

How to use this health care savings chart

Modified Adjusted Gross Income chart brought to you by HAP:

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Small Business Coverage:

For plans effective/renewing January 1, 2014:

  • Minimum of 90 day waiting period for new/eligible employees (1st of the  month following 90 days will not be allowed)
  • Employee count will be not be based on Full Time Eligible Employees but rather Full Time Equivalents (Full and part-time employees combined)

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Disclaimer: “This calculator provides a general overview of certain aspects of health care reform based on information currently available. It does not cover all of the requirements, and new information is released frequently. Information provided by this website about health care reform is offered as an educational tool and should not be considered legal advice. The effect of reform on your business may differ depending on your circumstances.”

ACA taxDisclaimer: Please be aware that this taxes/fees schedule and calculator may be specific to Priority Health; Certain pricing and tax factors were developed based on each carrier’s approach.  The factors and methodology for calculating these amounts for other carriers could be very different. This is here to give you an estimate only.  Your plan and carrier’s taxes and fees may differ.

      • Pediatric Dental and Vision will be required for all children 18 and under.  If you have proof of dental through another carrier, this fee for dental may be waived.  The fee is estimated at $20-$30 per child with a maximum fee of 3 (this may vary by carrier.
      • Essential Benefits will be embedded on plans effective 2014
      • Wellness Incentive Rewards may be available – a program to promote health by offering incentives such as discounted premium, gym memberships, etc.

Small Business Tax Credits may be available

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Disclaimer: “This calculator provides a general overview of certain aspects of health care reform based on information currently available. It does not cover all of the requirements, and new information is released frequently. Information provided by Priority Health about health care reform is offered as an educational tool and should not be considered legal advice. The effect of reform on your business may differ depending on your circumstances.”  This calculator is here to give you an estimate only.  Please use the website www.irs.gov for more exact calculations or visit your tax accountant.

 

      • Individual Premium Tax Credits/Subsidies will be available for those people who meet a certain income bracket.  If your employer offers coverage that meets minimum value criteria, you will not qualify for the tax credit/subsidy.
      • Cost Sharing Limits will be implemented.  Deductibles and out of pocket maximums will be limited to a certain dollar amount depending on your plan

Will I face penalties if I do not offer coverage to my employees?

  • Businesses with 50 + Full Time Equivalents could face a penalty in 2015 if they are not offering health coverage that does not meet minimum value to their employees
  • Businesses with less than 50 Full Time Equivalents will not face a penalty for not offering health insurance.

 

Disclaimer: The information listed has been reworded for better understanding.  It is an overview of some of the Health Care Reform topics.  It does not cover all topics or all of the requirements of The Health Care Reform. This is strictly a learning tool.  This information is not to be used legally or as advice.  This information may change frequently, so please visit healthcare.gov or www.cms.gov for more detailed information.

Some of the carriers we work with:

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