Ohio Health Benefits
LLC.
Your health insurance partner!!
Ohio Health Benefits
LLC.
Your health insurance partner!!
• “Obamacare” or ACA or PPACA or Health
Care Reform (HCR)
Patient Protection and
Affordable Care Act of 2010
• Signed in to law on March 23, 2010
• The bill itself is over 2700 pages long
So… how many “pages” are in the Affordable Care Act? In the actual legislation itself, there are just over 2,400. But the legislation is incomplete without the accompanying regulations, most of which have yet to be published.Ohio Health Benefits
LLC.
Your health insurance partner!!
2010‐2012
• Allows the FDA to approve more generic drugs. • Increases rebates on drugs through Medicare. • Gradually closes the Part D Medicare Coverage Gap or "Donut Hole". • The PCORI, an independent non‐profit advisory board, studies different types of treatments in order to ensure quality affordable health care under ACA. • Chain restaurants must now display calories on their menus. • Health Insurance companies can't rescind coverage when you’re sick.Ohio Health Benefits
LLC.
Your health insurance partner!!
**• Individuals can't be denied coverage for preexisting conditions. **• Children under the age of 19 can't be declined acceptance due to a pre‐ existing condition. • Children under the age of 26 can stay on their parents insurance. • Income exclusion for Indian Tribe health benefits that were provided after March 23rd, 2010 • Medicare cuts to hospitals and other health care facilities. • “Comparative Effectiveness Research,” or CER studies the effectiveness of drugs by comparing drug to drug and seeing which one works best.
Ohio Health Benefits
LLC.
Your health insurance partner!!
What exactly does the ACA include?
Ohio Health Benefits
LLC.
Your health insurance partner!!
What exactly does the ACA include?
Ohio Health Benefits
LLC.
Your health insurance partner!!
• Improves treatment for patients with chronic illnesses. **• Prohibits non‐group plans from canceling coverage. **• Limits the ability to use HSA and FSA money to purchase over the counter prescriptions. • Employers must list employee benefits on the employees W‐2 tax form. • Hospitals in "Frontier States" (ND, MT, WY, SD, UT ) receive higher Medicare Payments • Hospitals in "low‐cost" areas receive higher Medicare payments for 2 years
Ohio Health Benefits
LLC.
Your health insurance partner!!
What exactly does the ACA include?
Ohio Health Benefits
LLC.
Your health insurance partner!!
• Establishes state consumer assistance programs to help consumers file complaints, appeals, enroll in health care and other consumer related assistance to better understand trouble spots that need oversight. • Created a hospital "pay‐for‐quality" program. This is part of an overall effort to promote quality not quantity in the health care industry. • Imposes a 3.8% tax increase on capital gains over, unearned income, interest, dividends, annuities, rent, royalties, and inactive businesses. Exemptions include income from tax‐exempt bonds, veterans benefits and qualified plan distributions such as those from an IRA or 401k. • The 3.8% tax does not apply to selling your primary residence in most cases.
Ohio Health Benefits
LLC.
Your health insurance partner!!
What exactly does the ACA include?
Ohio Health Benefits
LLC.
Your health insurance partner!!
What exactly does the ACA include?
Ohio Health Benefits
LLC.
Your health insurance partner!!
What exactly does the ACA include?
Ohio Health Benefits
LLC.
Your health insurance partner!!
What exactly does ACA include?
Ohio Health Benefits
LLC.
Your health insurance partner!!
Ohio Health Benefits
LLC.
Your health insurance partner!!
Ohio Health Benefits
LLC.
Your health insurance partner!!
1.Outpatient care
2.Trips to the emergency room
3.Inpatient Care
4.Maternity Services
5.Mental health and substance use disorder
services: This includes behavioral health
treatment, counseling, and psychotherapy
Ohio Health Benefits
LLC.
Your health insurance partner!!
1.Prescription drugs
2.Habilitative and rehabilitative services and
devices.
3.Lab tests
4.Preventive services including
counseling,
screenings, and vaccines to keep you
healthy
and care for managing a chronic
disease.
5.Pediatric services: This includes dental care
and vision care for kids
Ohio Health Benefits
LLC.
Your health insurance partner!!
What does this mean for small business?
(Businesses with less than 50 employees)
• There is still no requirement for small businesses to offer
health insurance to employees.
• If small business does offer insurance participation rules
and contribution rules still apply. (75% and 50%)
• No underwriting on small business!
• No need for medical forms. “Street rates” are readily
available but in most cases higher!
• Rates are all age based.
Ohio Health Benefits
LLC.
Your health insurance partner!!
What does this mean for small business?
(Businesses with less than 50 employees)
• No subsidies for employees that are offered “affordable”
coverage.
• Employees not offered coverage can get subsidies.
• Employer cannot help pay for the subsidized insurance!
• Any financial assistance to employee must be in the form
of compensation.
• Employee can do whatever they want and choose any
plan or not. The employer is not involved.
• Some employees and their family members may be
Medicaid eligible.
Ohio Health Benefits
LLC.
Your health insurance partner!!
What does the individual market
look like for employees?
• On Exchange plans (subsidy eligible)
• Off Exchange plans (no subsidy)
• Medicaid
Ohio Health Benefits
LLC.
Your health insurance partner!!
Subsidy Chart Single
Single Person Non Tobacco
Yearly % of 20 yr old 30 yr old 40 yr old 50 yr old 60 yr old Cost as Income poverty Premium Premium Premium Premium Premium % of income
Yearly Monthly Yearly Monthly Yearly Monthly Yearly Monthly Yearly Monthly $11,170 100% Medicaid $0 Medicaid $0 Medicaid $0 Medicaid $0 Medicaid $0 $13,963 125% Medicaid $0 Medicaid $0 Medicaid $0 Medicaid $0 Medicaid $0
Subsidy Chart Family of 4
Family of Four Non Tobacco
Yearly % of 20 yr old 30 yr old 40 yr old 50 yr old 60 yr old Income poverty Premium Premium Premium Premium Premium
