How to Avoid the PPACA Health Insurance Penalty

Forego covering yourself with Health Insurance in 2014 or acquire a short term non-compliant policy?  The IRS come tax season 2015 will impose a penalty and charge you extra.  

If you didn’t have coverage in 2014, you’ll pay the higher of these two amounts when you file your 2014 federal tax return:

• 1% of your annual household income.  The maximum penalty is the national average premium for a bronze plan.
• $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.

1. Family members of a worker who qualifies for affordable individual coverage, but not for affordable family coverage.

The IRS put this in because of a quirk in PPACA and the PPACA implementation regulations.

Regulators say an employer can fulfill its obligations under PPACA to offer affordable coverage with a minimum value by providing coverage set up in such a way that a full-time worker's share of the self-only coverage premiums costs less than 9.5 percent of the worker's W-2 wages from that employer.

The employer does not have to offer the worker access to affordable family coverage -- and the family members of that worker do not qualify for PPACA public exchange premium subsidy tax credits.

But the family members will not have to pay the penalty to be imposed on people who fail to have MEC -- and, apparently, they won't have to go through an exchange certification process.

2. A client earns too little income to have to file a federal income tax return.

Some workers don't earn enough to have to file individual income tax returns. As long as those workers are heads of household, not dependents, they will be able to avoid the no-MEC penalty without going to the trouble of filing tax returns simply to report that they have little or no income.

3. The client ended up getting MEC but bought it a little late.

The IRS has created several sets of deluxe hardship exemption justifications for people who had public exchange problems in early 2014 -- or look as if they might have had exchange problems -- and eventually got MEC.

4. The client has been eligible for health care services from an Indian health care provider.

Clients who want to avoid the no-MEC penalty may develop an intense new interest in their Native American genealogical heritage.

5. The client has a low income and lives in a state that did not expand access to Medicaid coverage.

Many states used PPACA Medicaid expansion money to make Medicaid available to all people with income below 138 of the federal poverty level, but many did not. Low-income adults in the non-expansion states can get out of the no-MEC penalty without bothering to apply for exchange certification. 

Information and source from BenefitsPro:

http://www.benefitspro.com/2014/11/26/5-great-individual-ppaca-mandate-exemption-excuses?eNL=547e1be9150ba0b2554a3fad&utm_source=BenefitsBrokerPro&utm_medium=eNL&utm_campaign=BenefitsPro_eNLs&_LID=116707417&page=6

Staying Covered Through Open Enrollment

Health Insurance Failure to Review Example 1: Compare Silver PPO (copay) plans between Medical Mutual and InHealth Mutual.  Same deductibles, similar out of pockets, copays, and prescription coverage.  Both have the better networks in Ohio.  The family of 3 with Medical Mutual will lose 20% in premium, over $2,200.00 annually.  Many people are unaware of InHealth, a reputable insurance carrier, because of their lack of presence online.  Premium and medical expense dollars are wasted everyday in the health insurance market.  

The mistake people often make is thinking it costs extra or their policy will cost more by working with the Agent.  Not the case, the commissions are built into the premium whether you buy online yourself or use a credible referral through your Financial Planner.  Be sure to consult with an Independent Broker/Advisor about your options this open enrollment, its FREE.  

From CMMS:

Every fall, your health insurance company sends you a letter explaining changes to premiums and benefits for the coming year.

You can choose to stay in your current plan (as long as it’s still offered) or make changes. If you don’t take action by December 15, 2014, you could miss out on better deals and cost savings.

1. REVIEW PLANS CHANGE, PEOPLE CHANGE. Every year, insurance companies can make changes to premiums, cost-sharing, or the benefits and services they provide. Review your plan’s 2015 coverage to make sure it still meets your needs and you’re getting the best plan for you.

2. UPDATE Starting November 15, visit HealthCare.gov and log into your Marketplace account. Answer a few questions to get to your 2015 application – it will be pre-filled with your latest information from 2014. Step through each page of your application and make changes if you need to. This is important – even if none of your information has changed, you might be eligible for lower costs than last year! You also can call the Marketplace Call Center at 1-800-318-2596 to review or make updates over the phone.

3. COMPARE Log into your Marketplace account and follow the “Enroll To Do List” on HealthCare.gov to compare 2015 plan costs and benefits. New and more affordable plans may be available in your area this year. If you decide to stay in your current plan, follow the directions to search by that plan’s 14-digit ID – you can find the ID on the letter from your plan. Or, call the Marketplace Call Center at 1-800-318-2596 for help.

4. CHOOSE Choose a health plan for 2015. You can keep the same plan (as long as it’s still offered) or select a new one that better fits your needs. If you want to stay enrolled in your 2014 plan, use the plan ID in the letter you get from your health plan.

5. ENROLL Stay covered for 2015! Contact your plan to confirm your enrollment. Make sure to pay your premium.

STEP 1 Review - Things to remember:

• Look for a letter in the mail from your health plan describing any plan changes.

• Read the letter, and contact your health plan if you have questions.

• Write down important dates and information from the letter - like December 15, and your 14-digit plan ID.

STEP 2 Update - Things to consider:

• Can’t access your Marketplace account? Follow the steps on the screen to reset your password.

• Did any of your income, household, or personal information change? Even a small change can affect your premium tax credits and cost- sharing reductions, so make sure your information is up-to-date.

• After you submit your 2015 application, check your eligibility results carefully. Even if none of your information changed, you might get different cost savings because of changes in the Marketplace. 

STEP 3 Compare - When comparing plans, consider:

• Are there more affordable plans available to you that weren’t an option last year?

• Are you happy with the changes to your current plan?

• Are your current doctors in the plan’s network?

• Will your prescriptions be covered?

• What will your benefits and costs be?

 STEP 4 Choose - Things to remember:

• You can choose any plan available to you in your area in 2015, no matter what kind of coverage you had in 2014.
• All 2015 Marketplace plans include all benefits and protections required by the health care law.
• You can use any premium tax credits and cost-sharing reductions (if you qualify) only if you enroll in a plan through the Marketplace.

 STEP 5 Enroll - Things to remember:

• For health coverage starting January 1, 2015, you must enroll in a plan by December 15, 2014.

• If you want to change 2015 plans after December 15, 2014, you can do that any time during Open Enrollment, which continues through February 15, 2015.

• If you make updates and enroll in a new health plan after December 15, 2014, your coverage won’t start on January 1. Read the notice from your health plan to check when your coverage will start.

 Complete all 5 Steps to finish enrolling in a health plan, even if you want to stay in the same plan.

This is important to get the coverage you want and the most cost savings that you’re eligible for. If you don’t finish all of the steps by December 15, we’ll try to enroll you automatically so you stay covered. But this coverage might not be your best option for 2015 and you could miss out on cost savings.

If you have questions or need to find someone who can help you in person, we can help. Find local help at: 614.431.4302, Quote@mosaicemployeebenefits.com

Mosaic Employee Benefits, LLC

7650 Rivers Edge Drive

Columbus, Ohio 43235

American Majority No Longer Supports PPACA

 

(BenefitsPro, 9/9/14)

The downward spiral of public opinion surrounding
the Patient Protection and Affordable Car Act
continues since its July peak, just as midterm elections creep closer.

The latest Health Tracking Poll from the Kaiser Family Foundation
finds many more people pessimistic about the law, with 47 percent
viewing it unfavorably vs. 35 percent supporting it.
Among likely voters, targeted specifically by this poll,
that gap grows to 52 percent vs. 35 percent.

While those results might hearten
the hopes of Republicans plotting a midterm insurgence two months from now,
respondents overwhelming support repair over repeal,
by a 63 percent to 33 percent margin.

Ohio Granted Early Access to Fed SHOP

The Centers for Medicare & Medicaid Services will give benefit advisers and small employers in five states early access to the federally-facilitated Small Business Health Options Program, but benefit brokers say few employers are interested — so far.

Small employers, agents and brokers in Delaware, Illinois, New Jersey, Ohio and Missouri will have access to SHOP in late October. Although enrollment in the states will still not start until the official Nov. 15 enrollment kick-off, small employers in the states will be able to use HealthCare.gov to do such things as establish a profile, assign an agent or broker to their account, complete an employer eligibility application, and browse plans and pricing when they become available. - HIX 9/10/2014

Mosaic Benefits will be able to assist you through the SHOP enrollment should you choose this direction.  This will be a wait and see process.  Our expectations are very low considering this is the first year for the program (delayed in open enrollment 2013).  There’s still a lot of fear among brokers and employers regarding SHOP.  If it is anything like the inaugural enrollment for the Individual Marketplace, you can expect a disaster.  No billing process has been announced and affordability is still a question as we do not know the 2015 rates.  "Rates for pre-Obamacare plans have been significantly lower than the exchange plans," in most cases. However, the idea of employees of having the option to choose their carrier, premium, and plan benefits while maintaining the qualifications of a group plan is attractive to both the employer and employee.

**Open Enrollment for Individual and SHOP plans effective 1/1/2015 begins this November 15^{th .}  In addition to SHOP, Mosaic Employee Benefits will also have the capability and software to assist any of your lower income employees (and families) in the need of a premium subsidy / tax credit on their individual health insurance premiums.  If you do not offer insurance to your employees, we can certainly consider scheduling a “Health Insurance Day” at your office during the open enrollment period.  We will have a Licensed Broker on site to review each employee’s current status, run quotes, and enroll new individual plans. 

Any questions or concerns regarding your plan or thoughts for offering a plan in 2015 please do not hesitate to call 614.431.4302.

Open Enrollment 2015

     The 2015 Open Enrollment Period is rapidly approaching, November 15^th, 2014 – February 15^th , 2015.  I will be contacting you during this time to ensure your health insurance needs are taken care of.  If a change in carrier or benefits needs to be made, this will be the time to do it.  To ensure my clientele is handled properly and in a timely manner, I am releasing the below information highlighting the “need to knows.”  Please take a few minutes to read the information and come up with any questions or concerns you may have regarding your unique situation.  Premiums under the Patient Protection and Affordable Care act are expected to increase by an average of 7.5% in 2015 (PricewaterhouseCoopers Health Research Institute).   The highest proposed rate increase thus far came in Nevada, where consumers might see their premiums rise by 36%.  Planning for 2015 is a necessity.

     I ask that you please take into consideration your Friends, Family, and Business networks relative to the below information.  Referrals are the best way to expand the business and help improve the lives of other individuals.  We will be working with On (subsidized) and Off (no tax credit) Exchange Policies again for 2015.  Mosaic Employee Benefits established a goal of helping 100 new families between November 2014 and February 2015.  With your help, we can make that possible.  Keep in mind we also work with and offer Employer Sponsored Plans!

State Licenses: Ohio, Michigan, South Carolina, Kentucky, and Texas

Individual Health Insurance Carriers: Aetna, Anthem, Assurant, Blue Cross Blue Shield, Celtic, Cigna, IHC short term,  Golden Rule / United Health One, Humana, InHealth Mutual, Medical Mutual, Priority Health

Eric M. O’Brien

7650 Rivers Edge Drive

Columbus, Ohio 43235

614.431.4302

OPEN ENROLLMENT: NOVEMBER 15^th 2014 – FEBRUARY 15^th 2015

As of November 15, 2014, we may access the Federally-facilitated Marketplaces to enroll consumers in Individual Marketplace and Small Business Health Options Program (SHOP) plans for the 2015 plan year.  Please pay special attention to the rules and regulations, some of which have changed for 2015. This Open Enrollment Period applies to all individuals who do not receive their health insurance through their employer, tax credit/subsidy or no tax credit/subsidy!

When Enrollments Take Effect During The Initial Enrollment Period (*may vary by carrier)

Enrollment Selection Received                    Date Insurance Begins

11/15/14 – 12/15/14                                         January 1^st 2015

12/16/14 – 1/15/15                                           February 1^st 2015

1/16/15-2/15/15                                                March 1^st 2015

2014 Tax Year

·         The annual individual shared responsibility payment is the greater of

o    1% of the taxpayer’s household income that is above the tax return filing threshold for the taxpayer’s filing status, or

o    The taxpayer’s flat dollar amount, which is $95 per adult and $47.50 per child, limited to a family maximum of $285.

·         However the total payment amount is capped at the cost of the national average premium for a Bronze level health plan available through the Marketplaces in 2014.

2015 Tax Year

·         The annual individual responsibility payment is the greater of

o    2% of the taxpayer’s household income that is above the tax return filing threshold for the taxpayer’s filing status, or

o    The taxpayer’s flat dollar amount, which is $325 per adult and $162.50 per child, limited to a family maximum of $975.

·         However the total payment amount is capped at the cost of the national average premium for a Bronze level health plan available through the Marketplaces in 2015.

***The calculations above represent the amount of the payment for not having health insurance coverage for the entire year. Individuals will owe 1/12^th of the annual payment for each month they (or their dependents) do not have coverage and are not exempt.

Under certain circumstances, an individual may be exempt from the individual responsibility requirement. These circumstances include the following:

·         The individual is uninsured for less than three months of the year

·         The lowest-priced coverage available to the consumer would cost more than 8% of the consumer's household income

·         The individual does not have to file a tax return because his or her income is too low

·         The individual is a member of a federally recognized tribe or eligible for services through an Indian health care provider

·         The individual is a member of a health care sharing ministry

·         The individual is a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare

·         The individual is incarcerated, and is not awaiting the disposition of charges

·         The individual is not lawfully present in the United States

·         The individual has experienced a hardship (defined below):

ü  Becomes homeless

ü  Has been evicted in the past six months, or is facing eviction or foreclosure

ü  Has received a shut-off notice from a utility company

ü  Recently experienced domestic violence

ü  Recently experienced the death of a close family member

ü  Recently experienced a fire, flood, or other natural or human-caused disaster  resulting in substantial damage to individual property

ü  Filed for bankruptcy in the last six months

ü  Incurred medical expenses in the last 24 months that resulted in substantial debt

ü  Experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member

ü  Expects to claim a child as a tax dependent who has been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, the individual would not have to make a payment for the child

ü  As a result of an eligibility appeals decision, is determined eligible for enrollment in a QHP through a Marketplace, the premium tax credit, or cost-sharing reductions for a period of time during which he or she was not enrolled in a QHP through a Marketplace

ü  Was determined ineligible for Medicaid because his or her state did not expand eligibility for Medicaid under the Affordable Care Act

ü  Lost insurance coverage because his or her individual plan was cancelled and believes other available coverage options are unaffordable

ü  Experiences another hardship in obtaining health insurance

Updated Tax Credit Guidelines for 2015 (FPL – Federal Poverty Level)

Household Size	100%	138%	150%	200%	250%	300%	400%
1	$11,670	$16,105	$17,505	$23,340	$29,175	$35,010	$46,680
2	15,730	21,707	23,595	31,460	39,325	47,190	62,920
3	19,790	27,310	29,685	39,580	49,475	59,370	79,160
4	23,850	32,913	35,775	47,700	59,625	71,550	95,400
5	27,910	38,516	41,865	55,820	69,775	83,730	111,640
6	31,970	44,119	47,955	63,940	79,925	95,910	127,880
7	36,030	49,721	54,045	72,060	90,075	108,090	144,120
8	40,090	55,324	60,135	80,180	100,225	120,270	160,360

If Applying for a Tax Credit, the Marketplace verifies data for individuals seeking coverage through the Marketplace, including verification of:

·         Social Security Number (SSN) (if applicant has an SSN)

·         Citizenship or lawful presence

·         Incarceration status

·         Membership in a federally-recognized Indian tribe or status as a shareholder in an Alaska Native Corporation (if applicable)

·         Household income for consumers seeking eligibility for insurance affordability programs

o    Annual household income for premium tax credit/cost-sharing reduction eligibility

o    Current monthly household income for Medicaid/CHIP eligibility

·         Access to minimum essential coverage

Individuals enrolling in a QHP through an Individual Marketplace may be eligible for the premium tax credit, which reduces the cost of premiums for themselves and their tax dependents. An individual may choose to apply the tax credit towards QHP premium costs on an advance basis – with reconciliation at the end of the year – or to receive the credit on his or her federal tax return filed for the plan year. Advance payments are paid directly to QHP issuers on a monthly basis.

• Individuals eligible for a premium tax credit who do not receive an advance payment of the premium tax credit may claim the credit on their income tax return filed for the plan year. Individuals who are married at the end of the plan year are required to file a tax return and may not use the “Married Filing Separately” filing status on the tax return to receive a premium tax credit.
• Eligibility for the premium tax credit is based on household income, family size, and access to other minimum essential coverage.
• As a result of the Defense of Marriage Act (DOMA) ruling in 2013, the eligibility rules with respect to the premium tax credit treat same-sex spouses in the same manner as opposite-sex spouses, so long as the taxpayer and his or her spouse do not file a tax return with a filling status of “Married Filing Separately” for the taxable year.

Special Enrollment Period (60days) Qualification – An individual or family may apply for new coverage outside the open enrollment period if they experience:

Termination of Employment¹	Date eligibility for existing Minimum Essential Coverage is lost	Letter from employer on company stationary, letter must verify date of termination
Reduction in Hours Worked¹	Date eligibility for existing Minimum Essential Coverage is lost	Letter from employer on company stationary, letter must verify date of reduction in hours
Divorce¹	Date eligibility for existing Minimum Essential Coverage is lost	Divorce decree
Death of Spouse/Parent¹	Date eligibility for existing Minimum Essential Coverage is lost	Death certificate
Dependent Reaching Limiting Age¹	Date eligibility for existing Minimum Essential Coverage is lost	Benefit book displaying limiting age requirement
No Longer Qualify for Medicaid or CHIP¹	Date eligibility for existing Minimum Essential Coverage is lost	Termination of coverage letter for Medicaid or CHIP, letter must include termination date
Expiration of COBRA benefits¹	Date eligibility for existing Minimum Essential Coverage is lost	Documentation of COBRA expiration, letter must include termination date
Marriage¹ (addition of spouse)	Date of Marriage	Marriage License
Birth² (addition of new child)	Date of Birth	Birth certificate
Adoption² (addition of new child)	Date of Adoption	Adoption papers/Legal Guardianship papers
Placement for Adoption²	Date of Placement	Adoption papers/Legal Guardianship papers
Placement into Foster Home²	Date of Placement	Legal Guardianship papers
New Permanent Resident of Ohio³	Date of Permanent Move	Documentation required for both prior and new address:• Utility bill• Lease agreement• Mortgage paperwork• Letter from employer if move based on employment
Newly Ineligible for Federal Subsidy³	Date Notified of New Eligibility Status	Newly ineligible for subsidy, the individual may apply in the off-exchange market, MM will require termination of subsidy document which must include date subsidy will terminate.
Existing Individual Policy being Terminated¹ (not including termination in case of rescission)	Date Policy will be Terminated	Copy of termination letter which displays date of termination
Existing Individual Policy Renewal Date¹	Date Renewal is Effective	Copy of renewal which displays renewal effective date