The Health Exchange also known as The Health Marketplace or Obamacare Exchanges are set to open in less than 12 hours. Are you ready or aye you like most asking What is an Exchange? Starting Oct 1 you can enroll until March 31, 2014, though you’ll generally need to sign up by Dec. 15 of this year, to be covered as of Jan. 1. You can find your state’s marketplace at healthcare.gov. The prices for the marketplace plans are likely to be similar to those sold privately. A plan that is also available on the exchange may be eligible for subsidies. Heres an easy top 10 list of what you need to know.
10. Locate your State Exchange
Look up your state’s exchange here and Healthcare.gov. Some states are running their own exchange, others are running it through the federal government see www.healthcare.gov. For NY Tri-State the sites are:
NYS – http://info.nystateofhealth.ny.gov See rates here
CT – https://www.accesshealthct.com See rates here
9. Individual Mandate Penalty
For 2014, the annual penalty is $95 or 1% of your income, whichever is greater. The penalty will increase over the first three years. Coverage can include employer-provided insurance, individual health insurance, Medicare or Medicaid.
Health Insurance Individual Penalty for Not Having Insurance Pay the greater of the two amounts
Year
Percentage of Income
Set Dollar Amount
2014
1%
$95 & $285/family max
2015
2%
$325 & $975/family max
2016
2.5%
$695 & $2,085/family max
8. Individual Subsidies
Individuals who do not have affordable minimum essential coverage from their employer will be eligible for tax credit subsidies for their health insurance purchase on a state exchange if their income is below 400 percent of federal poverty level.
If you make under $45,960 or your family makes under $94,200, you could get a real break on health insurance costs More low-income people will also be eligible for free coverage under Medicaid For those eligible, the subsidies will cap the amount you pay for your exchange policy at between 2% and 9.5% of your income (on a sliding scale, based on your income). To find out how much you would pay, estimate your income for this year and plug it into any health subsidy calculator. You can also see estimate subsidies with these “health subsidy charts”.
7. Small Business Subsidy – SHOP Exchange
A key change is that the small business health care tax credits will only be available ONLY through the SHOP Exchange marketplace in 2014. Small businesses with 25 or fewer employees who receive less than $50,000 a year in wages may be eligible for tax credits if they purchase the plan through the SHOP marketplace. These credits will cover up to 50% of the employer’s cost (35% for non-profits) for the first two years of coverage. Click here to read more about the small business health care tax credits.
6. Your income
not your assets, such as your house, stocks or retirement accounts – will count toward determining whether you can get tax credits. When you buy your plan, you estimate your income for next year, and your tax credit is based on that estimate. The next year, your tax returns will be checked by the IRS and compared against your estimate.
5. Pre-Existing Conditions Eliminated
Your insurer generally can’t drop you, as long as you keep up with your insurance premiums and don’t lie on your application. Generally, people will be able to enroll in or change plans once a year during the annual open enrollment period. This first year, open enrollment on the exchanges will run for six months, from Oct. 1 through March of next year. But in subsequent years the time period will be shorter, running from October 15 to December 7.
4. Essential Health Benefits Covered
Each plan covers 10 “essential health benefits,” which include prescription drugs, emergency and hospital care, doctor visits, maternity and mental health services, rehabilitation and lab services, among others. In addition, recommended preventive services, such as mammograms, must be covered without any out-of-pocket costs to you. More info here.
3. Ninety-Day Maximum Waiting Period
Group health plans and health insurance issuers may not impose waiting periods of more than ninety days before coverage becomes effective. This also applies to grandfathered plans.
2. Annual or Lifetime Limits
Group health plans, including grandfathered plans, may no longer include more than restricted annual or any lifetime dollar limits on essential health benefits for participants. Limits may exist in and after 2014 for non-essential benefits.
1. Not Everyone is Eligible
Immigrants who are in the country illegally will be barred from buying insurance on the exchanges. However, legal immigrants are permitted to use the marketplaces and may qualify for subsidies if their income is no more than 400 percent of the federal poverty level (about $46,000 for an individual and $94,200 for a family of four).
members of certain religious groups and Native American tribes
incarcerated individuals
people whose incomes are so low they don’t have to file taxes (currently $9,500 for individuals and $19,000 for married couples)
Conclusion:
There has been a lot of news about individual Obamacare provisions getting delayed – Obamacare Employer mandate Delayed. Some people may assume that means the health law is being slowly dismantled, or put off for an additional several years. .The Affordable Care Act is an extremely complicated law with a lot of moving parts, but ultimately, the biggest provisions are still moving forward. There will likely be more hiccups along the way. As the enrollment period opens for Obamacare’s new exchanges, industry experts predict there will probably be other issues that need to be ironed out — but that doesn’t mean the whole law is collapsing
Still confused?
Don’t be. These are the common questions that we are working through with our clients daily. Am I better off going SHOP Exchange vs. Individual for my business? Am I better off going off Exchanges or onto Private Exchanges? Whats my minimum employer contribution? Do I have to cover employee and dependents? Is dental and vision included? What happens to my Healthy NY when it shuts down Jan 1, 2014? What employer notices must I be posting?
Please contact our team at Millennium Medical Solutions Corp if you have additional questions regarding how SHOP Exchanges and Individual Exchanges can benefit you Stay tuned to our site for updates as more information gets released. Sign up for latest news updates.
2023 Healthfirst Plans Healthfirst has released affordable new 2023 plans for NY small businesses and not a moment too soon. The only non-profit Health Insurer owned by hospitals has kept market low rates with a modest 7% INCREASE for 2023. By integrating a...
2022 Healthfirst Plans Healthfirst has released affordable new 2022 plans for NY small businesses and not a moment too soon. The only non-profit Health Insurer owned by hospitals has kept market low rates with a modest 4.1% INCREASE for 2022. By integrating a...
2020 Healthfirst Plans-Non-profit Health Insure- owned by hospitals. 2020 1.7% Increase for 2020. Best value.Call 855-667-4621 info@medicalsolutionscorp.com
2020 Healthfirst Plans-Non-profit Health Insurer owned by hospitals. 2020 4.7% DECREASE for 2020. Best value.Call 855-667-4621 info@medicalsolutionscorp.com
Healthfirst has released affordable new 2019 plans for NY small businesses and not a moment too soon. With the recent exit of popular CareConnect of NY the market is starving for an affordable option.
About HealthFirst
Healthfirst had entered the small business market Jan 1, 2017. Healthfirst is a provider-sponsored health insurance company that serves more than 1.3 million members in downstate New York and Nassau county. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.
The Healthfirst options include four Pro EPO plans with comprehensive benefits and pediatric dental and vision coverage that span all the metal tiers (Bronze, Silver, Gold, and Platinum). With Healthfirst plans, employees will have access to key features, including preventive and wellness visits (including annual checkups, vaccinations, and mammograms); a multilingual member services team; access to telemedicine via Teladoc; a robust choice of in-network doctors, specialists, hospitals, and urgent care centers; behavioral health and substance abuse services; coverage for acupuncture visits; and a user-friendly member portal that enables members to proactively manage their care.
Value
Healthfirst’s new January 2019 rates are in fact virtually the same as 4th Q 2018. Example, a single rate is approximately $16 or 1.7% higher. Todays largest networks with popular in-network only GOLD are priced at $900/single monthly. By comparison the Healthfirst Gold plan is $732 annually or 18% less expensive. For platinum the price gap jumps are even higher – $1100/single vs $896/single.
Members have access to a broad network of providers and dozens of industry-leading hospitals.
Community locations throughout New York City, Long Island and parts of Westchester.
All Metal Levels will be included for all size groups including 1-99 market. Referral’s are not needed to visit a Specialist MD but one must select a Primary Care Physician on the enrollment form.
Network Overview:
Healthfirst EPO Pro Network – Provider count expanded to 30,000 from 20,000 2 years ago. Geographic network coverage for NYC 5 Boroughs, Nassau/Suffolk and Southern Westchester. 136+ Urgent Care locations and 50+ hospitals included. Examples:
Free 24/7 Telemedicine Through Teladoc –Members can speak to a doctor anytime, anywhere, with a $0 copay.Telemedicine accessed via phone call or video chat.
Gym Reimbursement – Annual $400/member and $200/spouse reimbursement
Accupuncture Covered Benefit
CVS/Caremark – 7,998 CVS and 22,302 Local Pharmacies. †2X copay for Mail Order 90 days supply.
Free Flu Vaccine
Pro Plus EPO plans Option
Dental – Preventive Care covering Dental Exam, X-Rays, Fillings †& Cleaning †every 6 months. Emergency Dental. Major Dental covering periodontal services, endodontic services plus 6 months follow up care and limited orthodontia.
Vision – Exams, Lenses, Frames or Contacts covered every 12 months
SHOP Credits – SMB groups can enroll on tax credit program directly with our Brokerage
A business must have fewer than 25 employees
Average salary must be less than $53,000 per year Health insurance coverage must be offered to all full-time employees *Based on the New York State of Healths Small Business Health Options Program eligibility nystateofhealth.ny.gov/employer
Healthfirst has released affordable new 2018 plans for NY small businesses and not a moment too soon. With the recent exit of popular CareConnect of NY the market is starving for an affordable option.
About HealthFirst
Healthfirst had entered the small business market Jan 1, 2017. Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York and Nassau county. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.
The Healthfirst options include four Pro EPO plans with comprehensive benefits and pediatric dental and vision coverage that span all the metal tiers (Bronze, Silver, Gold, and Platinum). With Healthfirst plans, employees will have access to key features, including preventive and wellness visits (including annual checkups, vaccinations, and mammograms); a multilin
gual member services team; access to telemedicine via Teladoc; a robust choice of in-network doctors, specialists, hospitals, and urgent care centers; behavioral health and substance abuse services; coverage for acupuncture visits; and a user-friendly member portal that enables members to proactively manage their care.
Value
Healthifrst’s new January 2018 rates are in fact virtually the same as 4thQ 2017. Example, a single rate is approximately $2-$3 higher. Today’s largest networks with popular in-network only GOLD are priced at $857/single monthly. By comparison the Healthfirst Gold plan is $717 annualy or 15% less expensive. For platinum the price gap jumps are even higher – $1050/single vs $850/single.
Members have access to a broad network of providers and dozens of industry-leading hospitals.
Community locations throughout New York City, Long Island and parts of Westchester.
All Metal Levels will be included for all size groups including 1-99 market. Referral’s are not needed to vsisit a Specialist MD but one must select a Primary Care Physician on the enrollment form.
Attention CareConnect Clients:
Join us for Oct 25th Webinar.
We have been informed that the NY DFS has recently approved the following measures in the process of CareConnect exiting the market:
For individuals the market exit date is 12/31/2017.
For Small Group the market exit date is 11/30/2017.
All groups renewing starting 12/1/17 will no longer be accepted. Currently active group business will end on the last day of their policy year (For example, a 9/1/17 effective will remain in force until 8/31/18).
With recent announcement “CareConnect Withdraws from NYS Market” a Healthfirst addition to the NY Small Business market is especially important. In many instances the Healthfirst plans have a more robust network than CareConnect for NYC and LI. Namely, they have the same hospitals North Shore LIJ(Northwell), Maimonides, but additionally key hospitals such as Mt. Sinai, NYU, Lenox Hill + urgent cares such as CityMD and GO-Health. Rates are approximately $100/month higher for singles for example than CareConnect and would not be an automatic decision to move to Healthfirst.
HealthPass New York, a private health insurance exchange for small businesses, announces that it will offer Healthfirst insurance plans to small business employers in the metropolitan New York City area. Healthfirst, a provider-sponsored health plan serving more than 1.2 million members in New York City and on Long Island, offers small employer group EPO plans to fit the needs of hardworking New Yorkers.
HealthPass will offer Healthfirst Pro EPO plans to eligible employers that employ between one to 100 employees. These plans are available to small businesses with employees who live, work, or reside in New York City and Nassau County. Eligible employers and their employees can begin enrolling in the Healthfirst plans now for coverage that would take effect as early as December 1, 2017.
The Healthfirst options include four Pro EPO plans with comprehensive benefits and pediatric dental and vision coverage that span all the metal tiers (Bronze, Silver, Gold, and Platinum). With Healthfirst plans, employees will have access to key features, including preventive and wellness visits (including annual checkups, vaccinations, and mammograms); a multilingual member services team; access to telemedicine via Teladoc; a robust choice of in-network doctors, specialists, hospitals, and urgent care centers; behavioral health and substance abuse services; coverage for acupuncture visits; and a user-friendly member portal that enables members to proactively manage their care.
About HealthFirst
Healthfirst had entered the small business market Jan 1, 2017. Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York and Nassau county. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.
Attention CareConnect Clients:
With recent announcement “CareConnect Withdraws from NYS Market” a Healthfirst addition is especially important. In many instances the Healthfirst plans have a more robust network than CareConnect for NYC and LI. Namely, they have the same hospitals North Shore LIJ(Northwell), Maimonides, but additionally key hospitals such as Mt. Sinai, NYU, Lenox Hill + urgent cares such as CityMD and GO-Health. Rates are approximately $100/month higher for singles for example than CareConnect and would not be an automatic decision to move to Healthfirst.
•Change in tax treatment for over-age dependent coverage •Accounting impact of change in Medicare retiree drug subsidy tax treatment •Early retiree medical reinsurance •Medicare prescription drug “donut hole” beneficiary rebate •Break time/private room for nursing moms
•No lifetime dollar limits on essential health benefits
•Restricted annual dollar limits on essentail health benefits, phased amounts until 2014
•No pre-existing condition limitations for enrollees up to age 19 and no rescissions
•No health FSA/HRA/HSA reimbursement for non-prescribed drugs
•Increased penalties for non-qualified HSA distributions
•Additional standards for new or “non-grandfathered” health plans, including preventive care in network with no cost-sharing appeal and external review, provider choice and non-discrimination provisions for insured plans
•Income-based Medicare Part D premiums Pharmaceutical importers and manufacturers’ fees start
•Medicare, Medicare Advantage benefit and payment reforms
•Insurers subject to medical loss ratio rules
•Employers to distribute uniform summary of benefits and coverage (SBC) to participants (deadlines vary with group of recipients)
•60-day advance notice of mid-year material modifications to SBC content
•Form W-2 reporting for health coverage (track in 2012 for W-2 form provided in early 2013)
•Coverage for additional women’s preventive care services
•$2,500 per plan year health FSA contribution cap (plan years on or after January 1, 2013)
•Comparative effectiveness group health plan fees first due
•Annual dollar limits on essential health benefits cannot be lower than $2 million
•Employers notify employees about exchanges •Medical device manufacturers’ fees start •Higher Medicare payroll tax on wages exceeding $200,000/individual; $250,000/couples
•Change in Medicare retiree drug subsidy tax treatment takes effect •Health Insurance exchanges initial open enrollment period
•Health insurance exchanges
•Individual coverage mandate
•Financial assistance for exchange coverage of lower-income individuals
•States Medicaid expansion (possibly only some states)
•Employer shared responsibility
•Dependent coverage to age 26 for any covered employee’s child
•No annual dollar limits on essential health benefits
•No pre-existing condition limits
•No waiting period over 90 days
•Wellness limit increase allowed
•Health insurance industry fees
•Additional standards for non-grandfathered health plans, including limits on out-of-pocket maximums, provider nondiscrimination, and coverage of routine medical costs of clinical trial participants
•Small market, non-grandfathered insured plans must cover essential health benefits with limited deductibles (initially $2,000/individual, $4,000/family), using a form of community rating
•Insurers must apply guaranteed issue and renewability to non-grandfathered plans of all sizes
•Auto enrollment sometime after 2014
•Temporary reinsurance fees first due in late 2014/early 2015
•Additional employee-specific reporting and disclosure of 2014 coverage
•40% excise tax on “high cost” or Cadillac coverage
[tab_item title=”Reminder PCORI Research Fees Due by July 231st”]
Posted on July 24 2013
Fees Apply to Employers Sponsoring Certain Self-Insured Plans
Effective for plan years ending on or after October 1, 2012, and before October 1, 2019, employers that sponsorcertain self-insured plans are responsible for new fees to fund the Patient-Centered Outcomes Research Institute (also known as PCORI). HRAs and health FSAs that are not treated as excepted benefits are generally subject to the fees.
Fees are due no later than July 31st of the year following the last day of the plan year. The IRS has revised Form 720for affected employers to report and pay the required fees.
Review our Health Care Reform Checklist for information on other requirements impacting employers and group health plans this year.
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[tab_item title=”Affordable Care Act Weekly Webinar Series”]
Posted on July 23 2013
Free Series for Small Business Owners to Help Understand the Law
The U.S. Small Business Administration (SBA), together with the Small Business Majority (a national nonprofit advocacy organization), has launched the Affordable Care Act 101 Weekly Webinar Series. The webinars feature guidance on key pieces of the law for small business owners provided by SBA representatives, followed by a question and answer period.
Topics being discussed in the webinars include:
Small business tax credits—who is eligible and how to claim the credit;
Shared responsibility (also known as “pay or play”);
Cost containment; and
Tools and resources available for small businesses to learn more about the law.
The free series will take place every Thursday from now through the opening of the Health Insurance Exchanges (Marketplaces) in October. The first series of webinars will cover the same content; a second round of webinars featuring new content will be held later this fall.
The registration links for the first series of webinars can be found by clicking here. After registering, you will receive a confirmation email with all of the information needed to access the webinar either by telephone or online.
Visit our Health Care Reform Blog section to stay on top of the latest Affordable Care Act updates.
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[tab_item title=”4 Things Employers Should Know About Providing the Health Insurance Exchange Notice”]
Posted on July 19 2013
Notice Must Be Distributed to Current Employees No Later Than October 1, 2013
Following a delay in the original effective date, employers will need to comply with the new requirement to provide each employee a written notice with information about a Health Insurance Exchange (also known as a Marketplace) beginning this fall. Below are four important reminders about the notice.
The notice requirement applies to employers covered by the federal Fair Labor Standards Act (FLSA). In general, the FLSA applies to employers that employ one or more employees who are engaged in, or produce goods for, interstate commerce. For most firms, a test of not less than $500,000 in annual dollar volume of business applies. The FLSA also specifically covers certain entities such as hospitals, educational institutions, and government agencies.
Employers must provide the notice to each employee, regardless of plan enrollment status (if applicable) or of part-time or full-time status. Employers are not required to provide a separate notice to dependents or other individuals who are or may become eligible for coverage under the plan but who are not employees.
The U.S. Department of Labor has provided two sample notices employers may use to comply with this requirement. The law requires that specific information be included in each notice. One model notice is available for employers that offer a health plan to some or all employees, and another model notice may be used by employers that do not offer a health plan.
Notices must be provided to each current employee no later than October 1, 2013, and to each new employee at the time of hiring beginning October 1, 2013. In general, a notice will be considered provided at the time of hiring if it is provided within 14 days of an employee’s start date. The notice is required to be provided automatically and free of charge. Employers may distribute the notice by first-class mail, or electronically if certain requirements are met.
Visit our section on Health Reform Resource for information on other notices required to be provided and to download additional model notices available for employers and group health plans.
[/tab_item][tab_item title=”5 Q and As on Individual Shared Responsibility”]
Posted on July 12 2013
Employer-Sponsored Coverage Considered “Minimum Essential Coverage”
The individual shared responsibility provision, which goes into effect on January 1, 2014, requires individuals of all ages (including children) to have minimum essential health coverage for each month, qualify for an exemption, or make a payment when filing his or her federal income tax return. Below are five questions and answers related to the mandate that may be of interest to employers and employees.
1. What counts as minimum essential coverage? Minimum essential coverage includes employer-sponsored coverage (including COBRA coverage and retiree coverage), coverage purchased in the individual market, Medicare Part A coverage and Medicare Advantage, Children’s Health Insurance Program (CHIP) coverage, and certain other types of coverage.
Minimum essential coverage does not include coverage providing only limited benefits, such as coverage only for vision care or dental care, workers’ compensation, or disability policies.
2. If an employee receives coverage from a spouse’s employer, will that employee have minimum essential coverage? Yes. Employer-sponsored coverage is generally minimum essential coverage. If an employee enrolls in employer-sponsored coverage for himself and his family, the employee and all of the covered family members have minimum essential coverage.
3. Does an employee’s spouse and dependent children have to be covered under the same policy or plan that covers the employee? No. An employee, his or her spouse, and dependent children do not have to be covered under the same policy or plan. However, the employee, spouse, and each dependent child for whom the employee may claim a personal exemption on his or her federal income tax return must have minimum essential coverage or qualify for an exemption, or a payment will be owed.
4. A company’s health plan is “grandfathered.” Does the employer’s plan provide minimum essential coverage? Yes. Grandfathered group health plans provide minimum essential coverage.
5. Is transition relief available in certain circumstances? Yes. Notice 2013-42 provides transition relief from the shared responsibility payment for individuals who are eligible to enroll in employer-sponsored health plans with a plan year other than a calendar year (non-calendar year plans) if the plan year begins in 2013 and ends in 2014. The transition relief applies to an employee, or an individual having a relationship to the employee, who is eligible to enroll in a non-calendar year eligible employer-sponsored plan with a 2013-2014 plan year. The transition relief begins in January 2014 and continues through the month in which the 2013-2014 plan year ends.
For More Information You may review additional questions and answers in their entirety on the IRS website.
[/tab_item][tab_item title=”IRS Guidance on Delay of Pay or Play Requirements”]
Posted on July 10 2013
No Penalties Will Be Assessed for 2014
Formal guidance released by the IRS provides additional details regarding the delay of the Health Care Reform “pay or play” requirements. Under those provisions, certain large employers (generally those with at least 50 full-time employees) who do not offer full-time employees affordable health insurance that provides a minimum level of coverage may be subject to a penalty tax.
According to the guidance, no penalties (also known as employer shared responsibility payments) will be assessed for 2014. The “pay or play” requirements will be fully effective for 2015 and employers are encouraged to maintain or expand health coverage in 2014 in preparation for compliance.
The delay is a result of transition relief being provided for 2014 with respect to certain employer and insurer reporting requirements. Such reporting will be necessary for the IRS to determine whether a penalty may be due, and, consequently, the transition relief makes it impractical to determine which employers owe shared responsibility payments for 2014. Once the information reporting rules are issued, employers are encouraged to voluntarily comply with the reporting requirements in 2014.
The delay does not affect the application or effective dates of other Health Care Reform provisions, including the individual shared responsibility requirements and employees’ access to premium tax credits for enrolling in qualified health plans through the Health Insurance Exchanges.
