As the owner of BenefitPackages.com insurance agency, I have people come up to me who are concerned about there healthcare and the changes that will be coming in 2013. Most everyone’s healthcare will change in 2014, those who currently have an individual policy and as well as those who receive their benefits through an employer of less than 50 employees. Those who have an individual plan effective before March 23, 2010 are “grandfathered” and may keep there current plan.
This plan will most likely be less premium than the new metallic plans; platinum, gold, silver & bronze unless you are eligible for a tax subsidy. Tax subsidizes will be available for those whose AGI the previous year is between 133 & 400 percent of the Federal Poverty level (FPL), and the substantial credit AKA, “Advanced Premium Tax Credit” will be available for those below the 200% level. Those below 200% will be enrolling in the “Silver Plan” as this metal level will adjust the benefits to be even richer, for example eliminating the deductible. The good news is that the level of benefits or “actuarial benefit” for even the Bronze plan should be higher or richer than most people’s current plan.
One of the big questions for those who purchase there own individual health plan is whether or not they should do so through the Ca. exchange. For those who earn less than 200% of the FPL, absolutely. An agency like BenefitPackages will be exchange certified and be able to assist in the process without any additional fees. Most people who earn between 200%-300% of the FPL will most likely want to seriously consider the exchange too. For those who make more- say 300%-400%, the subsidy can be as little as around 6%. One possible downside of the exchange is that many plans may have a more limited network of physicians. That being said they might have a few plans with the same large provider network as outside of the exchange but that is still to be determined.
The small group market will have to decide whether to purchase through the SHOP or the Small business health insurance options program or not. There will be a small business tax credit for those who employ less than 25 but the full credit is for companies who employ less than 10 with the average wage being less than $25,000. California’s bill 1083 will trump the federal ACA with many respects. For example, carriers can’t charge more for smokers and the probationary waiting period for new employees will be no more than 60 days as opposed to the 90 days permitted with the ACA. Information is key to making the transition painless and hopefully better. Working with an experience agency who is also current on the new law and the constant evolution is imperative.