combsandco


So what’s my penalty if I don’t enroll?

So we are in the home stretch! Three more days to go and then Open Enrollment ends for 2016. From experience, I have learned that many people wait until the last minute to pick a plan and some people just continue to bury their heads in the sand. So for those of you that are wondering, how much it’s going to cost you if you don’t get your act together, take a look at this user friendly graphic that will show you what to expect!

Health Insurance Open Enrollment Closes 1-31-16

 



I *forgot* to sign up for Health Insurance, now what?

ImageYou’d be amazed at how many phone calls and emails we have been getting about signing up for the exchange after the deadline. Unfortunately….people that have waited are not special. Everyone had an Open Enrollment Period began October 1st and officially ended in the state of NY as of March 31st, that was 6 months….no one can say they didn’t have enough time but still so many people chose to bury their head in the sand. So if you are one of these people that didn’t sign up what does this actually mean to you:

  1. If you had started an enrollment on the New York State of Health Exchange Marketplace (https://nystateofhealth.ny.gov/) you have until April 15th to get your act together and get your application completed.
  2. If you haven’t started an application yet and you are CURRENTLY UNINSURED, then you are out of luck with Exchange and other Private options until the next Open Enrollment which is set to begin on 11/15/14 for an enrollment of January 1st, 2015.  Sorry, no one’s special here.
  3. If you are CURRENTLY INSURED you will be able to take coverage with the Exchange or other private insurance for effective dates after 4/1 as long as you can prove that you have had a Qualifying Life Event.  These are listed below:
    1.  Individual or dependent loses minimum essential coverage due to:
      1. job loss
      2. divorce
      3. death of a spouse
      4. becoming ineligible for Medicaid or Child Health Plus
      5. expiration of COBRA
      6. health plan is decertified
    2. Marriage, birth, adoption, or placement for adoption
    3. Gaining status as a citizen, national, or lawfully present individual
    4. Consumer is newly eligible or ineligible for tax credits and/or cost sharing reductions
    5. Permanent move to an area that has different health plan options
    6. Marketplace staff or contractor enrollment error
    7. Qualified Health Plan violated a provision of its contract
    8. American Indians can enroll or change plans one time per month throughout the year

 

Not considered a Qualifying Life Event:

    1. Voluntarily dropping other health coverage
    2. Being terminated for not paying your premiums
    3. Losing coverage that is not minimum essential coverage, in accordance with HHS guidelines

 

Moral of the story:  Be more proactive next year!!!

 



What’s my penalty?

Image

A question that comes up time and time again with the Affordable Care Act is:  “How does the Individual Responsibility (aka Mandate) Penalty work?”

To avoid the penalty you must enroll in a marketplace plan OR have private coverage no later than March 31st, 2014. If you do not, below are a breakdown of the penalties you will face.

  • 2014: Greater of $95      per adult and $47.50 per child under age 18 or 1% of household       income
  • 2015: Greater of $325      per adult and $162.50 per child under age 18 or 2%
  • 2016: Greater of $695 per adult and      $347.50 per child under age 18 or 2.5% of taxable gross income capped      at the average bronze-level insurance premium (60% actuarial) rate for the      person’s family.

**The total family penalty is capped at 300% of any annual flat dollar amount for those 18 and over.

**If the penalty applies for less than a full calendar year, the penalty will be 1/12 of the annual amount per month without coverage.

Example:

Let’s look at the O’Brien family of 4 that has 2 children under the age of 18 and the family household income is $100,000 per year.

Just to make the example easier, we are giving everyone names….Meet the O’Brien Family:  Mom – Samantha; Father – Mark; Son – Luke; Daughter – Sarah

Upfront we know that the Max Penalty the O’Brien’s’ can be given is:  $570 (this is figured by a $95 penalty each for Samantha & Mark since they are the only ones over 18 x 300%), now let’s look at the breakdown if they would hit the Max Penalty….

Remember, it is the GREATER of the below up to the Max Penalty:

Flat dollar amount penalty calculation :  $95 (Samantha) + $95 (Mark) + $47.50 (Luke) + $47.50 (Sarah) = $285

Percentage amount penalty calculation:  1% of $100,000 = $1000

Results:  Since the Max Penalty the O’Brien family can be given in this example is $570, this will be the penalty they will be responsible for, since the 1% of household income exceeds this amount.  This amount will be tacked on when Samantha and Mark’s taxes are calculated at the end of the year, so if they were planning on a nice refund this year, that will be deducted from that refund.  Keep in mind that if the O’Brien’s do not pay taxes, as of now, there is no mechanism to collect this penalty.



So do I really get to keep my insurance if I got canceled?

As many have heard, Obama has offered a “fix” to many of the people that have gotten notifications of their insurance being canceled.  I believe that this report, gives a good picture of it and I want to point out a few things before people start popping the cork and celebrating:

  1. Obama said that carriers “could” offer the plan for 1 more year…
  2. Obama pushed the ultimate decision over to the States and the Carriers…so far California, Idaho, Virginia and Kentucky have said no to this fix.
  3. If the carrier choose to offer to extend, then they are going to have to send the customers a comparison that shows the differences between their plan and all the Exchange Plans that they are offering, what this translates to is more work when we are already 45 days out, and the carriers do not have the extra time on their hands right now.
  4. The carriers do not have an actuarial value of any of these plans since they are not in their plan offerings and I believe that this would result in even higher prices as they would have to put in more man hours to reincorporate these plans.

If you have gotten a cancelation notice, I encourage you to call your carrier and see if they are going to pony up and continue to offer your plan, but don’t be shocked if you end up being one of many that they tell no.

 

 



Exchange Notice Deadline Approaching: October 1, 2013

Important Notice

Pretty much all employers will need to provide their employees with written notice that includes information regarding the Exchange (now called the Health Insurance Marketplace). The deadline to provide the notice is fast approaching; the notice must be provided to each employee not later than October 1, 2013.  Regardless of the size of your company and even if you currently do not offer coverage to your employees you *SHOULD* send this information out.  The reason we say should instead of MUST is because as of last week, this has been another penalty that has been delayed and they haven’t told us when it will come back.  Originally it was speculated a $100 fine for every day you have not complied with the request.  We still encourage everyone to comply now as then when / if the penalty goes into effect you are all in compliance.

Click below to view the English version of the notices that you can provide to your employees:

English notice if you DO offer coverage

English notice if you DO NOT offer coverage