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Tag Archive | "Affordable Care Act"

ACA open enrollment under way 


Michiganders newly enrolling or changing their health insurance offered through the Affordable Care Act have more options to choose from this time around, with an expansion of carriers in the state’s federally-run marketplace. Image courtesy of www.healthcare.gov.

Michiganders newly enrolling or changing their health insurance offered through the Affordable Care Act have more options to choose from this time around, with an expansion of carriers in the state’s federally-run marketplace. Image courtesy of www.healthcare.gov.

Mona Shand, Michigan News Connection

When it comes to open enrollment for health-insurance plans through the Affordable Care Act, experts say in many ways, the second time is the charm.

With the kinks worked out of the federal HealthCare.gov website and more options to choose from, the second open-enrollment period is off to a smooth start, said Philip Bergquist, director of health-center operations for the Michigan Primary Care Association. This time around, he said, more Michigan residents are able to use technology to their advantage.

“We’re seeing more mobile use of HealthCare.gov, folks with tablets at events, doing it in local businesses,” he said. “Really wherever the need is.”

From new enrollees looking for first-time coverage to those shopping the new additions to the marketplace, Bergquist said he sees signs that the conversation around health insurance in Michigan is improving.

“More detailed questions, more in-depth conversations,” he said, “and that’s really exciting because it’s showing that the base of enrollees in the marketplace is really learning a lot about the coverage that they’ve selected and how to use it.”

However, federal data suggest about a quarter-million Michigan residents who are eligible for coverage under the Affordable Care Act have yet to get it. Right now, 17 different carriers—four more than last year and the highest number of any state with a federally run marketplace—are offering policies.

The open-enrollment period runs through Feb. 15, but anyone looking for coverage to begin in January must purchase a plan by Dec. 15. Enrollment-assistance information is available online at EnrollMichigan.com.

 

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The Affordable Care Act: what businesses need to know


N-healthcare

By Judy Reed

While individuals have been confused about the new requirement for health insurance and what they need to do, many business owners are also struggling with what it means for them.

Gabrielle Warner, of Innovative Solutions Agency, Inc., gave the Post some insight on basic things that business owners need to know. Warner is a Chartered Benefits Consultant, and Marketplace and SHOP registered agent.

Things to know:

Timeline

The mandate for businesses to offer insurance to employees has been pushed to January 1, 2015.

What is considered a full-time employee?

The definition of a full-time employee changed under the Affordable Care Act. It used to be someone who worked 40 hours. That has been reduced to 30 hours.

Small groups of 2-25 employees

Small businesses with 2-25 employees do not have to offer coverage. However, if they do, they may be eligible for a tax credit. (It is based on the income of the employees.) However, if a small business wants to offer insurance in 2014, and try to get the tax credit, the plan must be SHOP eligible, even if they have already been offering insurance and getting the tax credit. (SHOP is the Small health options program.) The tax credit is in addition to the tax deduction business owners can claim. An agent will help owners choose a plan, and then help enroll the employees. A small group can enroll anytime during the year.

Businesses could also offer employees a self-funding arrangement, or use a defined contribution arrangement.

Small groups of 26-49 employees

Any business with 2-49 employees does not have to offer coverage. But groups with more than 25 employees are not eligible for the tax credit.

Instead of offering insurance, the businesses could offer assistance to employees on how to purchase individual polices, either on or off the healthcare exchange. An agent could go in and help educate the employees on the process.

Businesses with 50-plus employees

Businesses with 50 or more employees must offer coverage that meets Essential Health Benefits and Affordability standards or pay a penalty. The fine for 2015 is $2,000 per FTE (full time equivalent) beyond the first 30 FTE. In a full time equivalent, you don’t just count full time people. You must count part time hours as well. Two part time people might count as one FTE. (An agent can help with the formula.)  So a business with 55 FTE would deduct the first 30, leaving a penalty to be paid on 25 FTE at $2,000 each, or $50,000 per year. It would be divided up monthly.  The penalty will not stay $2,000 per FTE, however. In future years it will be adjusted upward. Some businesses may choose to do this rather than purchase insurance. “Even if the employer doesn’t provide coverage, the penalty is their way of pitching in. Their penalty goes into a pool to help pay for subsidies, although not directly to their employees,” explained Warner.

Rate structure change

Most people are used to seeing a rate or individuals, couples, and families. That is no longer the case. Rates will now be set according to each individual in your family. That means some plans will increase in cost, while others will drop.  Plans in both the individual and small group markets (both on and off the exchange) will be guaranteed—you will always qualify and can always renew. And the base rates will be the same. However, premiums may vary according to age, whether you use tobacco, and your geographic rating area. Rates can no longer be dictated by gender.

Waiting period

There will be no more than a 90-day waiting period before benefits begin for a new employee.

Cadillac plans

In 2018, a “Cadillac” tax goes into effect—a 40 percent tax on the value of benefits over $10,200 for single person plans and $27,500 for family plans. It includes the value of all employer-sponsored coverage.

 

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How do I get healthcare under the Affordable Care Act?


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By Judy Reed

 

Rhetoric. Sound bites. Pages upon pages of rules and exemptions. A website not quite up to par. And not much useful information printed for those who need healthcare under the Affordable Care Act. So many people just want to know, how do I get healthcare? Where do I go, what do I do, and how much is it going to cost?

The Basics

Starting in 2014, every individual in the United States of America is required to have some minimum essential health insurance coverage or pay a tax penalty when you do your taxes for that year.

The deadline to acquire coverage is March 31, 2014.

There are six ways to meet the minimum essential coverage:

1. Being insured through your employer or your spouse’s employer. 

2. Being insured on your parent’s policy. Children can remain on their parent’s policy until age 26 regardless of whether they are working, in school, single or married. However, if that child has a baby of his own, that baby is not covered on the grandparent’s policy.

3. Enrollment in another government health program such as Medicare, Tricare, or a Children’s Health Insurance Program (CHIP) or Michigan’s MiChild.

4. Being eligible for coverage under Medicaid due to expansion of coverage to people with income up to 133 percent of the Federal Poverty Level.

5. Purchasing healthcare through the Exchange or Marketplace at healthcare.gov

6. Purchasing healthcare insurance from a company in the individual market.

How to find out what you are eligible for

If numbers one through three do not apply to you, you will want to see if you are eligible for subsidies to help pay for insurance. The only way to do that is by applying at healthcare.gov. You can do that one of two ways: either try to navigate it yourself, or contact a registered agent who will do the work for you at no charge.

“You will pay the same amount either way. You are paying for an agent, even if you don’t use one,” explained Gabrielle Warner, of Innovative Solutions Agency, Inc. Warner is a Chartered Benefits Consultant, and Marketplace and SHOP registered agent.

An agent will be your advocate and guide throughout the process, and can track where your application is at all times.

An agent will take you through the healthcare.gov application process to see if you are eligible for subsidies to offset health insurance premiums. You will see one of three possible results: your income is low enough that you will best benefit by expanded Medicaid, which starts in April 2014; you are eligible for subsidies; or you make too much money.

If you are eligible for subsidies, then the agent will help you choose a plan through the three insurance companies in Michigan’s exchange or marketplace. If you are not eligible for subsidies, the agent will help you to purchase insurance from a company on the individual market.

To find a registered agent to take you through the process, go to www.wmahu.org. On the left side, scroll down to “find an agent.” Put in your zip code and choose “50 mile radius” in the drop down box. Go further down the page and mark Michigan in the section titles “Certified to sell health insurance exchange marketplace coverage.” Twenty or so random agents will come up.

What if I don’t buy insurance?

In 2014, the penalty for not having insurance is $95 per person, or 1 percent of your income, whichever is greater. The penalty for children is $47.50 per child. The maximum penalty is $285 per family. Next year it increases to 2 percent or $325 per person, and in 2016 it is 2.5 percent of income or $695 per person. In 2017 and beyond it will be adjusted by the cost of living. The penalty will be due when you pay your taxes. Paying the penalty does not give you insurance; you will still need to fully fund your own healthcare, at a non-discounted rate.

There are some circumstances that may help you qualify for a hardship exemption. To see those and to get a form to apply, go to www.healthcare.gov/exemptions/

What is the transitional reinsurance program?

One thing that caught some people by surprise this month is a new fee called the transitional reinsurance program. People covered under their own employer’s insurance plan began paying the fee this month, in addition to the fee deducted for their own insurance plan. The program takes the fees and then pays it to insurers in the individual market that cover high-risk individuals. The fee will be in place from 2014 to 2016, and supposedly “levels the playing field” across the health insurance markets, and protects the high-risk insurers from huge losses.

NEXT WEEK: What businesses need to know

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Breastfeeding moms: Tips for long-term success


August is National Breastfeeding month

HEA-Breastfeeding-month1(BPT) – No one argues the benefits of breastfeeding – 77 percent of babies start out being breastfed, according to the Centers for Disease Control and Prevention. The problem is that six months later, only 16 percent of babies are exclusively breastfed. What’s causing the significant drop off?

Both the American Academy of Pediatrics and the Surgeon General recommend exclusive breastfeeding until six months of age. And while breastfeeding and breast-pumping rates continue to grow, according to research from Medela, only 30 percent of moms are satisfied with their ability to meet their goals as well as national goals for breastfeeding.

Though breastfeeding is natural, the technique is a learned skill. Many new moms struggle with the task within the first months of their baby’s life, and frustrations paired with difficulties cause them to give up too quickly.

HEA-Breastfeeding-month2Moms-to-be can increase the likelihood of breastfeeding success with the right education and appropriate tools. Here are five expert tips for expectant parents to prepare themselves for a successful breastfeeding journey:

1. Get tools and supplies covered by the Affordable Care Act.

The Affordable Care Act (ACA) is redefining health care in America, and breastfeeding moms in particular are benefitting. While changes vary among insurance plans, the ACA now requires insurance companies to cover breastfeeding support and supplies. This may include lactation consultation, breast pumps and other health supplies needed for moms and babies to successfully breastfeed. For information on the ACA, how to talk to your insurance provider and more, visit www.breastfeedinginsurance.com. It’s important to have your questions answered and to be as knowledgeable as possible before baby arrives.

2. Educate yourself before baby’s arrival.

Reading books and watching videos can be extremely helpful for moms-to-be who want to breastfeed. Because there is a lot to learn, an online class can be particularly beneficial. The Medela Breastfeeding University is a 90-minute online course developed by health care professionals that walks moms through what to expect during pregnancy as their bodies change, what to expect at the hospital, how to transition at home and work, and even what fathers and grandparents can do to support breastfeeding efforts. Available in both English and Spanish, the $25 course fee will be donated to the Ronald McDonald House, plus moms who complete the course will receive a $25 coupon for a breastfeeding Accessory Starter Set. Visit-medelabreastfeedingu.com to learn more.

Use the code RELjN5GmY for a free registration for Medela Breastfeeding University in English, and use code RELSPqT6XAK to register in Spanish. Moms who use the free registration codes and complete the course are still eligible to receive the $25 coupon.

3. Build a support system

Breastfeeding takes time and dedication. Having a support system can help women overcome obstacles and successfully breastfeed for six months or longer. Spouses, family members and friends can all provide important support. Expert support can help as well, particularly when it comes to overcoming any hurdles such as latching problems or low-supply concerns. Consider meeting with a certified lactation consultant or join a support organization like La Leche League International or the Nursing Mothers’ Council. Your local Women, Infants and Children (WIC) office can also provide excellent breastfeeding support.

4. Prepare for comfortable breastfeeding at home

A few items can make breastfeeding at home easier and more comfortable for moms and babies. Some top supplies to consider stocking at home include a breastfeeding pillow to help support and position baby correctly, a rocking chair or glider, and multiple burping clothes to quickly clean up messes. Nursing bras, washable or disposable bra pads, and lanolin ointment are helpful also. Some women like to stock their breastfeeding area with bottled water, small snacks or reading material that they can enjoy while bonding with baby.

5. Prepare for heading back to work

With the right tools and a little preparation, mothers can continue breastfeeding while working. Federal law states employers must provide reasonable break times for employees to express breast milk for one year after a child’s birth. Employers must also provide a comfortable, private area that is free of intrusion, other than the bathroom. Talk with your employer or human resources contact about your intent to express milk during work hours. A double-electric pump and storage containers are good supplies to keep at work. Expressed milk can be safely stored at room temperature for four to six hours, in the refrigerator for three to eight days at 39 degrees or lower, and in the freezer for six to 12 months at 4 degrees or lower, according to www.BreastmilkGuidelines.com.

Stay connected to your baby, even when you’re not there. To learn more, visit www.medela.com.

 

 

 

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