Category Archives: Healthcare updates

Business Owners and Health Insurance

Healthcare updates

The IRS is really taking a look at the distinction between employees and independent contractors.

This year especially, because of the ACA’s requirement that employers with more than 50 workers offer health coverage. I have been advised by the National Association of Health Underwriters (NAHU) as well as the Iowa Association of Health Underwriters (IAHU) and many CPAs that it is ultimately important that when we work on your group benefits packages, that we get an accurate census of all employees and distinguish the difference between part time, full time, full-time eligible and independent contractors.

There is a calculation that is used to determine who is eligible and who is not. And that will define your responsibilities as a business owner. There will be consequences if this calculation is taken for granted. We work with your professionals as a team to keep you with a benefits package that suits the needs of your members, that is budget-friendly and compliant. This article will give you some insight.

Our consultations are free, please call us. I will educate you, I will distinguish your choices and keep you compliant and on budget. Please understand that this article is lengthy and probably more detailed than you need or want; however, it is from the IRS and that is the big brother that we have to answer to in the end. So, to provide you with the most current and the most accurate information, I rely on sources that are going to be what we have to live with to begin with. Scroll through this, and read what interests you. Please let know that this is an issue. I would be happy to partner with your CPA so that we provide optimum performance for your choices. If you do not currently have a CPA and you want references, we have a preferred directory for your reference.

Happy New Year from Sears Insurance!

Health Care Reform, Health Insurance, Healthcare updates
As we embark on the new year, there have been several items that have come to attention on the health care front.  I always rely on, well respected industry resources anytime I make reference. As we progress forward through the years and the ongoing implementation the provisions of the 2010 Affordable Care Act, I try to keep you informed. I take a very neutral political position, as there are always pros and cons to any law. Some will agree, some will win, others will not. It is not my job to judge, but to take the time to help each and every client sort through options and find a plan that meets their needs and their budget.
Below I have some interesting tax increases effective January 2015 that you should be aware of:
  • Top Medicare tax went from 1.45% to 2.35%
  • Top Income tax bracket went from 35% to 39.6%
  • Top Income payroll tax went from 37.4% to 52.2%
  • Capital Gains tax went from 15% to 39.6%
  • Estate tax went from 0% to 55%
  • These taxes were all passed under the Affordable Care Act aka Obamacare
This article from Forbes regarding sales tax increases as well as the implementation time line provided by The Kaiser Foundation.
Another source that I refer to often is The Galen Institute. I am also providing their website explaining 46 Changes to Obamacare thus far.
Healthcare is a complex system and it is an expensive system.  The ACA has a schedule of provisions occurring each year and at the same time the cost for the Affordable Care Act is also increasing.
My suggestion is to explore your options.  The marketplace is like a store front.  Anyone can shop there…some have a “coupon” (entitlement) and some do not.  When it comes to your health and the providers that we want access to when we have a serious illness or injury…it eventually becomes a situation where it has to be “all about the money”.  Our finest doctors have high cost and a long number of years of education.  They have years of experience.  In some states there is “no cap” on their malpractice liability driving their malpractice liability insurance premiums. (i.e. you could have a OB/GYN that does not choose to make part of their practice delivery of newborns, rather see patients with other needs and refer to others in the practice for their expecting patients).  When a patient comes to them they are wearing more than one hat – yes they are a doctors first, however, they are also assessing their liability with the acceptance of that new patient.  They must also assess how they are going to be reimbursed for the liability that they are taking.  If your insurance carrier reimburses them at a very low reimbursement, they may refer you to someone that could be accepting patients with your choice of  insurance.  Think of it as a niche in their market – the doctor taking the lower reimbursement will have volume to offset the low reimbursement.  That doctor may see three patients to the first doctor’s one patient.  In essence, like most things, you get what you pay for.
I have heard from well educated people that have spent many hours trying to navigate the system – then make benefit determinations – and then the cost.  But in the end do they know what provider network they have access to? Do they know how they will be covered if they are out of their “home” location on a trip?  Do they know how their college children are covered several states away?  Do they know if any one of their family would leave the country, such as study abroad, vacation, business, etc. would be treated?  Usually that is no.  For the maintenance issues some lesser quality plans will work, but for highly specialized care or care provided out of a given area, they may not have been your best choice.
To find a plan that meets your needs and your budget we recommend an independent agent.  We will help you with your healthcare options, decisions and budget.  We will also make suggestions for some tax-deferred options.  At Sears Insurance our business comes from repeat clients and the direct referrals they send us…because we know our business and we take care of our clients.  Please give us a call for a free consultation.  Know where you’re at.

 

Happy Holidays!

Health Care Reform, Health Insurance, Healthcare updates

Sears Insurance would like to thank you, each and every one of you, for your continued business and friendship. I have been helping families and businesses for 36 years and I could not have done it without you! As we near the end of 2014 it is time to give back to our family, friends, neighbors and the many individuals and businesses that we so truly depend on daily and throughout the year. We especially thank our soldiers and their families for the sacrifices that they consistently make for us.

In an effort to continue to strive to show appreciation to others, we must at some point put ourselves (our health) first. Without our health the rest of life and things take on a different meaning. An easy way to start the good intentions would be to log onto www.myWellmark.com. You can have all your health and benefits information at your fingertips. There is a personalized online health and wellness experience waiting for you. There is a wellness assessment, health, fitness and nutritional information, health trackers and tools…all Free! This is a very important tool if you are traveling or if you have a college student living other than home. Please check it out.

As we progress through each year of the Affordable Care Act, there are more questions, more regulations, more tax, and more confusion. On a State level, we have been challenged by Governor Branstad to be the healthiest state in the nation by 2016. “According to the 2013 Gallup-Healthways Well Being Index, Iowa is #10 in the nation when it comes to being physically, emotionally and mentally healthy. Though cracking the top 10 is a great improvement from the #19 positon we held when the Initiative was announced, we know we can claim #1 spot by 2016. It’s ambitious, but with your help, we can change Iowa and show the rest of the nation the road to wellness. Take the pledge to create a healthier, happier Iowa today! http://iowahealthieststate.com” To help accomplish this goal Wellmark has sponsored the Blue Zones Project. This project is a community by community well-being improvement initiative designed to make healthy choices easier through permanent changes to the environment, policy, and social networks. Please visit www.Wellmark.com to learn more.

I am pleased to share Wellmark’s new Blue Rewards plan starting January 2015. You can be rewarded for healthier choices with this collaboration between Wellmark, UnityPoint and Hy-Vee. Please call me for details!

If you have been wondering how the Affordable Care Act will affect you, I have a very user friendly timeline on my website. If you visit www.searsinsurance.info you will find newsletters and blogs with current information from well-respected sources for your reference. The timeline is easy to find at http://searsinsurance.info/2012/01/lets-look-at-2012-and-health-care/ I encourage you to educate yourself. If you are a business owner, you will want to know that Department of Labor and the IRS are both involved with the healthcare issues. Again, there is a lot of information out there…and it’s free…but what you need is an independent agent with experience and knowledge to assist you with your choices. There are many plans to suit your needs and your budget. When you are ready to enroll will provide you with personalized counseling and advice. Please give us a call.

Sears Insurance appreciates your friendship, your business and your referrals. Have a very safe and happy holiday season!

Deductibles and Maximum Out of Pocket Expenses for 2014

Health Care Reform, Health Insurance, Healthcare updates

The most you pay during a policy period (which is usually a calendar year) before your health insurance or plan starts to pay 100% for covered essential health benefits. This limit includes your deductibles, your co-insurance, co-payments or other charges, required of an individual which is a qualified medical expense for essential health benefits. This limit does not count premium balance billing amounts or spending for non-essential health benefits.

As mentioned in my previous post,the maximum out of pocket limit for any individual “market place” plan for 2015 can be no more than $6,600 for an individual or $13,200 for a family plan. If you have medical needs that have been unmet and you have met your maximum out of pocket expense, you may want to schedule procedures yet this year. If you are a Wellmark policy holder, you could go to www.mywellmark.com to track this topic. I encourage you while you have a little downtime from work over the holidays to download this handy tool.

There’s Still Time to Fund Your HSA Account!

federal compliance, Health Care Reform, Health Insurance, Healthcare updates

As our taxes creep up, deductions are always of interest.

If you have an HSA account, it’s not too late to make contributions. Individuals may contribute $3,300 (up $50 from 2013) and families can contribute $6,550 (up $100 from 2013). The high deductible health plans requiring deductibles for an HSA did not change between 2013 and 2014. We view this as being a good thing. On a high deductible health plan (HDHP), $1,250 for self coverage and $2,500 for family coverage.However, the maximum out of pocket expenses which includes deductibles, co-payments and other amounts (not premiums) are $6,350 for individuals (up $100 from 2013) and $12,700 for family coverage (up $200 from 2013).

HSAs are “IRAs on steroids” with triple tax advantages. You have tax deductible contributions, tax free accumulation of interest and tax free distributions for “qualified medical expenses”. This should not be taken as legal or tax advice. Seek out the appropriate professionals.

Please be cautious about spending your HSA dollars for unqualified medical expenses. The tax penalty is 20% of the HSA distribution. I highly recommend that you seek the advice of an independent agent and a CPA. But, if you want one more deductible for the year, this is something to look at.

Other Wellmark Products and Services

Health Care Reform, Health Insurance, Healthcare updates

Enhance your benefits package with other products to help protect employees and keep them healthy:

  • Dental – Once you’ve determined your base health coverage plan and cost, I would like you to know what your options are for other products and services. There are some very cost effective dental plans that will provide you with preventative care, basic restorative orthodontics and more.
  • Flexible Spending Administration – Your flexible spending administration is intended to reduce your payroll taxes and offer employees a way to save on their health expenses and independent care. Wellmark offers a complete administration for these products.
  • GeoBlue Global Health Care Products – These products are for groups with international travelers.
  • Standard COBRA Administration – This is available to groups with 20 or more employees.
  • Vision plans – Choose from vision coverage options with a choice of copays and benefit levels to fit a variety of needs.

Shopping for Health Care

federal compliance, Health Care Reform, Health Insurance, Healthcare updates

EVERYONE is eligible to look at different plans in the individual health market from November 15, 2014 – February 15, 2015. Some people will want to keep their plans if they were written before January 1, 2014. Those with ACA (Affordable Care Act) plans may keep your current plan or make a change. To start your thought process, I’ve got three points I’d like you to be aware of and then call me, because I’m sure you’ll have questions:

If your plan has not changed since September 2010, you have what’s called a “grandfathered plan”. If you have a plan that was written between September 2010 and December 2013, you have a “grandmothered plan”. Nick Gearhardt, Iowa Insurance Commissioner, has allowed these plans to stay in force until 2016. A good share of these plans are Wellmark Blue Cross Blue Shield of Iowa plans. There has been a request for a premium increase, however, the good news is, it should be a single digit increase. Hopefully, this will mean that the plan still fits your needs and you may not find it necessary to make any change at all.

If you have an ACA (Affordable Care Act), you can keep it and not make any changes if you still find it affordable. But, you can look at all plans. The expected premium increase on these plans will be much higher. The reason for that is pretty self-explanatory. These plans were written as a first-time-ever, meeting the guidelines of ACA, with no underwriting and consequently, there was no actuarial history to determine how these plans should be priced. The experience so far has been that an adverse selection (older, not necessarily insurable people) purchased a plan, has a procedure done, and did not renew, driving up the rates on the remainder of the policy holders. Until these have had a few years of history, the rates will undoubtedly experience a substantial increase. I recommend holding on to your traditional plans as long as possible.

Marketplace products. If you purchased your plan through www.healthcare.gov, you like your plan, your income has not changed from 2014 – 2015, perhaps it’s in your best interest to stay put. However, if your income is different in 2015, then 2014, I would encourage you to have a review before you incur a tax liability for 2016.

In summary of those three points, there are quality companies and products for us to choose from. I feel that our market has become more fragmented than ever before. What I mean is we have very low cost plans (you get what you pay for). We have some median coverage and price plans and of course, we have very quality products that would be priced possibly higher. The important thing is to have your agent review all of your options and by understanding your needs and your budget, assist you in making the right choice for you and your family. Call me, I’m sure you will have questions.

Large Group Employer Mandate Timeline

Compliance, Group Health Insurance, Health Care Reform, Healthcare updates

I have provided for you a time line of the provisions of the affordable care act (ACA) starting with its inception year 2010 running out and beyond 2015. If you click on the hyperlink under 2014, you will see the reform provisions that were implemented this year. If you go out to 2015, you’ll see even more.

The employer mandate in 2015 is something I’d like to draw your attention to. The employer mandate applies to large groups (50 or more full-time equivalent (FTE)). Please make careful note of this verbiage. You could have 80 people on your group, but you could actually have 40 that would be considered FTEs. This verbiage, as it applies to us here in Iowa, particularly impacts folks with seasonal occupations, such as our farmers, people doing outdoor work, possibly their jobs end in the late Fall as Winter approaches. Please read this carefully.

If you have any questions as to whether or not this applies to you, please give us a call. We will try to make the complicated appear simple. You will also see, on the left hand side of this web page, a menu of other items pertaining to the ACA. Towards the bottom, you will click on videos. These are short, very easy to understand, and cover a wide variety of topics. Scroll through this at your convenience. I hope you find this a helpful link.

Oftentimes, in your best interest, we will work closely with your CPA to determine the eligibility, if there is any doubt in an effort to keep you compliant and help you make strategic decisions going forward. We need to determine if you are a large group or a small group and then we would be happy to explain to you what your obligations are or not and how you can prepare, plan and budget this very important benefit to attract and retain quality employees.

Call Sears Insurance with any of your questions. We’ll be happy to help!

Are You an Employer? Do You Have Employees?

Compliance, federal compliance, Group Health Insurance, Health Care Reform, Health Insurance, Healthcare updates

The IRS and the Department of Labor are working together regarding the Affordable Care Act. If you have employees who have individual health insurance premiums and you are doing a pre-tax employer reimbursement for that, please consult your CPA immediately. This document explains the stiff penalties associated with the reimbursement of individual premiums.

In addition to talking to your CPA, and getting yourself in the proper position with your current situation, you may also want to contact me to explore the options and premiums associated with group insurance. Our quotes and consultations are free and keeping you compliant is a priority.

Affordable Care Act (ACA) Continues to Impact Small Employers

Health Care Reform, Healthcare updates

From our friends at McGowen, Hurst, Clark and Smith, CPA

Many small employers had established “Reimbursement Arrangements” under which the employer would pay part or all of the cost of an employee’s individual health insurance premiums. This payment was treated as a tax-free benefit to the employee and was allowable under the “old” rules.

The IRS recently reaffirmed that such Reimbursement Arrangements are not allowable under provisions of the ACA. On May 19, the IRS published information that stated such arrangements do not qualify under the ACA. Further, the IRS clarified that employers who continue to provide tax-free reimbursement of individual health insurance premiums to employees may be subject to penalties as high as $100 per day per applicable employee. Please contact your MHC&S provider for more information.

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