Your Source for Health Reform

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Many questions about how health reform is affecting us have already been answered. Perhaps yours is one of them. If you do not find the answer you need below, please send us your own question.


YOUR QUESTIONS ANSWERED

 Q:   Can people with SHOP coverage delay Medicare Part B enrollment without the penalty?

 A:   Yes. A person with SHOP coverage is the viewed the same as a person with an employer group health plan. The same enrollment rules apply. People must enroll in Medicare Part B within 8 months of retirement or their SHOP coverage ending, whatever comes first. This question and answer from Healthcare.gov addresses concerns Medicare beneficiaries may have about the marketplace.

 Q:   What if my employees do not want to enroll in the SHOP plan I offer?

 A:   If less than 70% of your full-time employees do not enroll in the plan, your small business will not qualify for the SHOP. To calculate your employee percentage, divide the number choosing to enroll by the number of eligible employees. The pool of eligible employees should not include individuals who have coverage through another job, another person's job, Medicare, Medicaid, TRICARE, Veteran's Administration healthcare, or the Indian Health Service. The pool of eligible employees should include those who have private coverage, including plans purchased through the health insurance marketplace. The Center for Medicare and Medicaid Services has a helpful fact sheet addressing questions on this issue.

 Q:   Can the Small Employer Tax Credit really save me money on my monthly premium?

 A:   Yes – if you have 25 or fewer employees, with average salaries below $50,000 you could potentially qualify for a credit of up to 50% of what you contribute to your employees' health insurance premiums. Check out our detailed fact sheet.

 Q:   I renewed my small employer health insurance plan early in 2013 to delay the price increases associated with Obamacare, what should I expect for my Fall 2014 renewal?

 A:   Some insurance carriers in Illinois will be allowing small employers that renewed early in 2013 to renew their pre-ACA plan for another year come this Fall. The plans will still be subject to renewal premium price increases – but will not be required to switch to community rating or comply with all ACA mandates. Fall healthcare renewals should be released by your insurance carrier as early as July or August. We suggest having a ACA certified broker review your options with you. Find one here at GetCoveredIllinois.gov.

 Q:   I heard that Open Enrollment ended in March – am I too late to get a plan started for my employees?

 A:   No, small employers have the opportunity to begin plans in SHOP Marketplace at any time during the year – there is no open enrollment cycle. If your applications are submitted by the 15th of the month, coverage can begin as soon as the 1st of the following month. If you are a sole proprietor or are looking strictly for individual insurance, you will have to wait until this year's open enrollment which starts on November 15, unless you qualify for one of these Special Enrollment Periods listed at HealthCare.gov.

 Q:   Does the SHOP Marketplace sell "government" insurance programs to businesses?

 A:   No, actually, although the SHOP Marketplace was established by the Affordable Care Act, the health insurance plans that a small employer can enroll in are sold privately. In Illinois, there are two organizations providing Qualified Health Plans in the SHOP Marketplace – Blue Cross Blue Shield and Land of Lincoln Health. To get a closer look at what plans are offered and some preliminary pricing you can start here at HealthCare.gov.

 Q:   Who can help me purchase insurance for my small business through the SHOP?

 A:   In 2014 business owners can work with health insurance brokers to enroll their organization in the SHOP marketplace, and to obtain the Small Business Tax Credit if they qualify. To find a certified broker in your area you can use this tool on the Illinois Marketplace.

 Q:   Can Insurance Agents & Brokers sell inside the Illinois health insurance marketplace and get a commission?

 A:   Yes, agents and brokers may sell (and receive commission on) Marketplace Qualified Health Plans using either the Marketplace website or individual issuer websites. To do this, they must be licensed in good standing in the state they wish to sell in, and are required to register with the federal Center for Medicare and Medicaid Services (CMS) in order to sell individual plans; CMS also encourages agents and brokers exclusively working in the small group (SHOP) market to register. The commission for the enrollments will be received directly from the issuer – enrollees will pay the same premium if they work with a broker, navigator or on their own. For more information about how agents and brokers can participate in the Illinois Marketplace (and other Federally Facilitated and State Partnership Marketplaces), visit "Resources for Agents and Brokers in the Marketplace" on CMS.gov.

 Q:   What is the SHOP (Small Business Health Options Program)?

 A:   Under the Affordable Care Act, each state was required to establish a health insurance exchange – and have it up and running by October 1, 2013. Exchanges would eventually come to be known as "marketplaces," and small businesses have one specifically geared to them. The Small Business Health Options Program (SHOP) Marketplace helps businesses provide health coverage to their employees. For 2014 the SHOP Marketplace is open to employers with 50 or fewer full-time-equivalent employees (FTEs). You can find information specifically about the SHOP in Illinois on the Small Business page at GetCoveredIllinois.gov.

 Q:   Are small businesses mandated to provide health coverage to their employees?

 A:   No employer is required to provide insurance. But starting in 2015, businesses with 50 or more employees that don't provide health care coverage may be subject to penalties.   However, if you have a firm with 50 or fewer people you are exempt from this mandate.  In addition, if you own a small business, the health law offers a tax credit to help cover the cost if you choose to provide a plan for your employees. Employers with 25 or fewer full-time workers who earn an average yearly salary of $50,000 or less today can potentially qualify for a tax credit.  Find out more about the tax credits

 Q:   How will health care reform affect small business employers who are paying for their employees' coverage?

 A:   The new health care law includes several short- and long-term provisions designed to help small businesses pay for and maintain health insurance for their workers, and to allow workers without employer coverage to gain access to affordable, comprehensive health insurance. Provisions include a small business tax credit - already available to firms that offer coverage - to offset premium costs; establishment of state-based insurance exchanges (in 2014) that promise to lower administrative costs and pool risk more broadly; and creation of new market rules and an essential benefit standard to protect small firms and their workers. See this Frequently Asked Questions from the IRS about the Small Business Health Care Tax Credit.


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