ACA Marketplace Archives

Group Insurance For Furloughed & Laid Off Employees

The coronavirus pandemic has taken a toll on many small businesses, and many are now struggling to stay afloat. In order to keep going, many small business owners had no choice but to furlough or lay off employees in order to save money. If you are one of them, you might be wondering what your former employees’ health insurance options are after you let them go. Is there still a way you can offer them group insurance? You can choose whether to pay monthly health insurance premiums on behalf of your employees, but if it is not possible due to financial constraints, your employees do have other options.

Furloughed Vs. Laid Off

Health coverage for an employee is determined by the employer’s (your) health plan. The plan indicates how many hours an active employee has to work to be eligible for health insurance. There are also rules surrounding what happens to their health insurance when they are no longer an active employee. When an employee is :

Laid off, their employment is terminated, even if you are considering the lay off temporary. After an employee is laid off, their health insurance plan ends on the last day of the month they were laid off.
Furloughed, their hours are reduced, or they might not be working at all. The difference is that they can expect to return to work again when the furlough is over, so they can continue to get health insurance coverage during the furlough period. If this is the case, the employee will either be responsible for their share of the plan’s premiums, or you, the employer, can temporarily waive employee contributions and pay all of their premium.

ERISA & Federal Income Tax Rules

In general, nothing actually prevents you from paying monthly premiums on behalf of furloughed or laid-off employees. You have the option to choose to pay monthly premiums as long as you are able to. The premium will continue to be excludable from the gross income of the employees. Be aware, though, that if the plan rules do not permit an employee to be covered, then you are in danger of:

Potential loss of tax-exempt status of the plan, which means both you and your employees might owe back taxes, since pre-tax qualification would be lost.
Your insurance company denying claims for any employees that they determine are not eligible to participate in the plan.
A possible fiduciary breach under the Employee Retirement Income Security Act (ERISA) if plan assets were used to pay for benefits of non-eligible employees.
Laid-off and furloughed employees qualify for COBRA insurance.

COBRA Insurance

Another option to continue coverage for your employees is the COBRA program. Both laid-off and furloughed employees qualify for a Consolidated Omnibus Budget Reconciliation Act (COBRA) plan if their group plan is terminated and you can no longer pay their premiums. COBRA can be expensive for your former employees, because if you do not contribute to their premiums, they will have to pay the full amount.

ACA Marketplace

Last but not least, losing a job is considered a qualifying life event, so a Special Enrollment Period will open up for your former or furloughed employees after they lose their job and their coverage. This means that they will have 60 days to get a health insurance plan on the ACA Marketplace. This could be a cheaper option for your employees than COBRA.

EZ Can Help

The pandemic has actually caused some changes in the way that group health insurance works. For example, some states have issued orders requiring or encouraging insurance companies to allow employers to make changes to their eligibility requirements so they can continue to offer group insurance to furloughed or laid off employees. Some states are even allowing a grace period for premium payments. To find out if your state is one of them, speak to an EZ agent, who can help find out the information for you. If you are interested in continuing to offer a group insurance plan, we can help you find a reasonable way to provide insurance to the employees that you had to let go. The times we are living in are not normal by any means, and we know it is not an easy decision to let go of your valued employees. EZ can help by offering our services for free, which includes checking all possible options, answering any questions, and comparing quotes.

To get started, simply enter your zip code in the bar above, or to speak directly with an agent, call 888-998-2027.

How Small Businesses Can SHOP Around for Healthcare

One of the questions often asked by small business owners is: can I offer my employees ACA Marketplace coverage and qualify for subsidies? The answer to this is actually yes and no. If you are a small business owner looking to offer insurance to your employees, you cannot apply for the subsidies that individuals shopping on the Marketplace can. However, you can offer your employees plans that are basically identical to individual Marketplace plans, and possibly qualify for a tax credit when you do so. If you run a small business but still want to offer your employees healthcare, you may want to look into the Small Business Health Options Program, or SHOP.

SHOP Plans

The good news about SHOP is it’s easy to understand: the plans offered look basically the same as those offered on the individual ACA Marketplace. Just as on the individual Marketplace, there are four types of plans that are based on a “metal tier” system. You can choose from Platinum, Gold, Silver, or Bronze plans, and, as Healthcare.gov points out, the levels do not indicate quality of care; rather, the categories are based on how the cost of care will be shared by your employees and your insurance company. Cost sharing for these plans generally look like this:

Platinum – 90% on average paid by insurance, 10% on average paid by employee
Gold – 80% on average paid by insurance, 20% on average paid by employee
Silver – 70% on average paid by insurance, 30% on average paid by employee
Bronze – 60% on average paid by insurance, 40% on average paid by employee

You can also choose to add dental coverage to these plans, or even offer a stand alone dental plan to your employees if they are interested.

How to Qualify

illustration of clipboard with a blue pen on it and blue check marks in all 4 boxes — *You can qualify for SHOP as long as you meet 4 requirements.*

SHOP is an easy and straightforward way to offer insurance to your employees, but not every business qualifies for it. Your business needs to meet 4 requirements:

Have 1 – 50 full-time (or full-time equivalent) employees. This does not include you, your spouse, or other family members.
Offer coverage to all full-time employees. This includes all workers averaging at least 30 hours per week. You can offer coverage to part-time employees, but you are not required to do so.
Enroll at least 70% of your full-time employees in your plan. However, if an employee already has another healthcare plan, they are not counted as rejecting your plan.
Have an office or employee worksite that is located in the state whose SHOP coverage you are using.

Also make sure to look at the specific plans offered in your state; they may have other specific requirements.

Why SHOP?

Now that we’ve looked at what SHOP actually is, let’s take a look at why it might be a good option for you and your business. As mentioned above, both the plan options and requirements are fairly straightforward. There are other advantages to it, as well:

SHOP offers you choice and flexibility. You can offer your employees one plan, or multiple options, you decide how much to contribute to their premium costs, and you can also decide how long new employees must wait before enrolling. There is also no need to wait for an open enrollment period; you can start offering your employees SHOP coverage at any time during the year.

You can work with an agent. You don’t sign up through Healthcare.gov, or need to start an account with them. You can work with a trusted insurance agent or broker to help you through the process.
You may be able to get the Small Business Health Care Tax Credit. This is where your alternative to ACA individual subsidies comes into play. If you meet certain requirements, you can get a tax credit worth up to 50% of the costs of employee’s healthcare premiums. To qualify for the minimum credit, you must have fewer than 25 full-time employees making less than an average of around $52,000; to qualify for the maximum credit, you must have fewer than 10 full-time employees earning less than an average of around $25,000.

Health insurance is complicated, especially if you’re running a small business and trying to figure how you can do the right thing and offer healthcare to your employees. SHOP might just be a way for you to simplify things a bit for yourself – and maybe get a little of that hard-earned money back in your pocket. And remember, whatever type of group health plan you’re looking into, EZ.Insure can help. We’ll connect you with your own personal agent who will answer all of your questions, get you the most accurate quotes, and even sign you up – all for free! Get started with us today by simply entering your zip code in the bar above, or you can speak to an agent by emailing or calling 888-998-2027.

Is Medicare For All Coming? Here’s Why You Should Check Your Insurance Options Now!

The Medicare for All debate is full of disagreements between politicians in regards to it’s future. Some Democrats advocate for the single-payer healthcare system that would eliminate private health insurance companies, while others push for a government option. Republicans, on the other hand, are in favor of sticking with a private system and getting rid of the ACA. All of this uncertainty about the future of health insurance brings an uneasy feeling. Medicare for All might happen, and the ACA might disappear. No matter what the outcome, health insurance is in a safe place right now with affordable plans. There is no better time than now to check your insurance options and find a good policy.

What Is Medicare For All?

group of people with a huge red heart in the babkground — *Medicare for All is a government-run system that would replace private health insurance offered through employers.*

Under Medicare for All, a government-run system would replace private health insurance offered through employers. This single-payer system would be paid for by tax dollars, and Americans would no longer pay premiums, deductibles, or any point-of-service costs for healthcare. While some see this as a good thing that would ensure healthcare for everyone, others see it as a potential disaster that would cost too much and create long wait times for care.

A poll from the nonpartisan Kaiser Family Foundation found that 56% of Americans support Medicare for All. When people were told it could lead to higher taxes, support fell to 37%. When asked whether they would still support it if it led to delays in care, the number fell to 25%.

However, as of now, talks of Medicare for All have been silenced; in fact, any talk regarding the future of health insurance for the U.S has been notably nonexistent. Where will this leave the health insurance industry after elections? Where will this leave you? Will Medicare for All take over? Will you have the option for private insurance, and if so, will the prices rise to unobtainable rates?

The Future Of The ACA Marketplace

On the other side of the aisle, Republicans have a less concrete plan for how to move forward. Their plan is still pushing for the repeal of the ACA: Republicans have been trying to get rid of the ACA since it was introduced by former President Obama. As of now, 18 Republican attorneys general are still planning to participate in a lawsuit that could mean the repeal of the Affordable Care Act within a year. If the ACA were to be dismantled, over 20 million Americans would lose health insurance.

The threat of repeal is causing uncertainty about the future of healthcare because, as of now, no Republican lawmakers have proposed a replacement plan.

A Lot Of Uncertainty

Medicare for All is a faraway dream (or nightmare, depending on who you ask) right now, and both political parties have been generally vague about their future plans for healthcare. It is better to be covered now with a secured policy than wait until the industry changes, when there are likely going to be fewer options for coverage and higher prices. Even insurers are uncertain about prices and what they expect healthcare to look like. Usually they have an idea, but not this time.

One thing that is certain is that there are still affordable ACA plans and private health insurance plans available. Currently there are a range of plans, with different coverage and prices that can meet your health and financial needs. Recently, more ACA insurance companies announced that they have expanded into new counties around the U.S. This means there are more options than ever for getting covered. It’s a good time to take advantage of the choices available and get grandfathered into a plan, in case the insurance market changes drastically in the future.

Doing the research can be a lot of work. It can feel overwhelming when you have to compare different plans to find the one that meets your needs. We get it, and that is why EZ.Insure is here to help. We won’t try to make a profit off of your confusion, we just want to help you make an informed decision. We will provide you with your own agent, who will go over all of the coverage options and prices, and guide you towards the best plan for you for free. To get started, simply enter your zip code in the bar above, or to speak directly to an agent, call 888-350-1890.

Can You Get Health Insurance at Any Time?

If you are unhappy with your current health insurance policy, then it might be time to shop for a different plan. But can you purchase a new plan at any time? Yes, and no. For marketplace plans, once the open enrollment period (November 10 to December 15) is over, you generally cannot get a new plan. The open enrollment period for employer-based insurance might be at a different time of year, but you will still only be able to change your plan during that enrollment period. In most cases, if you want to get health insurance or change your plan outside of the open enrollment period, you will need to qualify for a Special Enrollment Period (SEP). SEPs open up when you experience what is known as a qualifying life event.

Qualifying Life Events

caucasian couple hlding a baby girl in the middle while both are kissing each cheek — *You can get health insurance outside of open enrollment if you qualify for SEP such as getting married or having a baby.*

You have 60 days to change your plan if you:

Got married
Had a baby, adopted a child, or took in a foster child
Got divorced or legally separated. However, if you do not lose coverage due to divorce or legal separation, then you do not qualify for a Special Enrollment Period.
Had someone on your marketplace plan die
Changed residence. If you move to a new home in a new ZIP code or county, move to attend school, are a seasonal worker and move between job and home, or move from a shelter or other transitional housing to a permanent residence, you will qualify for an SEP.
Lost your health insurance. This includes losing job-based coverage, losing a plan you bought yourself, losing eligibility for Medicaid or Medicare, and losing coverage through a family member.
Gained membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
Became newly eligible for Marketplace coverage because you became a U.S. citizen
Left incarceration
Started or ended service as an AmeriCorps State and National, VISTA, or NCCC member

Short-Term Medical Plans

If you do not qualify for any of the life events listed above, all hope is not lost. You can enroll in a short-term medical plan. Short-term health insurance provides fast, flexible insurance with many benefits. These plans can be extended up to 3 years, and you can pick your deductible amount from many options. You are also able to drop coverage without a penalty if you want to change to a long term insurance option. Premiums are lower than ACA health insurance plans, and you get coverage as soon as a day after applying.

It is important to understand that short-term insurance is temporary and not ideal for those who require more comprehensive coverage or have health conditions. Short term plans are not guaranteed-issue, meaning they do not cover pre-existing conditions. They only cover the basics.

Do you qualify for a special enrollment period? If not, are you considering a short-term health insurance plan to hold you over until open enrollment begins? EZ.Insure can help. We offer accurate health insurance quotes based on your specific region, free of charge. That’s right. We will provide you with an agent who will compare all available plans for you, and help you choose a health insurance plan that is based on your health needs and budget, for free. To get your free quotes, simply enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

Should You Go for Gold?

Silver or gold? If given the option, which would you choose? You’d probably be tempted to immediately answer gold. But when it comes to group health insurance, it’s not that easy. It turns out that the group health plans known as “Silver plans” are far more popular than “Gold plans.” So when is it worth it to go for gold?

The ACA Marketplace

family of 4 in a bubble being held by caucasian hands. — *People can now go to this “marketplace” and shop for the plan that is right for them,*

The Affordable Care Act, otherwise known as the ACA or Obamacare, was signed into law in 2010. It mandated that health insurance exchanges be created in each state. It changed the way insurance worked. People can now go to this “marketplace” and shop for the plan that is right for them, choosing between different metal tiers of coverage (Bronze, Silver, Gold, and Platinum).

Under the ACA, small employers (businesses with 1- 50 employees) can also benefit from this marketplace. In the past, it could be challenging for small business owners to find multiple options for group insurance. But now they can shop around to choose between the same metal tiers as individuals can.

What is a “Metal Tier”?

Just like with individual plans, the metal tier options available to small businesses are Bronze, Silver, Gold, and Platinum. While it may sound like it, the different tiers do not indicate different levels of care.. After all, under the ACA, all plans must cover at least the 10 essential health benefits. What the metal tier actually represents is the cost-sharing split between the employee and the insurance company, meaning how much they will pay versus how much the insurance company will pay for medical care.

Employees with Bronze plans will pay the lowest monthly premiums, while those with Platinum plans will pay the highest premiums. However, premiums are not the only cost to consider: there are cost-sharing requirements, as well, including:

Deductibles – the amount you need to pay for medical care before insurance “kicks in”
Coinsurance – the percentage the insurance company will pay for services after you have met your deductible
Copays – the amount of money you are responsible for, over and above what your insurance company pays – for example, it may cost you a flat copay of $35 to visit your doctor

The metal tier offers coverage within different premiums, copays, and deductibles. Usually the silver plan is preferred.

Because Bronze plans are the lowest tier and have the lowest monthly premiums, they have the highest cost-sharing requirements, while Platinum plans, on the other hand, have the lowest out-of-pocket costs. The cost of premiums and these cost-sharing requirements varies between the metal tiers: for example, with a Bronze plan, employees will pay 40% of costs (with the insurance company paying 60%), while with a Platinum plan, the split is 10% / 90%. That being said, there is an out-of-pocket limit for every plan, which for 2020 is $8,200 for individuals and $16,400 for families. The out-of-pocket limit varies and will probably be highest for those with Bronze plans.

Silver Versus Gold Plans

The most popular plan among employers is the Silver plan, around 50% of employers choose this type of plan. Coming in second is the Gold plan, with almost 30% of employers choosing that type of plan. Leaving out Bronze plans with their high out-of-pocket costs, and Platinum plans, with their high premiums, let’s look at Silver and Gold plans.

With a Silver plan, employees will pay 30% of costs, and with a Gold plan they will pay 20%. These numbers are really dependent on how much healthcare they need throughout the year. For example, if an employee only uses their plan to see the doctor for an annual visit plus one or two other minor visits, they will be paying far less than 20% or 30%. But if they end up with a serious illness and need hospitalization or long-term care, they will be paying far more.

a pile of blocks of gold stacked on top of each other. — *Gold plans are perfect for people with chronic conditions or are in higher risk categories or have children in sports.*

It is understandable, then, that many employers choose Silver plans as a one-size-fits-all option. The premiums are lower, and you might be banking on an able-bodied, working-age group of employees who will use medical services an “average” amount. In this case, the 30% cost sharing doesn’t seem too daunting.

When to Go for Gold

If lower monthly premiums are important to you as a small business owner in order to attract employees, then Silver may be the way to go. But when is Gold worth it?

Simply stated, a Gold plan is worth it for people who expect to use their health insurance. They are perfect for people with (or who have dependents with) chronic conditions or are in higher risk categories for things like the flu – or even those with very young children or children who play sports.

Remember, because of HIPAA (Health Insurance and Portability Act), you cannot directly ask employees about any specific health conditions they may have. You can, however, send out an anonymous survey and ask your employees what they are looking for generally in a healthcare plan. You may find that they are willing to pay more for premiums in order to lower their out-of-pocket costs. If they are worried about being faced with high bills when they need care, then a gold plan might be the right option.

Remember, if you are at a loss at where to begin in choosing group health insurance, EZ.Insure can help. You can start by simply entering your zip code in the bar above to get a quote, or you can contact us by email at [email protected] or call 888-998-2027.

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