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Your 2020 ACA Compliance Checklist

If you’re purchasing or renewing group health coverage, then you’ll need a comprehensive look at what changes are coming in 2020. The ACA is updated every year, so it can be difficult to stay on top of things. With our checklist, you’ll have a better understanding of what’s taking place so that you can make the best decisions for your company’s health coverage.

ACA checklist for business owners — *As a business owner, you already have a lot on your plate, but don’t forget this checklist too!*

Are you an Applicable Large Employer?

Several rules only apply to you if you’re considered an ALE (Applicable Large Employer). For example, the ACA states there are Employer Shared Responsibility rules that require ALEs to offer affordable coverage. However, if you don’t have 50+ employees in your workforce, this doesn’t apply to you.

This also goes for Employer Mandate Penalties. If you’re considered an ALE, you can incur penalties if you don’t follow certain ACA standards like:

Offering coverage to full-time employees plus their families (or dependants)
Offering coverage that is not affordable
Offering coverage that does not provide minimum value

As a note, the minimum value is the standard minimum coverage that you can get in employer-based plans. For example, the policy needs to pay at least 60% of the total cost of medical services for an average population.

Are You Informing Your Employees?

There are three major instances where your workforce needs to be notified. This means not only reaching out with the correct information, but also making supplemental information available, and being knowledgeable yourself so that you can help them make solid decisions.

The first is a written notice of ACA Exchange Requirements. This needs to be given to all new hires. Inside the notice, it should detail the ACA’s health insurance exchange and talk about how and why an individual can obtain coverage through an Exchange.

The second is a Summary of Benefits and Coverage or an SBC. Any plans you offer, including the providers that write these policies, need to be provided to each employee. Basically, this is to make sure everyone is up to date, and no one can say that they weren’t sure about different plan options or otherwise.

business owner talking with employees about ACA changes — *Your employees are your team. Make sure you’re taking care of them with the best group policies.*

The third is for ALEs only, and it’s providing 1094-C and 1095-C tax forms. These forms are specifically used to detail what benefits each employee receives from their employer’s health plan.

For non-ALEs, the plans are 1094-B and 1095-B. These are only if you sponsor your workforce with a self-insured health plan.

For both of these cases, you need to give the forms to your staff by January 31, 2020, and the forms need to be reported to the IRS. Once that’s done, you’re set!

Coverage Affordability

Your employees need to be able to afford their health plans. How can something qualify as unaffordable? Technically, the IRS has a guide to help make these decisions.

A plan is considered unaffordable if it’s offered at 9.78% less than their taxable household annual income. This means if they have a yearly income of $10,000, then the offered plans will be considered unaffordable if their costs amount to $9,780 or more for the year.

New Out-of-Pocket Maximum

With the ACA affecting health plans, there are changes to the dollar amount for certain factors in your health policies, specifically the out-of-pocket maximums.

The maximums for out-of-pocket expenditures are not to go above $8,150 for your employees as long as they cover the essential health benefits. This number is for individual coverage in your group health plan. For family coverage, the maximum is $16,300.

These changes can be confusing, and you don’t want anything to slip by when you decide on coverage. For any group health plan, the bottom line is to keep both your employees happy and your insurance premiums well within budget.

If you need help picking out the best policy, EZ.Insure offers you an expert guide. Your agent will answer any questions you have, compare the plans for you, and even sign you up, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. EZ.Insure makes the entire process easy, simple, and quick.

Trump’s New Plan To Strengthen Medicare

With all of the recent talk and debates about “Medicare For All”, President Trump has decided to take action. In October, Trump signed an executive order while visiting Florida, pertaining to the Medicare health program. His goal is to improve Medicare by giving seniors the ability to choose from more affordable plans.

Protecting and Improving Medicare for our Nation’s Seniors

Because Democrats are pushing to expand Medicare to everyone, Trump proposed this plan in response. He stated that he will do whatever it takes to prevent the “socialist” proposal of Medicare For All. Trump’s order is aimed to reduce regulations, curb fraud, and provide quicker access to therapies and medical devices.

trump and new medicare plan book on shelf — *Every president we have tries to improve our healthcare system. Let’s see how these changes work in the long run.*

The order wants Medicare to offer and use more medical telehealth services, in order to reduce costs to seniors. The more that seniors have access to their doctors through telehealth, then the fewer emergency room visits would occur. And in order to accomplish this, Trump proposes to get rid of regulatory requirements that prevent medical professionals from practicing at the top of their licenses.

This means that the focus will move from doing clerical tasks that don’t require a physician’s level of training to the patient’s care. For example, instead of filling out forms, faxing paperwork, and requesting medical records, the tasks can be alleviated by an assistant, freeing up the medical staff’s time to give more attention to the sick.

Allowing nurse practitioners and medical assistants to practice at the top of their license would “really enhance access to care, enhance provider availability for all Medicare beneficiaries, including in fee-for-service, and really help, especially with the rural healthcare crisis,” HHS Secretary Alex Azar said in the media call.

More Money Back To Seniors

The order directs Medicare to create a new payment model that adjusts Medicare Advantage supplemental benefits. The purpose is to allow seniors to directly be a part of any cost savings that Advantage plans generate. This will include any monetary rebates, and lowered prescription drug prices.

Azar stated, “The executive order commissions us to examine all practices, regulations, and guidance to just make sure that we are not steering people into fee-for-service as opposed to giving them a genuine choice of Medicare Advantage or fee-for-service.”

“We’re lowering the cost of prescription drugs, taking on the pharmaceutical companies. And you think that’s easy? It’s not easy… I wouldn’t be surprised if the hoax didn’t come from some of the people that we’re taking on,” Trump said. He was referring to drug companies that were backing the impeachment efforts in Washington. He believes they were doing this as a way to sabotage his efforts of making prescriptions more affordable to medicare recipients.

seniors with medicare holding their grandchildren — *As we age, we need healthcare. So, any insurance system that focuses on helping us as we mature should be improved.*

What Trump Is Pushing For

The order is undoubtedly a way to pushback against Bernie Sanders’ Medicare For All proposal, which would open the Medicare gates to everyone in America. Trump sees it as socialism, with the administrator of the U.S. Centers for Medicare and Medicaid Services, Seema Verma backing it up, calling it a “pipe dream” that would just lead to higher taxes.

Trump hopes that his proposal will be more beneficial to seniors, making Medicare a little more affordable, while at the same time condemning Medicare for All proposals.

Texas Judge Rules Obamacare Unconstitutional- What This Means For The Future

Just before Christmas, a federal Texas judge, Reed O’Connor, ruled that the entire Affordable Care Act, also known as Obamacare, was unconstitutional. This all began December 2017, when President Trump eliminated the individual mandate from Obamacare. The individual mandate was the penalty people had to pay during tax season if they did not get health insurance for the year. When the mandate was officially gone, many states decided to take action against the ACA, filing a lawsuit deeming the ACA unconstitutional. Texas is the first state to rule against the ACA’s validity. Obamacare may now face some challenges. However, as of now the ACA open enrollment will still take place for 2019, and people will still get coverage.

*Texas judge ruled Obamcare (ACA) unconstitutional, making it invalid.*

If the ACA is completely dismantled, then this means that other provisions would go away as well. This includes pre-existing conditions, young adults staying on their parents’ insurance until the age of 26, and the coverage of “essential benefits” such as mental health, prescription drugs, and maternity.

The ACA Holds Up For Now

In response to the judgement from O’Connor, Obama wrote “it’s so important for you to know that last night’s ruling changes nothing for now. As this decision makes its way through the courts, which will take months, if not years, the law remains in place and will likely stay that way. Open enrollment is proceeding as planned today. And a good way to show that you’re tired of people trying to take away your health care is to go get covered! A lot of good people are fighting to ensure that nothing about your care will change. The ACA protects your pre-existing conditions, no matter how you get your insurance. Young people can stay on their parents’ plans until they’re 26. Preventive care like checkups, mammograms, and contraceptive care are still covered. Mental health care is still covered. Women can’t be charged more just for being a woman. All of that is guaranteed by the ACA as long as it’s the law.”

Trump on the other hand was happy of the judgement stating in a tweet, “It was a big, big victory by a highly respected judge, highly, highly respected in Texas, and on the assumption that the Supreme Court upholds, we will get great, great health care for our people. We’ll have to sit down with the Democrats to do it, but I’m sure they want to do it also.”

*As of now, Obamcare will be available for 2019. The future of the ACA is unkown, especially not until 2020 after the high court hears Texas’ case.*

What The Future Holds

While legal experts predict that the decision will be overturned by the high court, it will not be likely to take place until 2020. Until then, the ACA law is not yet invalidated, even though enrollment has taken a hit. Enrollment is down by 12% compared to the previous year. The ACA has withheld a lot over the years, and only time will tell it’s future, but as for now, it is here to stay.

Trump Promises To Protect Pre-Existing Conditions

Over the years, President Trump has been slowly picking away at Obamacare, also known as the Affordable Care Act. But there has been one section of the ACA that he intends to keep, which is the pre-existing conditions clause. Trump recently stated he was going to “totally protect people with pre-existing conditions.” Despite the Trump Administration putting the provision in jeopardy, Trump is stating he backs it and that Democrats do not.

*Trump promises to protect and cover pre-existing conditions, even after the ACA is gone.*

The controversy all began when Trump was running for presidency. One of his promises was to get rid of Obamacare, and so far he has kept that promise. Over the years, he has gotten rid of the individual mandate. This mandate stated that people must get health insurance or they will face a penalty. Due to getting rid of this mandate, many states have challenged the ACA’s constitutionality in a lawsuit this past February. These states are saying that since the mandate is unconstitutional, then the entire health care is also.

The Promise

Throughout the dismantling of the ACA, Trump is fighting to protect people with pre-existing conditions. He wants to make sure that they are still able to get health insurance, and will not be rejected or pay more because of the conditions. This is all came about as midterm elections were approaching, and he was urging people to vote Republican. In his tweet he stated that Republicans will back those with pre-existing conditions, and that Democrats will not, so “vote Republican.”

Trump administration officials said they will allow states to use federal subsidies to pay for health plans that don’t cover pre-existing conditions. Republicans all over the U.S. back what Trump has said about pre-existing conditions.

*Make sure you plan ahead so that you are covered. Look into a short-term plan, and if it will work for you.*

However, there are many doubts if this will actually hold true. A lot of people are skeptical about the pre-existing provision, especially after the midterm elections. Many see this as an attempt to get people to support Trump. The fact is that premiums may be high for those with pre-existing conditions, and not necessarily protect them.

Short-term plans are being expanded in hopes that people will go for them, which does not offer comprehensive plans. This means they may not necessarily cover pre-existing conditions. But if Trump does truly stand behind protecting pre-existing conditions, he can take some steps to ensure it will be be protected, which we have yet to see.

Once the lawsuit between the states and the government to get rid of the ACA is over, only then will we know what will happen with pre-existing conditions. This can cost a lot of people looking for health insurance a lot of money, and even possibly be denied coverage.

Trump’s Plan for Health Insurance to Be Sold Across State Lines is Becoming Reality

While announcing the proposal of association health plans amongst small businesses, the Trump Administration is also aiming to facilitate health insurance policies across state lines. The rule will allow insurance companies to sell plans across state lines. The goal is to be able to provide plans and coverage that cost less.

*Trump plans to allow insurance cpmanies to sell plans across state lines.*

Trump stated “I have private insurance companies coming and will sell private health care plans to people through associations. That’s going to be millions and millions of people. People have no idea how big that is. And by the way, and for that, we’ve ended across state lines. So we have competition.”

The issue that Trump is referring to is the state regulations that each state has. Each state differs in the requirements of what must be covered by insurance companies.

The association health plans would be considered under the federal law that allows large employers the freedom from state regulation. This way, these health plans can be sold across state lines.

Issues that lies with these plans are the fact that they can surpass the ACA’s requirement of providing the 10 essential benefits such as maternity care, mental health care, and emergency services to name a few. This allows the plans to offer fewer benefits, therefore costing much less. But the association plans cannot discriminate or overcharge individuals with pre-existing conditions.

These health plans can be structured across state lines, giving them the opportunity to market anywhere in the country. They may also set up to serve communities, or span several states. However, pricing is uncertain whether people in Manhattan will be priced the same as those in Texas.

“We are concerned that this could create or expand alternative, parallel markets for health coverage, which would lead to higher premiums for consumers, particularly those with pre-existing conditions,” according to a letter last month to state regulators, signed by America’s Health Insurance Plans and the Blue Cross Blue Shield Association. “Further, these actions destabilize the health insurance markets that guarantee access to comprehensive health coverage regardless of health status.”

Allowing this new rule will hopefully help Americans save money on health inurance. — *Allowing this new rule will hopefully help Americans save money on health inurance, says Trump.*

Pennsylvania’s acting insurance commissioner, Jessica Altman, voiced her opinion on the matter. “Generally speaking, these types of plans are exempt from state law and outside my jurisdiction,” Altman stated. “That means any issues that consumers have, I won’t be able to help them. More and more people would fall under the jurisdiction of the federal government, and I think state regulators would say we really do it better.”

The opportunity for health insurance plans to be sold across state lines will have an impact on the market. People will be able to purchase less comprehensive plans at a cheaper rate. But this can cause customers with extensive health issue or needs a hard time finding affordable plans. Healthier individuals will leave the marketplace for the skimpier non-regulated health plans, which will create a rise in premiums for those who need it- the sick.

Details on the rule must still be worked out by Congress and voted on, but if passed, it will change the health insurance market.

Healthcare Rates to Rise in 2019

In 2017 when President Trump did away with cost-sharing subsidies, it forced insurers to raise premiums. The cost-sharing subsidies helped pay back insurers for giving customers lower premiums due to their income status. Due to the halt in the subsidies, health insurance premiums have been rising. Mainly for those who have to buy their own insurance, approximately 34% in 2018 for silver plans. Insurers are now brainstorming what they will charge and if they want to participate in the ACA exchanges for 2019.

Insurers have been participating less and less in the market exchange, leaving customers with fewer choices. If more insurance companies decide to pull out of the exchanges, it will mean that customers will have even fewer choices available to them, at higher costs.

Health Insurance rates are increasing next year — *Health Insurance premiums and deductibles are increasing next year*

Premium Increase

Premiums will continue to keep growing without the cost-sharing subsidies to help with the costs impacted on insurers. The hike in premiums could be as much as 30% for 2019. It is projected that those that will be impacted the most are those who make too much money to qualify for premium support subsidies.

Eyles and Ceci Connolly, president and CEO of Alliance of Community Health Plans both voiced their disappointment of Congress failing to take action to fund cost-sharing subsidies.

“What’s happened is that several pieces of the puzzle have been pulled away. It is hard for me to isolate CSRs, what we are looking at now is a puzzle that is falling apart piece by piece,” Connolly said. “Losing the individual mandate, losing the cost sharing reduction subsidies and losing any hint of reinsurance, not to mention the risk corridors that were already gone, you’re just running out of options to manage the cost of this program.”

Funding

Midterm elections are approaching which brings up the issue of health care. While both political parties will be criticized, the polls have shown that voters hold Republicans more responsible for the high costs. Both parties have come to an agreement to include health insurance funding in the spending law. However, they could not agree on the details of what to fund exactly. Republicans are pushing for abortion restrictions stating insurers can cover abortions but cannot use federal funding for them, while Democrats do not agree.

Lawmakers are hoping the stabilization effort of adding funding to the bill will offset the costs of insurance. Health-policy experts disagree on how much it will help. Health experts state that the higher premiums will be offset for people by other subsidies they will be qualified for.

Republicans are not thrilled to stand behind the idea of the stabilization funding. They view it as saving the insurers of the health law, ACA, which they promised voters they would repeal. They blame the ACA’s regulations which stopped competition and drove up premium costs. Congress is leaning towards unlikely passing the stabilization bill.

Insurers are expected to announce the premium price hike sometime in the fall.

Tag: ACA