Premium Changes- According to a study by PriceWaterhouse Cooper, Premiums under the Affordable Care Act are expected to increase an average of 7.5% in 2015. The largest increase is 36% in Nevada, and the biggest decrease is in Arizona (23%). Premium increase for the large carriers (such as Blue Cross) are above 9%.
COBRA and PPACA- There are some significant conflicts generated by these two laws. For example, COBRA coverage applies retroactively, but PPACA coverage is prospective – either the first of this month or next month. While both have a 60 day election period, COBRA begins from the day notice is received, so may actually provide a longer window. A person electing COBRA gets to continue meeting their current deductible, while an exchange policy begins fresh right away. And electing COBRA nullifies your rights to enroll on the exchange and to get a subsidy.
Uninsured now covered? 87% of those that enrolled on the exchange were previously uninsured, and 70% of those are paying under $100/month for insurance, accounting for their subsidies. The states with the fewest uninsured are lead by Massachusetts (1.2%) who has had mandated coverage for years, and West Virginia showed the most improvement (11% more insured). The worst states? Texas (25%), Mississippi (21%, and actually got worse) and Louisiana (21%).
FINES- If you make more than $250,000 and have a family of 5 that is uninsured, your fine? A whopping $12,240. Most Americans, of course, come nowhere near that number, and will be the greater of $95 or 1% of their income for being uninsued in 2014. There is no penalty for those making less than 410,150. The penalty is due when you file your 2014 tax return.
Rebating your premiums- Insurers are required to return premiums to individuals and small businesses if they spend less than 80% on claims (85% for large group). Rebates occurred in almost every state, with Blue Cross and Blue Shield of FLorida leading the pack, returning $10.1 million. States with the largest refunds include New Hampshire, South Carolina, Indiana.
New Qualifying Events- if you have a pre-tax plan, your employees cannot simply disenroll during the year, except for certain situations. 2 more have been added- if your employee enrolls in the marketplace, and if they have a reduction in hours during the “stability period.”
Full Time Equivalent Calculation- This calculation now is determined over the prior year – if you have over 50 FTE’s during any consecutive 6 month period, you are subject to play or pay fines.