ACA Major Medical
( all states)
Facts: Employers with under 50 employees DO NOT have to offer group benefits (there will be no penalties to the employer).
- If an employer offers group benefits, no employee, employee’s spouse or children are eligible for a subsidy regardless if the employees takes the group or not. Moving to the individual market allows for all employees to try and qualify for a subsidy.
- 87% of all businesses in America are made up of groups sized 5-15.
- 80% of small groups took early renewal last year to lock in a lower rate and protect the employer from the massive rate increase the ACA mandates would generate. Therefore, these employers will be getting huge renewal letters/rates in the last quarter of this year. Now is the time to transfer employees to individual policies.
- To get started, complete the Group Worksheet at the top of this page.
- As of January 1, 2014 every American is required to own health insurance (ACA Qualified Plan). The question is, what are the options?
- On Exchange-subsidized health plan through the federal government. People who make less than $40,000 typically will qualify for these plans. You must be certified with the Exchange before you can enroll anyone.
- Off Exchange-Private Health Insurance for individuals who make more than $40,000. These plans are sold directly with the insurance company.
- Tricks of the trade: First question to ask each prospect is “how much did you make last year?” This will guide you either towards a plan on exchange (subsidy) or off exchange (private). The next question is about their doctor and hospital choice. This will guide you either towards an HMO or PPO.
- Big Opportunities: Small Group Market. ACA law states when you cancel a small group, a qualifying event has been triggered and every employee has 60 days to buy an ACA policy without a penalty.