Obamacare Tax Surprise Looming

The next Obamacare controversy is right around the corner.


Soon, Obamacare enrollees who received payment assistance to help pay for coverage will have to reconcile how much they really earned in 2014 with how much they estimated when they applied months ago.


If you underestimated your income you will either receive smaller tax refunds or you will owe the IRS money.


This is because the payment assistance is actually tax credits that are based on annual income, but some got their 2014 payment assistance before knowing exactly what they would be making in 2014. You will have to reconcile the two with the IRS during the upcoming tax filing season.


If many enrollees guessed incorrectly, it will not be a surprise. Many signed up in October 2013, when the sign up period began, and did not know what they’d earn in 2014.


The Benefits Firm Obamacare Tax Surprise LoomingPayment assistance amounts could also be recalculated because of major changes in their circumstances such as landing a new job or getting married.


According to the most recent figures reported by the Obama administration, those who applied through the federal exchange received an average monthly payment assistance of $264. Roughly 85% of total enrollees received help with insurance premiums; they only had to pay $82 a month, on average, for coverage. Last month the administration said 2014 enrollment was 6.7 million.


Though there is a $2,500 cap for those who remain eligible for payment assistance, those who underestimated their earnings could owe thousands of dollars. The eligibility threshold for eligibility is based on income – $45,900 for an individual and $94,200 for a family in 2014.


Those who overestimated their 2014 income may get a healthier-than-expected refund, and others will see no change.


What happens next is:


By Jan. 31, Obamacare enrollees should receive Form 1095-A from their exchange. It lists who in the household had policies and how much they received in monthly payment assistance.


Taxpayers then use that documentation to complete Form 8962, which will ask details about insurance, subsidies and income. If you weren’t covered for the entire year, you will have to break down the payment assistance payments by month.


141229140655 tax credit instory 620xa Obamacare Tax Surprise Looming

Be Aware of Penalty Fees in 2015

During 2014, those who did not have health insurance will have to pay a penalty fee that starts at $95 and goes up based on how much is earned; a key and controversial element of the Affordable Care Act plan that will begin to affect several million Americans for the first time starting in early 2015.

According to Census Department data, roughly 40 million adult Americans still lack health insurance. A recent poll by Gallup shows that about 55% of the uninsured plan to get insurance, while 35% say they’re willing to pay the fine for not having coverage. Leaving 10% uninsured – about 4 million people, who are unaware that they need insurance or will have to pay a penalty.


The Benefits Firm Be Aware of Penalty Fees in 2015The only ones who will have exemptions from these penalty fees are low-income workers and those who would have to pay more than 8% of their income for a health insurance policy.


There is plenty of information available for Americans who are unsure of how the mandate applies to them from the government itself and from many third-party web sites. The law was designed to make it cheaper for most people to buy insurance than pay the penalty fee. In 2015, the penalty fee rises $325 per person or 2% of your income (whichever is greater). (The maximum penalty is the national average premium for a bronze plan.)

Walgreens Onsite Flu Shots

Walgreens Flu Shots Walgreens Onsite Flu ShotsWalgreen’s pharmacists are flexible and can set up a clinic date/time that is convenient for the business. They do not charge a fee to come and there is no minimum number of vaccines required for them to schedule a clinic.  They bill pharmacy insurance for each employee and can run a test claim on one member prior to the clinic to verify coverage.  Many plans now cover 100% of the cost of the flu shot. Walgreen’s pharmacists set up a schedule for the office and plan for about 25 flu shots per immunizer per hour.  Depending on the number of interested employees, they can bring more than one immunizer to move the clinic quickly and avoid wait times/reduced productivity for employees.  They also offer additional vaccines (pneumonia, tetanus, whooping cough, etc.) and can speak more specifically with each group to determine a need.  Pharmacists are seeing broader insurance coverage for these vaccines with healthcare reform.


Walgreen’s pharmacists also provide biometric screening services offsite and have a contract with Humana Vitality to provide the full wellness panel including blood pressure, blood glucose, cholesterol, and BMI/body composition.  For this service, pharmacists would need an approximate head count of participants and each employee would need to bring their voucher to the clinic.  For health screenings, morning appointments are ideal given the need for patients to fast for 9-12 hours prior to the tests.


Please let us know if this is something you would be interested in setting up with us this fall to keep your employees and clients well!


Walgreens Worksite Immunization Programs


Ph: (502) 451-4560


620 S. 3rd Street, Suite 102 Louisville, KY 40202

2015 Open Enrollment Checklist

Grandfathered Plan Status


□    If you have a grandfathered plan, determine whether it will maintain its grandfathered status for the 2015 plan year. Grandfathered plans are exempt from some of the ACA’s requirements. A grandfathered plan’s status will affect its compliance obligations from year to year.


□    If your plan will lose grandfathered status for 2015, confirm that the plan has all of the additional patient rights and benefits required by the ACA. This includes, for example, coverage of preventive care without cost-sharing requirements.


Cost-sharing Limits


□    Review your plan’s out-of-pocket maximum to make sure it complies with the ACA’s limits for the 2015 plan year ($6,600 for self-only coverage and $13,200 for family coverage).


□    If you have a health savings account (HSA)-compatible high deductible health plan (HDHP), keep in mind that your plan’s out-of-pocket maximum must be lower than the ACA’s limit. For 2015, the out-of-pocket maximum limit for HDHPs is $6,450 for self-only coverage and $12,900 for family coverage.


□    If your plan uses multiple service providers to administer benefits, confirm that the plan will coordinate all claims for EHB across the plan’s service providers, or will divide the out-of-pocket maximum across the categories of benefits, with a combined limit that does not exceed the maximum for 2015.


□    Be aware that the ACA’s annual deductible limit no longer applies to small insured health plans.


US Insurance Exchage 2015 Open Enrollment ChecklistHealth FSA Contributions


□    Work with your advisors to monitor IRS guidance on the health FSA limit for 2015.


□    Once the 2015 limit is announced by the IRS, confirm that your health FSA will not allow employees to make pre-tax contributions in excess of that amount for 2015. Also, communicate the 2015 health FSA limit to employees as part of the open enrollment process.


Transition Policy for Small Group Health Plans


□    Pre-existing Condition ExclusionsThe ACA prohibits health plans from imposing pre-existing condition exclusions (PCEs) on any enrollees. (PCEs for enrollees under 19 years of age were eliminated by the ACA for plan years beginning on or after Sept. 23, 2010).


□    Coverage for Clinical Trial ParticipantsNon-grandfathered health plans cannot terminate coverage because an individual chooses to participate in a clinical trial for cancer or other life-threatening diseases or deny coverage for routine care that would otherwise be provided just because an individual is enrolled in a clinical trial.


□    Comprehensive Benefits PackageInsured plans in the individual and small group market must cover each of the essential benefits categories listed under the ACA. Each state has a specific benchmark plan for determining the essential health benefits for insurance coverage in that state.


Employer Penalty Rules


□    Determine ALE status for 2015, including eligibility for the one-year delay for medium-sized ALEs;


□    For sponsors of non-calendar year plans, determine whether you qualify for the transition relief that allows you to delay complying with the pay or play rules until the start of your 2015 plan year;


□    Establish a system for identifying full-time employees (those working 30 or more hours per week);


□    Document plan eligibility rules; and


□    Test your health plan for affordability and minimum value.


HSA Limits for 2015


If you offer a high deductible health plan (HDHP) to your employees that is compatible with a health savings account (HSA), you should confirm that the HDHP’s minimum deductible and out-of-pocket maximum comply with the 2015 limits. Also, the 2015 increased HSA contribution limits should be communicated to participants. The following table contains the HDHP and HSA contribution limits for 2015.


HDHP Minimum Deductible Amount

Individual                                                         $1,300

Family                                                              $2,600


HDHP Maximum Out-of-Pocket Amount

Individual                                                         $6,450

Family                                                              $12,900


HSA Maximum Contribution Amount

Individual                                                         $3,350

Family                                                              $6,650


Catch-up Contributions (age 55 or older)    $1,000


For more information please contact The Benefits Firm.

Ph: (502) 451-4560


620 S. 3rd Street, Suite 102 Louisville, KY 40202

Health Care Reform: Common Acronyms

There are a growing number of acronyms used in health care reform-related materials today. Use this handy reference to view the different acronyms and the definitions for each.

health insurance 300x147 Health Care Reform: Common Acronyms


ACA: The Affordable Care Act. Used to refer to the final, amended version of the health care reform legislation.


CDC: The Centers for Disease Control and Prevention.


CHIP: The Children’s Health Insurance Program. Program that provides health insurance to low-income children, and in some states, pregnant women who do not qualify for Medicaid but cannot afford to purchase private health insurance.


DOL: United States Department of Labor.


EBSA: Employee Benefits Security Administration. A division of the DOL responsible for compliance assistance regarding benefit plans.


EPO Plan: An exclusive provider organization plan. A managed care plan that only covers services in the plan’s network of doctors, specialists or hospitals (except in an emergency).


ERRP: The Early Retiree Reinsurance Program. A temporary program created under health care reform to provide coverage to early retirees.


FPL: Federal poverty level. A measure of income level issued annually by HHS and used to determine eligibility for certain programs and benefits.


FLSA: The Federal Fair Labor Standards Act. Amended by PPACA to incorporate health care reform-specific provisions.


FSA: Flexible spending account.


HCERA: The Health Care and Education Reconciliation Act of 2010. Enacted on March 30, 2010, to amend and supplement PPACA.


HCR: Health care reform.


HDHP: High deductible health plan.


HHS: United States Department of Health and Human Services.


HMO: Health maintenance organization. A type of health insurance plan that typically limits coverage to care from medical providers who work for or contract with the HMO.


HRA: Health reimbursement arrangement or account.


HSA: Health savings account.


IRO: An independent review organization. An organization that performs independent external reviews of adverse benefit determinations.


MLR: Medical loss ratio. Refers to the claims costs and amounts expended on health care quality improvement as a percent of total premiums. This ratio excludes taxes, fees, risk adjustments, risk corridors and reinsurance.


NAIC: The National Association of Insurance Commissioners.


OCIIO: The Office of Consumer Information and Insurance Oversight. A division of HHS responsible for implementing many of the health care reform provisions.


OOP: Out-of-pocket limit. The maximum amount you have to pay for covered services in a plan year.


PCE: Pre-existing condition exclusion. A plan provision imposing an exclusion of benefits due to a pre-existing condition.


PCIP: The Pre-Existing Condition Insurance Plan. A temporary high-risk insurance pool to provide coverage to eligible individuals until 2014.


POS Plan: Point-of-service plan. A type of plan in which you pay less if you go to doctors, hospitals and other health care providers that belong to the plan’s network. POS plans require a referral from your primary care doctor to see a specialist.


PPACA: The Patient Protection and Affordable Care Act. Enacted on March 23, 2010, as the primary health care reform law.


PPO: Preferred provider organization. A type of health plan that contracts with medical providers (doctors, hospitals) to create a network of participating providers. You pay less when using providers in the plan’s network, but can use providers outside the network for an additional cost.


QHP: Qualified health plan. A certified health plan that provides an essential health benefits package. Offered by a licensed health insurer.


SHOP Exchange: The Small Business Health Options Program. A program that each health insurance exchange must create to assist eligible small employers when enrolling their employees in qualified health plans offered in the small-group market.