Health-Care Reform. PPACA. Obamacare. #?@!&*%!
No matter what you call it, you have surely seen that even the experts are at a loss to communicate health-care reform to their next-door neighbor. But now, with only days until the big October 1 date, there is a potential ray of sunshine in this dark and stormy sky. Employers have a unique opportunity to calm the fears of their employees through succinct and timely communication. Think of a billboard – not a novel.
So, let’s address some of the more common Affordable Care Act (ACA) questions we are hearing from employers – particularly smaller companies without a full HR or communication staff.
1. Which of my employees can enroll in the state/federal marketplaces?
What should be an easy answer is actually a bit tricky. All of them CAN enroll in the state/federal marketplaces (the public marketplaces are open to everyone), but the question is really, “Which of them can get a subsidy?”
First, employers need to know whether their health coverage meets “essential health benefits.” Essential health benefits include hospitalization, preventive care (with no out-of-pocket costs), mental and substance abuse services, maternity care and much more. This site should provide a little more clarity here.
- If a plan does meet the essential health benefit standards, employees will not be eligible for a subsidy/tax credit. However, employees can still enroll in health coverage offered through the government-sponsored marketplace (ConnectedHealth’s platform will offer Qualified Health Plans through the Federally Facilitated Marketplace as well).
- If a plan does not meet the essential benefit standards, employees can buy health coverage through your private exchange solution (if you offer one) or directly through the government-sponsored marketplace. ALSO, they may be eligible for a subsidy or tax credit to help reduce the cost of their premiums, depending on their household income.
Keep in mind that health plans that are required to provide essential health benefits will also have to limit the amount consumers pay out of pocket (i.e., cost sharing). Here’s a quick breakdown of those regulations:
- Health plans will be prohibited from requiring consumers to pay annual cost sharing that is greater than the limits for high deductible plans that are linked to health savings accounts (HSAs). Currently, those limits are $5,950 per year for individuals and $11,900 per year for families.
- Also, small group plans must limit annual deductibles to $2,000 for individual coverage and $4,000 for family coverage. As with all health plans under the ACA, there is no cost sharing for certain preventive health services recommended by the United States Preventive Services Task Force.
2. How do employees find out if they are eligible for a subsidy/tax credit?
First, remind them that their savings on premiums (if any) depends on their household income. Next, refer them to www.healthcare.gov for more information about their specific needs. This free, online subsidy calculator is available, too.
3. How should we address any differences in the coverage we are offering employees in 2014?
Plain and simple: Employees want to know if they should expect any drastic changes. Create clear and consistent communication materials (see the tips in my guest blog from last week) and training for your employees that highlight any changes coming their way.
4. When should we let employees know they can begin enrolling in 2014 benefits coverage?
This is a good time to tee up 2014 enrollment dates. Also, if you’re not offering a private exchange, let employees know that the marketplace in their state will open in October.
Good luck, and check out the Department of Labor’s website for additional information on communicating ACA details to employees.
Guest blogger Julie Horner, owner of Ultraswayed, helps influence behaviors and drive business change through communication. Julie spent five years as the Senior Director of Benefits Communication at Wal-Mart Stores, Inc., overseeing all health, wellness and retirement communication to 1.5 million U.S. And Puerto Rico associates. Prior to Wal-Mart, Julie was with Hewitt Associates / Atlanta for 12 years. Julie was a partner in a design/marketing firm for 11 years. Clients included Coca-Cola USA, IBM Corporation and Miller Brewing.