Affordable Care ActAffordable Care ActSHOP Marketplace Implementation BriefingSHOP Marketplace Implementation Briefing

PA ASSOCIATION OF COMMUNITY PA ASSOCIATION OF COMMUNITY HEALTH CENTERSHEALTH CENTERS

July 23, 2014July 23, 2014

HEALTHCARE.GOV

Joanne Corte Grossi, MIPPJoanne Corte Grossi, MIPPRegional DirectorRegional Director

U.S. Department of Health & Human U.S. Department of Health & Human Services, Region III Services, Region III

Pennsylvania, Delaware, District of Columbia, Pennsylvania, Delaware, District of Columbia, Maryland, Virginia, West VirginiaMaryland, Virginia, West Virginia

WHAT IS THE SHOP WHAT IS THE SHOP MARKETPLACEMARKETPLACE??

SHOP = SHOP = SSmall mall BBusiness usiness HHealth ealth OOptions ptions PProgramrogramPart of the Health Insurance Marketplace created by Part of the Health Insurance Marketplace created by the Affordable Care Act (ACA)the Affordable Care Act (ACA)Offers employers a choice of health plans and dental Offers employers a choice of health plans and dental plans and tools for making informed choicesplans and tools for making informed choicesOffers qualified small employers access to the Offers qualified small employers access to the enhanced Small Business Health Care Tax Credit – now enhanced Small Business Health Care Tax Credit – now worth up to 50% of employer’s premium contributionsworth up to 50% of employer’s premium contributionsWorks with new insurance reforms to spur competition Works with new insurance reforms to spur competition based on price and qualitybased on price and quality

NOTE:NOTE: If you have fewer than 50 full-time equivalent (FTE) If you have fewer than 50 full-time equivalent (FTE) employees, you are not required to offer health insurance and employees, you are not required to offer health insurance and there is no penalty if you choose not to.there is no penalty if you choose not to.

WHO CAN BUY FEDERALLY-WHO CAN BUY FEDERALLY-FACILITATED SHOP COVERAGEFACILITATED SHOP COVERAGE

Small employers whoSmall employers who:: Have 50 or fewer employees in 2014 (becomes 100 Have 50 or fewer employees in 2014 (becomes 100

employees in 2016)employees in 2016)

Have at least one common law employeeHave at least one common law employee• Self-employed purchase insurance in the Individual MarketplaceSelf-employed purchase insurance in the Individual Marketplace

Offer coverage to all of their fOffer coverage to all of their full-timeull-time employees employees In the Federally-Facilitated SHOP (FFS) this means employees In the Federally-Facilitated SHOP (FFS) this means employees

working on average 30 or more hours per weekworking on average 30 or more hours per week

Can be for-profit or tax-exemptCan be for-profit or tax-exempt

Meet minimum participation ratesMeet minimum participation rates• In many states using the FFS Marketplace, at least 70% of full-In many states using the FFS Marketplace, at least 70% of full-

time employees must accept the employer’s offer of coveragetime employees must accept the employer’s offer of coverage

For employers:For employers:With fewer than 25 FTE employeesWith fewer than 25 FTE employeesWhose employees’ wages average less than $50,000 Whose employees’ wages average less than $50,000 per yearper yearWho contribute at least 50% of employee’s premium Who contribute at least 50% of employee’s premium costscosts

Starting in 2014 the tax credit is:Starting in 2014 the tax credit is:For employers who offer employees a Qualified Health For employers who offer employees a Qualified Health Plan (QHP) through the SHOPPlan (QHP) through the SHOPWorth up to 50% of employer’s premium contribution Worth up to 50% of employer’s premium contribution to SHOP health and dental plans (up to 35% for tax-to SHOP health and dental plans (up to 35% for tax-exempt employers)exempt employers)Available for two consecutive yearsAvailable for two consecutive years

Visit the SHOP Tax Credit EstimatorVisit the SHOP Tax Credit Estimator

Healthcare.gov/small-business tax-credit-calculator/Healthcare.gov/small-business tax-credit-calculator/

THE SMALL BUSINESS HEALTH THE SMALL BUSINESS HEALTH CARE TAX CREDITCARE TAX CREDIT

SHOP FOR PLANS WITH SHOP FOR PLANS WITH CONFIDENCECONFIDENCE

All SHOP QHPs:All SHOP QHPs:Meet new coverage standardsMeet new coverage standards

• Must offer “essential health benefits” – items and services such Must offer “essential health benefits” – items and services such as doctor visits, preventive care, hospitalization and as doctor visits, preventive care, hospitalization and prescription drugsprescription drugs

Benefit from broad protections under the Benefit from broad protections under the health care law. Insurance companies:health care law. Insurance companies:

• Face limits on the portion of premium dollars they can keep for Face limits on the portion of premium dollars they can keep for administrative and overhead costsadministrative and overhead costs

• Must disclose and justify proposed Must disclose and justify proposed rate hikesrate hikes, generally of 10% , generally of 10% or more, which state or the US HHS can reviewor more, which state or the US HHS can review

• Cannot sell coverage charging higher rates based on an Cannot sell coverage charging higher rates based on an individual’s pre-existing health conditionsindividual’s pre-existing health conditions

• Face limits on charging additional premiums for older Face limits on charging additional premiums for older employeesemployees

• Generally must pool risks across a state’s small group marketGenerally must pool risks across a state’s small group market

BROWSE BEFORE BUYING IN BROWSE BEFORE BUYING IN THE FFS THE FFS

Find premium estimatesFind premium estimatesOnline tool shows price estimates for the FFS QHP and QDP in Online tool shows price estimates for the FFS QHP and QDP in the business areathe business areaPrice estimates are based on the age ranges of employees Price estimates are based on the age ranges of employees and location of businessand location of business

Useful information for employer to have on Useful information for employer to have on handhandNumber of full-time employeesNumber of full-time employeesAge of employeesAge of employeesDetermine if offering coverage to dependentsDetermine if offering coverage to dependents

BUYING SHOP COVERAGE: BUYING SHOP COVERAGE: WHEN & HOW?WHEN & HOW?

When can an employer offer a SHOP QHP?When can an employer offer a SHOP QHP?Get started now, or offer anytime during the yearGet started now, or offer anytime during the yearUnlike Marketplace for individuals, Unlike Marketplace for individuals, nono limited Open Enrollment Period for the SHOP limited Open Enrollment Period for the SHOP

How does an employer buy a SHOP QHP?How does an employer buy a SHOP QHP?For FFS, in 2014 only – must use For FFS, in 2014 only – must use Direct EnrollmentDirect Enrollment

• Work directly with an agent broker or insurance companyWork directly with an agent broker or insurance company• Similar to how small businesses have gotten coverage in the pastSimilar to how small businesses have gotten coverage in the past• Use the same process for buying a SHOP Qualified Dental Plan (QHP)Use the same process for buying a SHOP Qualified Dental Plan (QHP)

With Direct Enrollment an employer will:With Direct Enrollment an employer will:• Select a SHOP QHP to offer employees (and a SHOP QDP, if applicable)Select a SHOP QHP to offer employees (and a SHOP QDP, if applicable)• Submit a hard copy employer application to the SHOPSubmit a hard copy employer application to the SHOP• Have the agent, broker, or insurer help enroll those employees who acceptHave the agent, broker, or insurer help enroll those employees who accept• Pay the insurance company, directly or with the help of an agent or brokerPay the insurance company, directly or with the help of an agent or broker

In states running their own SHOP MarketplaceIn states running their own SHOP Marketplace• Enrollment processes may differEnrollment processes may differ• Many offer online enrollmentMany offer online enrollment

FFS ELIGIBILITY: HOW TO FFS ELIGIBILITY: HOW TO APPLYAPPLY

To apply to the FFS Marketplace, an employer can:To apply to the FFS Marketplace, an employer can:Ask an agent, broker or insurance company for helpAsk an agent, broker or insurance company for helpGet help from a Marketplace-approved Navigator or assisterGet help from a Marketplace-approved Navigator or assisterGet the paper application and instructions from HealthCare.govGet the paper application and instructions from HealthCare.govApply by phone through the SHOP Employer Call CenterApply by phone through the SHOP Employer Call Center

Role of the SHOP Marketplace:Role of the SHOP Marketplace:Determines whether the employer is eligible to participate in the SHOPDetermines whether the employer is eligible to participate in the SHOP

• This determination is a requirement for receiving the tax creditThis determination is a requirement for receiving the tax creditDoes not determine whether the employer is eligible to receive the tax Does not determine whether the employer is eligible to receive the tax creditcredit

• This is an IRS matterThis is an IRS matter

THE BOTTOM LINETHE BOTTOM LINEThe SHOP helps small businesses by:The SHOP helps small businesses by:Giving employers a choice of health plansGiving employers a choice of health plansProviding access to tax credits for qualified small employersProviding access to tax credits for qualified small employersOffering tools to help them make informed choiceOffering tools to help them make informed choice

• How much do SHOP plans cost, and what do they cover?How much do SHOP plans cost, and what do they cover? HealthcCare.gov/find-premium-estimates/HealthcCare.gov/find-premium-estimates/

• How do employers find out if they qualify to use the SHOP?How do employers find out if they qualify to use the SHOP? HealthCare.gov/fte-calculator/HealthCare.gov/fte-calculator/

• How much might the tax credit be worth to a business?How much might the tax credit be worth to a business? HealthCare.gov/small-business-tax-credit-calculator/HealthCare.gov/small-business-tax-credit-calculator/

More features and options coming for 2015More features and options coming for 2015

HOW SHOP WORKS:HOW SHOP WORKS:MOVING TOWARDS EMPLOYEE MOVING TOWARDS EMPLOYEE

CHOICECHOICEA key goal of the SHOPA key goal of the SHOPOptions for small employers and their employeesOptions for small employers and their employeesSuch as offering employees a single plan or a choice of plansSuch as offering employees a single plan or a choice of plans

In 2014:In 2014:The FFS Marketplace offers employer choice, but no employee The FFS Marketplace offers employer choice, but no employee choice optionchoice optionStates running own SHOP can offer employee choice option – many States running own SHOP can offer employee choice option – many dodo

In 2015:In 2015:The SHOP in some states may offer small employers an employee The SHOP in some states may offer small employers an employee choicechoice18 states – including Pennsylvania – have asked for a waiver 18 states – including Pennsylvania – have asked for a waiver

RESOURCES:

SHOP Employer Call CenterSHOP Employer Call Center

(For small employers and those assisting them)(For small employers and those assisting them)1-800-706-7893 1-800-706-7893

TTY users should call 711 to access the Call CenterTTY users should call 711 to access the Call Center

Employer SHOP ApplicationEmployer SHOP ApplicationHealthCare.gov/downloads/shop-employer-application.pdfHealthCare.gov/downloads/shop-employer-application.pdf

Information on the Small Business Healthcare Tax Information on the Small Business Healthcare Tax Credit:Credit:

Irs.gov/uac/Small-Business-Health-Care-Tax-Credit-for-Small-Irs.gov/uac/Small-Business-Health-Care-Tax-Credit-for-Small-EmployersEmployers

Thank you!Contact:

joanne.grossi@hhs.gov