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• W386742636 abstract "[ILLUSTRATION OMITTED] The Patient Protection and Affordable Care Act (PPACA), PL. 111148, created the most significant government health care program since the Medicare and Medicaid legislation in the 1960s. The law's complexity is compounded by the intricacies and interdependencies of health insurance and the health care delivery system that the legislation and related regulations have struggled to address. CPAs have a significant role to play in helping businesses make the best health insurance decisions in an environment that has changed significantly as a result of the new laws. Here are 10 things CPAs need to know to steer businesses in the right direction: 1. Insurance Markets: Individual, Small Group, Large Group, and Self-Insured The PPACA's underwriting provisions primarily affect the individual and small group insurance markets and have a smaller effect on the large group and self-insured markets, so it is important to understand which is which. Although its use is not required, the small group market exchange known as SHOP (Small Business Health Options Program) presently is available to employers with 50 or fewer employees, but it will be available to those with 100 or fewer employees in 2016. That redefinition of the small group market exchange is a critical event for affected employers because costs tend to be higher and benefits lower in the small group market than in the individually underwritten policies more available to the large group market. Individual policies are a higher for insurers because they are managed one at a time. They are subject to different deductible and out-of-pocket limits under the PPACA. One thing CPAs should keep an eye on is that, if the pattern of bad risk in exchange-sold individual insurance policies continues, states may decide to exercise their option under the PPACA to merge the individual and small group pools into a single pool. This would lead to another dramatic premium increase for small employers. Massachusetts did this after its 2006 health care reform law went into effect. The self-insured market is where many employers may want to be, and it warrants an analysis, especially if you have a good risk profile--such as young, healthy employees in a low-risk industry 2. The Precious Metals of Health Insurance The PPACA mandates certain coverage levels for the individual and small group markets that fall into four metal tiers, which are not based on the quality of care, but rather on the plan's actuarial value (AV), which is the amount that a plan pays toward medical expenses and the premium and out-of-pocket costs covered by the customer. These metal levels are platinum (90% AV), gold (80% AV), silver (70% AV), and bronze (60% AV). All plans offered in these markets by carriers must fall within these parameters and cannot vary by more than [+ or -]2% from any AV (e.g., a gold plan could have an AV between 78% and 82%). This will cause plan offerings in the individual and small employer markets to clump around these AVs, which will lead to changes to plan options when renewals are made throughout 2014. In addition, these metal values are important to the large group market in 2015 for employers with 100 or more employees and in 2016 for employers with 50 or more employees, since an employer must offer a plan that meets a minimum value level (bronze) or potentially pay a penalty Among individuals selecting Health Insurance Marketplace plans, the silver plans overwhelmingly have been the most popular. Sixty-five percent of individuals selecting a Health Insurance Marketplace plan through April 19 chose silver plans, according to Department of Health & Human Services data. Bronze (20%), gold (9%), platinum (5%), and catastrophic (2%, available only to individuals) were considerably less popular. Note: The figures do not add up to 100% because of rounding. …" @default.
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• W386742636 date "2014-07-01" @default.
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• W386742636 title "Health Care Reform Essentials: Ten Things CPAs Should Know about the Affordable Care Act" @default.
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