“Making Hay in the ACA”
“what is in it for me?”
Call 1-866-309-0557 Access Code *1291180*
During a live webinar
For the courtesy of all participants, please:
• Place your phone on mute
• Either press *6*
• Or press the mute button on your phone device
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Agenda
• Important resources to help you and your prospects
• Health Insurance Marketplace Certification
• BCBSTX Certification
• 2014 BCBSTX ACA plans & agent commissions
• Using tax subsidies to prospect and grow your clientele
Agenda Continued
• SHOP Exchange Update
• Small Group Health Insurance Tax Credits (HITCs)
• Using HITCs to get more small group health insurance
• Early renewal strategies
• Marketing tips
Disclaimer
• This presentation is tailored for independent health insurance agents
in the state of Texas that intend to write BCBSTX in the HIMs.
09-27-13
Valuable ACA Resources
All located in our Health Care Reform section at www.TheBrokerageInc.com
Resources at www.TheBrokerageInc.com
Scroll down to “Health Care Reform”, where ACA related
resources may be found.
Visit www.AskBlueInsurance.com
www.Medicare.gov
https://www.healthcare.gov/
(available in Spanish)
CuidadoDeSalud.gov
Hola?
• 9-26-13: The Spanish version of www.healthcare.gov will not be able
to accept new HIM enrollments “for a few weeks”
• 10-25-13: Spanish online enrollment is not going to happen…this year
• An estimated 10 million Latinos are eligible for coverage, and 4 million
of them speak Spanish primarily.
• The state of Texas is 40%+ Latino
Use www.CMS.gov for YouTube video learning
Registration Process for Agents / Brokers
• Note: the agent distribution channel did not create the problems…but
we must deal with them.
• Know that we would like to help you register, but we cannot do
anything to fix the volume or technology challenges.
• If you need assistance, call 855-267-1515.
• The certification process is beginning to work now.
Getting set up to market on the HIMs
Four step process:
1. Register at the CMS Enterprise Portal (Part 1)
2. Complete your certification at The Health Insurance Marketplace
website
3. Register to accept applications in the HIMs (Part 2)
4. Complete the BCBSTX required certification
Step One: Register to certify
https://www.regtap.info/uploads/library/AB_slides_092713_5CR_092613.pdf
Certify
https://marketplace.medicarelearningnetworklms.com
Step 3: Register to enroll people in the HIMs
Step 3 - Setting Up Your FFM Account
• You create your FFM UID (Federally Funded Marketplace User ID)
when you create your account on the CMS Enterprise Portal during
the agent/broker registration process.
• If you forget your FFM User ID or password information, click on the
"Forgot my User ID/Password" link on the CMS Enterprise Portal login web page at https://portal.cms.gov/.
Step 4: Get certified with The Blues
www.bcbstx.com/producer
The message is simple:
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Right now, nothing is required by Federal law for you to own.
On January 1, 2014, that changes.
You will then be required by law to own a qualified health insurance.
If you cannot afford a QHP, you will be subsidized.
If you choose not to own a QHP, you will be penalized.
If you need help, I will help you.
Simplify the message – use the Government sources!
Marketing tips
• Know how to calculate subsidies
• Know how to complete a HIM application
• Hint: no health questions, more qualification questions
• Find the Health Insurance Marketplace applications for a QHP at
www.TheBrokerageinc.com in the HCR Resources section
• Know how to calculate Health Insurance Tax Credits for groups of 2-25
Use HITCs to prospect small groups of 2-25 lives
Health Insurance Marketplace (Short Form)
HIM (Short Form)
HIM (Short Form)
Who are the 50M uninsured?
And how do I get quotes and sign them up?
Individuals Eligible for Premium Tax Credit, by Income
Individuals Eligible for a Premium Tax Credit,
by Employment Status
Individuals Eligible for a Premium Tax Credit, by Age
How do you get a health insurance quote?
You will end up at the Kaiser website
www.kff.org – Subsidy Calculator
Enter demographic info & click “submit”
Instant results
Subsidies are based on the 70% Actuarial
Value Plan or “The Silver Plan”
• 70% AV Plan Premium
• Minus the subsidies
• Net premium cost to family
$11,450
- $ 8,085
= $ 3,365 per year
Total Family Premium is $280 per month
60% AV Plan or “The Bronze Plan”
• 60% AV plan premium
• Minus the subsidies
• Net premium cost to family
$9,490
- $8,085
= $1,405 per year
Total Premium is $117 per month
ACA “MOOP” (Max Out of Pocket)
• $6,350 for an individual
• $12,700 for a family
• Same as the MOOP of an HDHP (high deductible health plan)
• Bronze or Silver plans have the same max out of pocket
• If you only make $50K per year, how can you pay this MOOP?
• Add a supplemental health plan
Sales Idea: “The Combo Plan”
“Bronze Plan” and “Active Care”
• Bronze Premium
$117
• Active Care Premium
$153
• Total Family Premium
$270 per month
$10 less per month than The Silver Plan at $280 per month, but the supplemental
health plan helps offset the $12,700 MOOP.
What is Active Care?
• New supplemental health product
• combines Critical Illness, Cancer, Heart Attack, Stroke, ESRD, and Accident
benefits into one product
• Simplified underwriting
• May be list billed
• Agent commission is 50%
• Contact Belynda@TheBrokerageInc.com for complete details
• Visit http://thebrokerageinc.com/insurance-products/critical-illness/
Let’s review these numbers again…
HIM Plan
Amount paid
by family
Subsidized
Amount
Total Premium
Commission
70% value (Silver)
$3,365
$8,085
$11,450
6% = $687
60% value (Bronze)
$1,405
$8,085
$9,490
6% = $569
“Active Care”
+ $1,836 =
$1,836
+ 50% = $918
$3,241
$11,320
= $1,487
6% commission is paid by BCBSTX for years 1-3, and 4% level after that.
Which plan is best suited for the family?
• The Silver Plan costs $280 per month
• The Bronze Plan / Active Care plan costs $270 per month
• The Combo Plan saves the family $10 per month in total premium
• The Combo Plan offers better protection to the family
• The Combo Plan pays the agent 54% more commission!
<250% Federal Poverty Level =
CSR or Cost Sharing Reductions
• Similar to the Medicare Savings Plan (Low Income Subsidy), a person
at or below the 250% FPL is eligible for cost sharing on the Silver Plan
• Think of how the “low income subsidies” work within the “Medicare
Savings Program”
• How might this impact your recommendations?
• Should they even consider a supplemental plan(s)?
• Or should they consider less of a supplemental benefit plan(s)?
2014 BCBSTX HIM Plans
• Rx Benefits
• The Gold Plan On Exchange & The Gold Plan Off Exchange
• The Silver Plan On Exchange & The Silver Plan Off Exchange
• The Bronze Plan On Exchange & The Bronze Plan Off Exchange
2014 BCBSTX Individual Plans Rx Benefits Structure
• Benefit Structures
• Drug Card
• Coinsurance after Medical Deductible
• Formulary
• Standard Formulary on PPO Network
• Generics Plus formulary on narrow networks
• Generics Plus is essentially a leaner version of the standard
formulary and includes non-specialty and specialty drugs for
all major therapeutic categories
• 5-Tier Drug (2-tier Generics)
• Drives utilization towards Generic drugs
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.
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On Exchange – Gold
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.
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On Exchange – Silver
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.
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On Exchange – Bronze
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.
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Rating Characteristics
Age Bands
• Age 0-20 is one age band
• Age 21-63 have single year age bands
• Age 64+ is one age band
Family Demographics
• The maximum number of dependents (age 0-20) that will be
rated on a family plan is capped at 3
• Dependents age 21+ do not count toward the cap
• Under age 20 or younger count toward the cap
Benefit Design
• Metallic Level & Actuarial Value
• Cost Sharing
• Network
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.
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Rating Characteristics
Tobacco Use
• “6 month look back” to qualify for non-tobacco
• BCBSTX tobacco rates are 10-33% higher than the non-tobacco
rates (permitted to rate up to 50% higher)
• Rates are subject to the 3:1 rating ratio
Geographic Rating Areas
• Geographic rating will be by county, not Zip Code
• Based on the address of the Primary Insured - Even if any
member on a policy has a different address than the Primary
Insured
• Texas has 26 defined rating areas
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.
Training & Certification
On Exchange (Public)
• You must obtain CMS Certification
• You must submit your Marketplace ID to BCBSTX
• You must complete the BCBSTX Product Training module
Off Exchange (Private)
• You must complete the BCBSTX Product Training module
PROPRIETARY INFORMATION. PROPERTY OF HEALTH CARE SERVICE CORPORATION. DO NOT USE WITHOUT PERMISSION.
The Small Business Health Options Program
The “SHOP” Exchange
Health Insurance Tax Credits (HITCs)
• How can you use HITCs (Health Insurance Tax Credits) to prospect for
more business?
• How many CPAs understand HITCs?
• Where do you get info to see if your clients will qualify?
• How do you get employer HITC calculations?
• Or are they called health premium tax credits?
https://www.healthcare.gov/small-businesses/
HITC calculator at www.NFIB.com
Small group HITCs at www.HealthCare.gov
Get used to referencing www.HealthCare.gov
http://www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit-for-Small-Employers
http://www.taxpayeradvocate.irs.gov/calculator/SBHCTC.htm
IRS Tax Tips:
The Small Business Health Care Tax Credit
Early renewal strategies
• New policy effective date in December 2013 will push the ACA
requirements back by one calendar year, delaying the move to a plan
that may be more expensive
• Creates a new health plan year from 12-1-13 through 11-30-14
• What may happen in December 2014
• Convert to an ACA compliant product
• Convert to a defined contribution strategy
• Drop your health plan
• How could this impact calendar year Section 125 plans?
Wrap up…go sell !
• The Brokerage is proud to be a BCBS General Agent in:
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Texas
New Mexico*
Oklahoma*
Illinois*
• You will be able to sell in the:
• Public Exchanges
• Private Exchanges
• SHOP Exchanges
*Medicare related products only
Your time is now!
• Get appointed with BCBSTX through The Brokerage
• Get certified
• For help getting started, call The Brokerage
• Toll free 800-442-4915
• Direct lines:
• Belynda DiCiaccio 469-635-6715
• Cristin Hopkin-Bishop 469-635-6707
• Dana Ragsdale 469-635-6749
Click here to meet our staff online
Don’t forget
• 6,200,000 uninsured Texans
• About 2.2M are 138% FPL or below – let the Navigators enroll this
population
• That leaves 4,000,000 uninsured Texans
• Say 1 out of 4 enroll
• There are about 13,000 BCBSTX appointed agents
• 1,000,000 divided by 13,000 is 77 apps per agent
• Go forth and prosper!
During the Q & A session
• Typing a question in the GoToMeeting box is best
• Keep your phone on mute:
• Either press *6*
• Or press the mute button on your phone device
• To ask a question, please unmute your phone
• To unmute, press *6* or the unmute button on your phone device
• Reminder: do not place your phone on hold at anytime
• Any background music playing while on hold ruins the event for all participants and may
result in a session terminating prematurely
• Either remain on mute or hang up if you need a break
Thank you for your participation!
This presentation has been recorded and will be posted in the HCR
Resources section at www.TheBrokerageInc.com