Showing posts with label Affordable Care Act. Show all posts
Showing posts with label Affordable Care Act. Show all posts

Friday, September 23, 2022

How Low-Income Americans Can Access Healthcare

According to the U.S. Census Bureau, over 40 million people in the United States live in poverty. That means a family of four struggles to get by on less than $24,000 a year. And while there are many programs and services available to help low-income Americans, accessing them can be a challenge.

The Healthcare Gap

One of the biggest challenges for struggling Americans is finding affordable healthcare. The Affordable Care Act (ACA) was designed to help make healthcare more affordable. However, there are still many people who struggle to pay their premiums, deductibles, and co-pays. 

If you or someone you care for is facing this situation, finding a healthcare advocate or community resource can help. They have access to a wide variety of resources and have the connections and know-how to help you navigate what can often be a tedious and confusing process.

Common Solutions

There are programs available to help low-income Americans pay for their healthcare. For example, Medicaid is a government program that provides free or low-cost health insurance for eligible adults and children. 

If you live in a state that has expanded Medicaid under the ACA, you may be able to get coverage even if your income is slightly above the poverty level. 

Medicaid plans will vary by state, so reach out to your state's Medicare administration office and find out what you need to do to qualify.


Another option is to contact your state’s health insurance marketplace. If you qualify for a subsidy, you may be able to get help paying for your premiums

You can also shop for private health insurance plans on the marketplace. As we've mentioned, some people still have trouble paying those premiums, as plans with low monthly premiums may be offset by higher annual deductibles and co-pays. 

This is another situation where a healthcare advocate could help you sort through the best options for your situation.


If you need help paying for prescriptions, there are programs available to assist with that as well. The Partnership for Prescription Assistance can help you find assistance programs that offer free or low-cost medications. 

There are also prescription assistance programs offered by many pharmaceutical companies. And if you’re a senior citizen on a fixed income, you may be eligible for the Extra Help program through Medicare, which can help you pay for your Medicare Part D prescription drug coverage.

Community Resources

There are also community resources that can help low-income Americans access healthcare. These include free or low-cost clinics, community health centers, and faith-based organizations. 

You can use the Health Resources and Services Administration’s (HRSA) Find a Health Center tool to find community health centers near you. 

Many of these organizations offer sliding-scale fees based on your income, so even if you don’t have insurance, you may still be able to get the care you need.

If you struggle to access healthcare, know that you’re not alone. There are many resources available to help you get the care you need. And while it may seem daunting at first, reaching out for help is an important first step.

Friday, December 3, 2021

Money for Medicine: Finding Ways to Afford Your Health Care

Everyone wants to know their health will be taken care of. Unfortunately, it can be expensive sometimes. Luckily there are ways you can still afford your health care without having to break the bank. Here are some tips on how to do so.

Use Health Insurance

Everyone should have some form of health insurance, and it doesn’t have to be a crazy expensive one either. If you don't have any yet, get on the internet and look up health insurance companies in your area. 

Many offer plans for really cheap, like non obamacare health insurance, which was created for those without pre-existing medical conditions and who don’t engage in risky behaviors such as drugs. Look into the options out there and you will be sure to find something that works for your budget.

Take Advantage of Free Government Programs

Many programs exist that can help make it possible for you to afford healthcare. A few examples would include programs like Medicaid, Medicare, and even the Affordable Care Act (otherwise known as Obamacare). 

Trying to handle medical issues without some form of healthcare, even government assisted ones, can often make your bills much, much higher and close more expensive treatment options to you. It’s better to make sure you have some kind of avenue towards healthcare than none at all.

Ask about Payment Plans

If you do not qualify for any of the programs mentioned, don't forget to ask if there is a payment plan option available to you. Many hospitals offer this and it can make all the difference in continuing your health care needs. You might even be able to set up a monthly payment that you can afford.

Go to a Free Clinic or Find a Low-Cost Option

If you're in a bind and just can not seem to find any other options available, there is always the option of going to a free or low-cost clinic. 

These clinics will either have you pay nothing at all or a small fee (very small compared to regular clinics and doctor’s offices) for treatment. A simple internet search should tell you if there are any nearby, as they’re all largely community-based.

Look Into Alternative Medicine

A lot of health care options exist that are much less expensive than the normal doctors and hospitals you find in your area. Acupuncture, chiropractors, homeopathic medicine, herbal remedies; there are lots of things you can try before running to the doctor for everything. If this is an option available to you, maybe give it a shot.

If you are financially struggling, these options might be your best bet for taking care of medical needs. Look into them or ask about payment plans to see which ones work best for you.

Friday, November 21, 2014

The Effects of Obamacare and What has Changed

When the Affordable Care Act, more popularly known as Obamacare, was passed in Congress, many thought the problems of a large uninsured portion of the population would be solved. Unfortunately, theory does not always translate into practice. Although more people today are insured, problems with reimbursement rates and disgruntled citizens who refuse to apply, still present obstacles for doctors and hospitals. 

More people are insured, which means less people in emergency rooms

Before, many would simply wait until they were too sick to work, and then go to the ER. Unfortunately, that usually meant they would end up being hospitalized. But Dr. Ira Potter, who practices in one of the poorest regions of Kentucky, told the Louisville Courier-Journal that now his low-income patients are receiving subsidies for insurance, or have been moved to Medicaid. With help from the government, he said, they can now afford to pay for a physician.

Reimbursements are low—meaning many doctors won’t take Obamacare

Dr. Bob Russo, radiologist and president of the Connecticut State Medical Society, told National Public Radio that low rates and administrative headaches that come along with the program could make it a “financial loser”. He pointed out that if doctors can’t be convinced that they're not losing money doing their job, there will be problems. “And they haven't been able to convince people of that," he said.

The problem is not just in Connecticut; numerous companies have cut their reimbursement rates for plans that fall under Obamacare. When Blue Shield of California was designing the new health plans it would offer under Obamacare, the insurer asked doctors and hospitals in its network to accept rates as much as 30 percent lower than what it previously paid.

Only 60 percent of the doctors and 75 of the hospitals that participate in the Blue Shield of California’s group plans chose to participate in plans purchased through the state’s insurance exchange. Some of the state’s most prestigious hospitals, including Cedars-Sinai Medical Center in Los Angeles and University of California medical centers, dropped out altogether.

Hospital charity care is being tied to Obamacare signups

To a number of people, Obamacare carries a whiff of socialism. The end result is that for many hospitals in rural areas, many will still go uninsured and risk getting sick despite the fact that they would be eligible for insurance coverage. William Parsons, 40, told a reporter that he has no health insurance and doesn't intend to apply. "Goin' to the doctor just isn't something I like to do. ... No good comes of going."

Parsons is not an exception. Many hospitals are now reevaluating their charity care policies and demanding that those who would normally be eligible at least attempt to sign up for subsidized insurance. According to a high risk pregnancy specialist, Dr. Gilbert Webb, even insurance for one time procedures like pregnancies are affected. As an example, Southern New Hampshire Medical Center in Nashua now states that applicants who do not purchase federally-mandated health insurance when they are eligible to do so will not receive charitable care.

Katherine Arbuckle, senior vice president and chief financial officer at Ascension Health based in St. Louis, told the Washington Post that the question is whether a patient can pay or simply doesn’t want to. “How do you treat those who decline [coverage]? Do they get free services when others have paid?” she asked.

In reality, Obamacare is still in the shakedown phase. In order to ensure that the program is as effective as possible, it needs to be tweaked in certain areas in order to ensure that the most vulnerable populations are covered. Combined with better education about the program, Obamacare should prove to be more successful in years to come.

Information Credit: Vitals

Wednesday, September 24, 2014

If I Fall Behind on my Health Insurance Premiums What Happens?

If you’re having financial difficulties it may be that you’re in danger of falling behind on your health insurance premiums. This can obviously be a worrying time for you but it needn't be major problem unless you let it.

The most important thing to note is that you should always take out a plan that you feel as though you can keep up with. That way you can avoid many problems. But many of us have unexpected changes in our lives that mean are financial circumstances are different. There is always a chance you will experience difficulties in paying your premiums, but finding an affordable plan at the outset is still the best option. Keep reading at the HBF health insurance site, where you can learn more about the coverage available & ask questions relevant to your situation.

Can I get help with health insurance from the outset?

If you’re looking at the health insurance marketplace you’ll be able to view a lot of different plans with different provisions and costs. You will probably be able to find a plan that is suitable for your budget. However, there are tax credits available if you are really struggling to afford your health insurance.

You have access to these tax credits straight away and they are intended to take some of the pressure off you financially by enabling you to afford a health insurance plan. You don’t have to buy a plan through the marketplace but it does give you a wide range of choice and it does give you the option of applying for tax credit help. 

If I experience problems after purchase what happens if I miss payments?

If you get a plan that you can afford then hopefully you won’t have any difficulties but life doesn’t always work that way. We have all experienced unexpected events in our life and one of these may lead to you having problems with continuing to pay your premiums.

There are rules that apply under the Affordable Care Act to allow for issues that people may have meeting payment requirements. The one thing you should always remember is to let your insurer know as soon as you are aware that you will be having difficulties; there is no point trying to hide the issue as this will not help. The rules of the Affordable Care Act mean that you have three months within which to catch up with payments you have missed.

Of course this doesn’t mean you should take the whole three months, the sooner you can get back on track with your payments the better. There‘s a very good reason for this as your insurer will only accept claims from you for thirty days after you miss a payment. If you don’t catch up by this time you stand the chance of being faced with a large bill if you have the misfortune of falling ill.

This isn’t going to help you financially and may lead to you missing further premium payments. This is a potentially serious situation as if you don’t pay all of the premiums due by the end of the three months your insurance will be cancelled.

Monday, January 27, 2014

The 4 Ways Health Care Has Changed For Your Retirement Fund

Most retirees depend upon Medicare for health care. The Affordable Care Act made changes that continue to go into effect throughout the rest of the first quarter of the century. Your retirment fund should be on the forefront of your mind and every aspect should be accounted for. For many senior citizens the changes affect how much of their retirement fund is allocated for medical care. Although there are many changes, four stand out in particular.

Preventative Services

Medicare insurance companies have to provide some preventative checkup services for free that required a co-pay in the past. Mammograms and colonoscopies are two of the screenings now completely covered. A yearly check-up is now also included as part of the free service. However, to pay for the new services many insurance companies are cutting other services that they were not required to pay for but covered as part of their marketing. For example, many Medicare enrollees no longer have free access to health clubs through their policy. The key here is to remember that changes have been made and to fully research what you are covered for exactly. 

Pharmaceutical Drugs

Greater access to pharmaceutical drugs at a discounted price is part of the ACA. The “doughnut hole” is being discarded, which can save many seniors several thousand dollars a year. Seniors can continue to use an ongoing drug treatment program without fear of running out of money halfway through. A greater percentage of coverage has gone into effect for both brand name and generic drugs. 

Medicare Advantage

Those who are on Medicare Advantage may feel that they have lost the advantage the program provided. Known for its low cost care, the program is suffering under the ACA. Many insurance companies are raising the cost for the program, and the services it provides. It has become much more competitive with the standard Medicare Part B supplement program. Many seniors are finding it financially wise to meet with a Medicare insurance agent to compare plans and finding the best option for them. 

Dental Care

The greatest change is one that did not happen in spite of the desires of many seniors. The ACA did not provide any additional coverage for dental care. Medicare does not cover any treatment for the general health of the teeth, leaving seniors to handle expensive bills on their own. Fortunately for them places such as Ivory Dental Centre exist to provide excellent care for reasonable fees. Many dental practices also extend credit to help patients with extensive bills.

Managing retirement and health care remains a juggling act. The changes to Medicare make part of the task easier, but care is needed to understand all the options. Make sure you contact your insurance representative and ask if the changes made will affect you and make sure you fully understand everything that is going on with your funds. Preparation is going to be needed as you enter retirement, make sure nothing goes unnoticed.

Saturday, November 9, 2013

How The Affordable Care Act May Impact Medical Debt

There are many Americans that are struggling to pay down some of their medical bills. They may be wondering how they can find support to eliminate some of these burdens and get on with their life. The new Affordable Care Act penned in to law by President Obama is slated to go in to effect soon. Some people are wondering whether this will provide help with medical bills, which would be beneficial for many. There are several new changes that will be ushered in by this law, so it may be worthwhile to review some of the pros and cons that it will bring.

First, the new Affordable Care Act will simply make it more accessible for people to get healthcare coverage. While this won't directly affect existing medical bills, it may provide people with much needed support as they move forward. If they are continuing to receive medical treatment for an illness, this provision may just make it more affordable. This can reduce the overall burden that they have to pay out of pocket. If they can't afford to pay for a private health insurance package, some people might qualify for Medicaid. The limit for qualifying for this package has been raised to 133% of the federal poverty level.

The Affordable Care Act will also provide additional support to families that are hovering above this poverty level. If a family of four makes less than $94,000, then they will be able to qualify to receive support. Some people may be able to get tax credits, which can offset much of what they pay for their health insurance package. This could prove to be helpful, since many people currently pay high out of pocket costs. These types of benefits may seem small, but the cumulative effect may allow many people to get out of medical debt.

There are a few other benefits that may be available to different kinds of consumers out there. Some people may work with a large employer that does not currently offer health benefits. With the introduction of the Affordable Care Act, these large businesses will start to receive tax credits for providing health insurance. Additionally, families can claim their kids up to age 26 on their healthcare plans. This will provide them with much more flexibility in the way that they offer coverage. If they are struggling with medical debt, they could expect to get a lot of support going forward.

Some people may want to consider a few of the cons that the program may introduce in the future. There are some sources that are predicting that some insurers will be passing on the costs of the legislation to their customers. This may cause premiums to go up over time, which will be challenging for them. There are also many people who might need to get additional testing to confirm a diagnosis. It can be important for people to consider whether they want to pay for these additional diagnostic tests. They may not be able to afford some of the extra costs that this will bring to them.

In all, a vast majority of consumers can expect to get assistance with the implementation of the Affordable Care Act. They likely won't be able to get direct help with a medical bill that they already have. Some people may need to think about checking out some of the insurance deals available through the exchange system being implemented. This could prove to help people find out whether they can get a little help to get back on track. This may be enough for people to eliminate some of their more extensive medical bills.

Tuesday, October 8, 2013

Unexpected Costs: Five Things That Could Surprise You After Retirement

For well over 30 years analysts and demographers have spoke of the years when the Baby Boomer generation would hit retirement age. That has now come to pass, with more than 5,500 individuals in the United States hitting 65 every day. Those seeking senior living Mesa AZ, offers are arriving in that city by the thousands each year. For those who have planned well, the golden years lay before them. For over half of those new seniors, however, they are financially unprepared for the prospects of retirement. 

In addition, even those who tried to plan financially are finding that there are a number of potential surprises in retirement that upset those plans. Their experiences serve as a cautionary tale of financial issues that can disrupt your retirement plans. Below are five of those potential additional costs of which you should be aware. 

Unanticipated health care costs.

Many retirees have not borne the brunt of their personal health care expenses until they are on their own. Additionally, people that have been healthy all their lives are surprised by sudden diseases and ailments that come with the aging process. With the new Affordable Care Act, there is a great deal of uncertainty and confusion about how best to manage medical costs. One unpleasant irony for many is the more they have prepared and have adequate financial resources, the more they are often charged for their care. This includes surcharges for Medicare patients with higher incomes (currently $85,000 single and $170,000) filing jointly.

Taxes on income.

The fact that social security benefits are subject to taxes above a certain income threshold both surprise and aggravate many. Instead of being seen as the fruit of after-tax dollars, the government stands ready to again rake another share of the income you receive. 

Loss of income

Couples who plan to retire together make plans that deal with average life expectancies. When one spouse passes earlier than planned, the survival benefits lost can upset those budgets. Experiencing injury within the workplace could also effect this loss of income and could create a decrease in investments funds. 

Taxes on withdrawals.

There are very explicit rules concerning the taxation of withdrawals from different retirement savings plans. Aside from the risk of extra taxes and penalties, many find the taxes to be a larger burden than built into their budget. Creating alternative sources of funds will be able to maintain the investment path while decreasing the taxation seen on the withdrawals. 

Greater than anticipated spending.

Financial planners work with individuals to set up spending for 20 to 30 years in the future. Even with allowances for inflation, many retirees find that it simply costs more to live and enjoy their freedom than they ever anticipated. Rather than living a sedentary lifestyle sitting at home, individuals find they enjoy traveling and visiting with grandchildren. Everything from dinner out to giving more gifts than planned can cause shortfalls in the budgets that were established when much younger.

Wednesday, September 25, 2013

What Will the Health Exchanges Mean for Seniors?

English: President Barack Obama's signature on...
English: President Barack Obama's signature on the health insurance reform bill at the White House, March 23, 2010. The President signed the bill with 22 different pens. (Photo credit: Wikipedia)
The Affordable Care Act will go into effect on January 1, 2014. Most people are trying to prepare for the new law to go into effect. Unfortunately, there are many misconceptions about the law that may prevent people from making informed decisions. The effect that the health exchanges will have on seniors is especially confusing. You will need to know what the health exchanges are and how they will impact you. Here are some things you should know.

Health Exchanges Won’t Replace Medicare

The federal government recently hired Kelton, an independent consulting firm, to find out what seniors believe about Medicare. Their new survey found that 86% of seniors believe that the new health exchanges will replace Medicare. A number of other seniors believe that the eligibility age for Medicare will increase when the law goes into effect.

Many seniors are foregoing healthcare, choosing not to fill prescriptions or looking for a part-time job because they think that they won’t receive the assistance they need. They may even forego getting assisted living such as by visiting a senior neighborhood living in Reading, PA.

Health officials want to make sure that they understand the new law so that they can make better decisions. Here are some of the misconceptions they want to clarify:

  • Eligible seniors will still receive Medicare after the ACA goes into effect.
  • The ACA will not raise the eligibility age for Medicare.
  • They shouldn’t expect to pay more for prescription drugs.
  • They can begin enrolling in Medicare in October.

Eligible seniors should still apply for Medicare. However, they may find that Medicare won’t cover all the services they need. You will want to know how to buy private insurance on the exchanges as well.

Tips for Buying Insurance on the Exchanges

Many seniors will want to consider buying insurance on the health exchanges. They may not be old enough to qualify for Medicare yet or would rather have a more comprehensive policy. Here are some guidelines to help you choose.

Understanding Your Rights

The Affordable Care Act carries a number of changes for seniors looking to buy health care. Insurers will no longer be allowed to disqualify them from receiving coverage based on their age or preexisting conditions. However, they will be allowed to charge seniors up to three times as much for coverage.

Tips for Reducing Premiums

The health care law prohibits insurers from setting higher premiums based on preexisting conditions. However, it does allow them to charge higher premiums to people who smoke. You may want to consider kicking the habit if you want to reduce your premiums.

You may also be able to receive lower premiums if you participate in an employer sponsored health plan. You should consider doing so if you are still working.

Look Into Subsidies

You will want to see if you are eligible for any of the subsidies. Anyone who is making less than 400% of the poverty line will be eligible for subsidies. You will want to apply for these subsidies if you are below this income threshold.

Understand the Health Plan Classifications

You will need to decide whether you want to pay lower premiums every month or lower deductibles. This will depend on what services you believe you will need in the future.

You can already offset your insurance premiums by paying higher deductibles and copays. The health exchanges will make it easier for you to choose a plan that meets your needs. You can choose between bronze, silver, gold and platinum policies. The bronze policies offer the lowest premiums but the highest deductibles. Premiums will be higher while deductibles will be lower with the other plans.

About the Author: Kalen is a financial advice writer with an MBA. He shares tips to help people of all ages plan for the future.

Thursday, August 29, 2013

5 Tips for Discussing Health Care Reform at Your Business

When a new change to federal law and how businesses operate makes national news, chances are your employees will be concerned about how it affects them. You may or may not have to change how you approach health insurance for your employees in light of the Affordable Care Act, but regardless, your employees are probably worried about how things will change, if things will change and what it means for them. The savvy business owner does what she can to understand the impact of the law on her business. Your plan for tackling these issues at your business consists of five simple steps.

1. Hire a Speaker

Contact a speakers bureau to book a professional speaker with expertise on health care reform and how businesses deal with insurance issues. Even if you have a fairly good idea of how the changes to law may influence your business, you’re probably not an expert on the subject. It helps to have an expert lecturer to deliver the message to your employees.

2. Provide Information

The actual documents put out by the government explaining the Affordable Care Act are tremendously long and confusing to those not familiar with legalese. Your employees don’t have to know everything about the Affordable Care Act, but it would help if they had access to a few key points explained in everyday language. Talk with your hired professional speaker about providing a print-out or a digitally distributed list of key bullet points every employee ought to know. Use the U.S. Small Business Administration information for additional help.

Don’t forget to look into how your specific state is handling the changes and point your employees to the necessary information about the affordable insurance exchange.

3. Explain the Changes

In addition to your bullet points highlighting the basic things to know about the changes to federal law, highlight any changes that will directly impact your employees, or if there won’t be any changes, explain why. With all of the information from a myriad of sources floating around, your employees need to know that they can zero in on the actual points that will matter to them. As their employer, you’re in the best position to provide an explanation of what will be happening at your individual business.

4. Offer a Timeline

If there are changes to come, include a timeline in your print-out or digital distribution of information. It helps employees to visualize the changes by organizing them by month and year. A calendar complete with deadlines highlighted — days on which employees need to provide information or their last days to switch insurers, for example — will prove especially helpful in making the transition as seamless as possible. Send out an additional reminder at least a week in advance of each deadline.

5. Invite a Discussion

As part of your professional speaker lecture on the topic, invite employees to pose questions and discuss concerns with the expert in a forum or debate held after the lecture. In addition to addressing questions and concerns the day of the lecture, keep your office and human resources representatives’ offices open for additional issues that arise. If possible, put up a forum on a locked employee-only website that allows for additional debate, FAQs and discussion about the changes (or lack of changes) to come. If employees feel like you’re listening to them and addressing their concerns, they’re less likely to become stressed out about the new laws.

Your employees need to know how health care reform will affect them, if at all, and your business is the only organization that can really address the issue with them, as it’s going to impact every business differently. Clear up the confusion and anxiety with your health care reform discussion plan. With the help of experts and an open forum for questions and concerns, worrying about the health care changes to come will become less of an issue, and your employees can better focus on their daily tasks.

About the Author: John Raines is a small-business owner in Iowa. He frequently relies on professional speakers to help address important issues, goals and changes that impact his business.

Thursday, August 22, 2013

New Health Care Law Will Change Employee Wellness Programs

In an era of rising health care costs, many employers are turning to employee wellness programs to keep their workers healthy and to keep health insurance coverage costs down. According to the National Compensation Survey conducted by the U.S. Bureau of Labor Statistics, more than half of all employees have access to some sort of wellness program benefit; programs range from discounts at local fitness facilities and educational programs to comprehensive, closely-monitored programs designed to help employees better manage chronic conditions like diabetes or make significant lifestyle changes such as quitting smoking. In exchange for undergoing screenings and meeting other goals, employees also often receive discounts on their health care coverage premiums.

While employee wellness programs are popular, some experts question their value. Because participation is voluntary and companies are prohibited by law from discriminating against employees on the basis of health screening results and their participation in wellness programs, experts point out that employees may be less than truthful (“I quit smoking!” “I go to the gym four times a week!”) to qualify for the discounts, and that the result is often higher costs to employers with few measurable benefits. However, federal lawmakers disagree with the notion that the programs are not effective — to the point that significant provisions for employee wellness programs were included in the Patient Protection and Affordable Care Act passed in 2010.

Health Insurance Discounts

One of the primary reasons that employees opt to participate in their employers’ wellness programs is that participation often translates to discounts on health insurance premiums. With the cost of coverage going up every year, especially when an employee is paying for coverage for the whole family, voluntarily participating in the employee wellness program and agreeing to engage in healthy behaviors usually means at least a small break on the cost of health insurance.

However, businesses are limited as to how much of a discount they can offer. Under federal law, the maximum discount for signing up for an employee wellness benefit is 20 percent. Employers recoup those costs in the form of fewer health care claims and an overall lower cost for their organization, as insurance carriers give their best rates to their healthiest customers.

Realizing that the bigger the incentive, the greater the participation, the government is increasing the maximum insurance discount to 30 percent for employee wellness participants, with the potential for discounts to reach 50 percent if the program is designed to help people stop smoking. At the same time, the law also allows employers to levy penalties of up to 30 percent of the cost of health coverage should employee participants fail to meet the specific health standards established by the insurer, or for engaging in unhealthy behaviors like smoking. The law does account for employees who cannot participate in wellness programs for documented reasons by allowing them to meet different health standards or participate in alternative programs.

Grants for Wellness Programs

While the majority of larger employers — those with more than 100 employees — offer some type of employee wellness program, many smaller businesses cannot afford the costs associated with managing such a program (on average, about $150 per employee per year). The PPACA aims to help smaller employers develop wellness programs by establishing a $200 million grant program designed to pay for the costs associated with employee wellness. Employers with fewer than 100 employees implementing programs that meet certain criteria (for example, making efforts to improve employee engagement and create a healthy environment) can apply for the funding. These grants will not only improve the availability of employee wellness programs, but the money will create opportunities for public health professionals, as most small businesses do not have the resources to maintain a wellness specialist on staff. (Click here for additional resources on online MPH degree programs and opportunities in the public health field). 

CDC Support

In addition to increased funding, employers can expect additional support from the Centers for Disease Control and Prevention in their efforts to get employees healthy. Under the Affordable Health Care Act, employers of all sizes will have access to the CDC’s tools to analyze, evaluate and measure their wellness efforts. These tools will help employers more effectively manage their programs and maximize their cost savings.

The PPACA will completely change the face of health care in the U.S., including the way employers manage their employee wellness programs. Programs will vary by employer, but expect to see a great deal more attention paid to these popular employee benefits.

About the Author: After earning a master’s in public health, Lara Mack went on to serve as the director of employee wellness for a large financial services provider.

Wednesday, August 21, 2013

How the Affordable Care Act Could Affect Small-Business Taxes

Small-business taxes are about to become significantly more complicated thanks to the Patient Protection and Affordable Care Act (PPACA). Understanding and planning for these changes now instead of later will give your small business a competitive edge in the coming tax years. 

Because of PPACA, small-business owners need qualified accountants more than ever before. If a career in accounting interests you, then now is a good time to find out more about available online graduate tax programs. The IRS has a good resource center for more in-depth exploration, but it's no replacement for a qualified accountant.

The PPACA Contains No Mandate for Small Businesses

All small businesses with fewer than 50 employees are exempt from any employer responsibility requirements. They can take advantage of tax credits and health insurance exchanges if they want to offer coverage.

Starting in 2015, businesses with over 50 employees that either do not offer coverage or do not offer “affordable” coverage will have to pay a fine.

· In businesses with more than 50 workers, the employee's share of the premium for his or her own policy should cost no more than 9.5 percent of his or her wages. If the employee's share of premiums exceeds 9.5 percent of wages, then the coverage is not considered “affordable.” Businesses can offer insurance for family members, but employee contributions toward those policies are not subject to the 9.5 percent premium cap.

· Businesses with more than 50 employees that offer no health insurance will pay a $2,000 fine for each employee after the first 30. For example, if you have 53 employees, you will pay $2,000 x 23, or $46,000, if one of your employees receives a tax credit for buying insurance through an exchange.

· Businesses with more than 50 employees that do not meet the 9.5 percent requirement will also pay a penalty. These companies will pay $3,000 for every employee that purchases individual coverage through a health insurance exchange and receives either a premium tax credit or a cost-sharing reduction.

Tax Credits Small Businesses Can Get for Offering Health Insurance

Small businesses meeting the following requirements are eligible for a tax credit to offset the cost of purchasing health insurance for employees:

  • Employ fewer than 25 full-time employees. Workers count as full-time if they work 30 or more hours per week. Two part-time workers is the equivalent of one full-time worker under the law. Seasonal employees can work no more than 120 days per year or else they will count as part-time workers.
  • Pay average annual wages of $50,000 or less
  • Contribute 50 percent of total premium cost for employees

Currently, small businesses are eligible for a tax credit of up to 35 percent of their contributions toward employee premiums. In 2014, the credit rises to 50 percent of contributions as long as insurance is purchased through state insurance exchanges. The 50 percent credit is offered for two years.

Tax Planning Issues to Talk Over With Your Accountant

When you're deciding what you want to do about offering health insurance, these are some questions that you should address with your accountant:

  • How many employees should I hire? If you're near the 50-employee cutoff, then you may want to make sure that you have no more than 50 employees to avoid penalties. Also, you may want to be careful to limit your seasonal employees to 120 days. 
  • Will I benefit from purchasing employee coverage from state health insurance exchanges? Combining the tax credit with potentially lower premiums from the state health insurance exchange may lower your overall costs. Alternatively, a private insurance option may be more affordable. 
  • Should I offer coverage if I have more than 50 employees? Your accountant can calculate whether coverage would cost more than the penalty for not having it. You'll also need to weigh whether insurance is an important benefit for hiring and retaining employees.
  • What procedures should I change? Work with your accountant to adjust your HR and payroll procedures to meet the new reporting requirements.

Finally, tell your accountant that you expect to be kept informed about changes in the health care laws. In all likelihood, the law will undergo changes and modifications as it rolls out. Working closely with your accountant to navigate the changes could save your small business a significant amount of money.

About the Author: Gary Robertson, M.A., C.P.A., provides tax planning services for small businesses.

Sunday, July 28, 2013

How Will the Affordable Care Act Affect Medicare?

The Patient Protection and Affordable Care Act, also known as Obamacare, is set to take full effect next year. The legislation is set to cut $716 billion from Medicare and will bring some significant changes to the program. The Affordable Care Act has already expanded Medicare coverage to include preventive care, and it’s slowly closing the coverage gap in Medicare Part D. 

The Affordable Care Act aims to improve the quality of hospital care for seniors by rewarding hospitals that provide quality care with increased funding, and penalizing those who provide poorer care with decreased funding. Although the legislation does cut some Medicare programs, these cuts aren’t intended to affect benefits; instead, they’re meant to increase Medicare’s cost-effectiveness by moving the money to areas of the program where it can be put to better use.

How Are Medicare Benefits Changing?

The Affordable Care Act broadens existing Medicare benefits, making it possible for seniors on Medicare to receive preventive care with no out-of-pocket costs. Seniors can now get check-ups, cancer screenings, vaccines and other forms of preventive care for free. These changes have been in effect since 2011.

Another important change in Medicare benefits under the Affordable Care Act concerns the so-called “donut hole,” or the coverage gap in Medicare Part D. Under Medicare Part D, many seniors must pay for their own prescription drug costs. As of 2012, seniors receiving Medicare became eligible for discounts on brand-name and generic prescription drugs. These discounts will grow each year until 2020, when the coverage gap should close completely, and Medicare recipients will only need to pay co-pays for their prescription drugs.

The Affordable Care Act also aims to reduce federal spending on Medicare Advantage, a form of supplemental Medicare insurance administered by private insurance companies. Medicare Advantage, which was originally intended to reduce federal spending on Medicare, has turned out to cost the government 14 percent more per patient than traditional Medicare. It is hoped that cutting federal spending on Medicare Advantage will lower overall Medicare costs.

What Is the Value-Based Payment Provision?

Under the Affordable Care Act, providers who offer high-quality care to Medicare patients stand to receive a one percent increase in Medicare payments in 2014, and a two percent increase in Medicare payments in 2015. Conversely, those who provide a lower standard of care — as measured by high re-admittance rates and patient dissatisfaction — stand to lose up to two percent of their payments from Medicare by 2015.

In this way, the Affordable Care Act intends to improve the quality of care seniors receive.Quality care is something that professionals in the field will have to focus on. Though it may have gone unmentioned before, health care employees had better take notice or suffer the consequences. Human services will be especially influential in this regard and it is anticipated that more positions in human resources will be created to address the importance of quality care. To learn more about earning a human services degree online, you can research online for a program that fits you. 

Where Are the Medicare Cuts Coming From?

According to the Congressional Budget Office, the anticipated total cost of Medicare over the next 10 years will be about $7.5 trillion. Between 2013 and 2022, the Affordable Care Act plans to cut $716 billion from Medicare. Of that amount, $415 billion comes from federal payments to care providers and private insurance companies. The rest of the cuts come from parts of the program that are not considered to be cost effective, such as the Medicare Disproportionate Share Program, which compensates hospitals for treating lower-income Medicare recipients who do not have supplemental insurance.

How Does the Affordable Care Act Change Medicare Funding?

The Affordable Care Act changes Medicare funding by reallocating the $716 billion in cuts to other parts of the program, where it’s believed the money can be put to better use. The new law will also levy a 0.9 percent tax on members of the top tax bracket in order to raise money for the new law.

The legislation also allows for the creation of an Independent Payment Advisory Board, which will have the authority to recommend reduced provider payments if Medicare spending grows too fast in the future. Payments from Medicare to health care providers will also grow at a slower rate. These two things are intended to keep Medicare costs down in the future. Medicare is expected to cost $900 billion per year by 2022.

The Affordable Care Act has expanded Medicare benefits to include preventive care like checkups, vaccines and cancer screenings. Over the next several years, it will gradually close the coverage gap in Medicare Part D, which provides prescription drug coverage to seniors. It will also cut spending on Medicare Advantage and tie providers’ payments to the quality of the care they give. The Affordable Care Act intends to fund these changes and keep Medicare solvent in the future with $716 billion in cuts to other parts of the program and with a 0.9 percent tax increase on members of the top bracket.

About the Author: Contributing blogger Alisa Martin has more than 15 years of experience in public health policy. She currently works with his local government to improve public health services.

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