Editor’s note: This is the third in a series regarding the Affordable Care Act.
Beginning Tuesday small business owners can see if purchasing insurance through the state’s insurance program is a better deal than buying it through a private company.
The Small Business Health Options Programs provide side-by-side comparisons of plans, benefits, costs and quality between one’s current plans and those available on the Marketplace.
Small businesses are defined as those with 50 or fewer full-time employees. Enrollment in the Exchanges qualifies employers to receive rebates up to 50 percent of premium costs beginning in 2014. For businesses with fewer than 25 employees, tax credits of up to 35 percent will also be made available to help pay for a company’s share of premiums for those enrolled in the group plans. To qualify, a business must pay at least 50 percent of the premiums for his employees and wages must be $50,000 and below. This benefit has been available ever since the Affordable Care Act was passed in 2010, and thus can be applied retroactively if businesses have not taken advantage of it thus far.
The higher tax credits are available only to businesses that participate in the Exchanges.
Businesses with 25-50 employees aren’t eligible for the additional tax credits.
Employees will be able to shop for the insurance plan that best suits their needs on the Marketplace. Blue Cross Blue Shield of Kansas and Coventry are the only two insurance companies participating with the Kansas plan. That said, a plethora of plans and formularies will be available.
“Medications typically dictate what plan works best for an individual,” said Sheldon Weisgrau, a health care consultant who has an extensive background in rural hospitals.
Under the new formula, employers will make one check paying toward employees’ premiums to the state-run Exchanges which will cover the myriad plans their employees choose.
“It gives employees the advantage of choosing the best plan that suits them, not what suits the employer,” Weisgrau said. Employees do not have to participate.
The first step in seeing if a state-run plan is better than what an employer currently offers is to compare a plan’s benefits, premiums and co-pays. Employers can download the PDF application form from the Internet by inserting the term “Small Business Health Options Program application.” For in-person help, certified application counselors are available. To find the nearest one go to www.InsureKS.org or contact the Kansas Insurance Department.
Employers who currently provide insurance can also have their insurance brokers help them research the state program.
A BIG advantage of the Affordable Care Act is those with pre-existing conditions — arthritis, diabetes, heart disease or cancer, for example; or a history of injuries — back, knees and shoulders — can no longer be denied health insurance. Obamacare prohibits insurance companies from dropping chronically ill patients from their rolls and also bans a limit as to how much an insurance company will pay for a person’s care. In other words, a person can’t “cap out” of care because of high charges, as in previous times.
Enrollment for the new system is from Oct. 1, 2013 to March 31, 2014.
