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Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019

Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019

Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019

On Dec. 20, Congress passed the Tax Cuts and Jobs Act, which makes significant changes to individual and corporate provisions of the U.S. tax code, including a reduction in the corporate tax rate to 21%, down from 35%, beginning in 2018. The bill includes permanent effective repeal of the Affordable Care Act (ACA) individual mandate, requiring individuals to purchase and maintain health coverage, by zeroing out the penalty beginning in 2019. For 2018, most individuals are still required to maintain coverage or pay a penalty when they file their 2018 federal income tax return.

The bill was negotiated by a conference committee comprised of representatives from both the Senate and House after each chamber passed their own versions of tax reform. The final bill was passed 51-48 by the Senate and 224-201 by the House before being sent to the President. President Trump is expected to sign the bill into law soon.

The bill also changes how certain tax thresholds will be indexed for inflation. Affected provisions, including the ACA “Cadillac” Tax (scheduled to take effect in 2020), will now be indexed to the Chained Consumer Price Index (CPI) instead of the regular CPI (the previous metric). That change makes it likely that more employer-sponsored plans would trigger the Cadillac tax sooner.

We will keep our clients advised of timely developments of the Tax Cuts and Jobs Act as it relates to employee beneifts. For now, though, it appears that the biggest impactsthe next couple years are likely to be with respect to the individual mandate repeal and the Cadillac Tax changes.

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CareConnect Withdraws from NYS Market

CareConnect Withdraws from NYS Market

CareConnect Withdraws from NYS Market

CareConnect today has announced their intent to withdraw from the NYS 2018 market. The ACA Risk Adjustment Program was penalizing CareConnect again $100 Million for 2018 after a $112 million tax in 2017.

The problems CareConnect was facing were not new and was covered in last month blog. This problem has bipartisan recognition and Cuomo Administration Asks Feds for ‘Immediate Changes’ to Risk Adjustment Program. While this tax or “risk adjustment penalty” was intended to increase competition it is blamed as the single largest bankruptcy cause for the 12 of 16  Obamacare Co-Ops such as the Health Republic of NY and for start-ups like Oscar and CareConnect.

The formula used to calculate payments in the risk-adjustment program has been criticized for unfairly favoring larger plans with more claims experience. Smaller companies that sell on the ACA’s exchanges have said they don’t have as many claims data, and therefore their membership base looks healthier than it is. In a twisted way, the young companies in need of help were actually subsidizing mature Insurers with legacy data systems.

Who is CareConnect?

CareConnect is a physician/hospital-owned Insurer by Northwell Health also formerly known as North SHore LIJ.  Careconnect manages the health of 400,000 individuals, including 125,000 customers.  Outside of the risk adjustment penalty the Insurer was managing population health and would have posted a profit.  Their past rate increases were single digits.

Sadly, this is a tremendous consumer market hit.  Their growth was predicated on delivering excellence of care while still mindful of consumer affordability, see chart below.  Not only were they on average 20-30% less expensive but their benefits were typically enhanced.  Example:  A Tradition Gold plan member would NOT have a deductible nor coinsurance for surgeries and hospital stays at a time when all competing Gold plans did.

Regrettably, no State appeal has been victorious as of yet.  With logger-head federal conflicts in Government today on repairing Obamacare flaws the victims will once again be the middle-class consumer.

See Press release:

https://www.northwell.edu/about/news/press-releases/while-preserving-its-population-health-commitment-northwell-withdraw-careconnect-nys-insurance-market

CareConnect Leaving NY Market 2018CareConnect Individual rates

Next Step:

Please sign up for the Sept 13th webinar below on CareConnect Exit & Next Steps for Your Group.

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HSA 2018 Limits

HSA 2018 Limits

HSA 2018 Limits

The IRS has released the 2018  Health Savings Account (HSA) inflation adjustments. To be eligible to make HSA contributions, an individual must be covered under a high deductible health plan (HDHP) and meet certain other eligibility requirements.

New HSA 2018  limits are as follows:

HSA Annual Contribution Limit:

 Single –  $3,450 ($3,400 in 2017)

Family – $6,900 ($6,750 in 2017)

Catch-up – $1,000 ($1,000 in 2017) for age 55+.

HDHP Minimum Annual Deductible: 

Single – $1,350  

Family – $2,700 

HDHP Out-of-Pocket Maximum: 

Single – $6,650 ($6,550 in 2017)

Family – $13,300 ($13,100 in 2017)

Age 55 Catch Up Contribution-As in 401k and IRA contributions, you are allowed to contribute extra if you are above a certain age. If you are age 55 or older by the end of year, you can contribute additional $1,000 to your HSA. If you are married, and both of you are age 55, each of you can contribute additional $1,000.

HSA/HDHP Market Growth

HSA holders own the assets in the accounts and can build up substantial sums over time.  Enrollment in HSA-compatible insurance plans has increased to 10 million earlier this year, from 1 million in March 2005, according to, America’s Health Insurance Plans (AHIP), a trade group.

HSAs were authorized starting in January 2004. Since then, AHIP has conducted a periodic census of health plans participating in the HSA/HDHP market.

  • The number of people with HSA/HDHP coverage rose to more than 11.4 in January 2011, up from 10.0 million in January 2010, 8.0 million in January 2009, and 6.1 million in January 2008.
  •  30 percent of individuals covered by an HSA plan were in the small group market, 50 percent were in the large-group market, and the    remaining 20 percent were in the individual market.
  •  14% of all workers in the private sector that have access to a Health Savings Account acc. to Bureau of Labor Statistics.
  •  States with the highest levels of HSA/HDHP enrollment were California, Ohio, Florida, Texas, Illinois and Minnesota.

HSA Advantages:

  • Opportunity to build savings – Unused money stays in your account from year to year and earns tax-free interest. The HSA also gives you an investment opportunity.
  • Tax-free contributions and earnings – You don’t pay taxes on contributions or earnings.
  • Tax Free Money allowed for non traditional Medical coverage– As per IRS Publication 502, unused moneys can be used  for dental,vision, lasik eye surgery, acupuncture, yoga, infertility etc.  Popular Examples
  • Portability – The funds belong to you, so you keep the funds if you change jobs or retire.

Our overall experience with HSAs have been positive  when employer funding is at minimum 50% using either the HSA or an HRA (Health Reimbursement Account-employer keeps unspent money).  Traditional plans trend of higher copays and new in network deductibles has also led to the popularity of an HSA.

Is your HSA compliant?  Which pre-tax qualified HSAFSAHRA spending card is right  for you? Please contact our team at Millennium Medical Solutions Corp (855)667-4621 for immediate answers.  Stay tuned for updates as more information gets released.  Sign up for latest news updates.

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Breaking: House Passes Obamacare Repeal & Replace

Breaking: House Passes Obamacare Repeal & Replace

Breaking: House Passes Obamacare Repeal & ReplaceBreaking: House Passes Obamacare Repeal & Replace

In a first step toward repealing and replacing Obamacare ie. Affordable Care Act (ACA), the  House of Representatives narrowly passed the American Health Care Act (AHCA) today by a vote 217-213. Every House Democrat and 20 House Republicans opposed the measure. The bill will now be sent to the U.S. Senate. Until this legislation is passed by the U.S. Senate and signed into law by President Trump, all existing ACA requirements remain in effect, including penalties for noncompliance.
Notable Provisions of the American Health Care Act
If signed into law, the American Health Care Act would, among other changes, make the following revisions to key features of the ACA over the next three years:

SIMILARITIES

  •  Pre-Exissting Conditions Covered: Under the Affordable Care Act, insurance companies are required to cover pre-existing conditions. This is still the case under the AHCA, but the creation of High Risk Pools, funded with $8 billion dollars was an added amendment to the AHCA.  Pools provide coverage if you have been locked out of the individual insurance market because of a pre-existing condition, and are subsidized by a state government. The premium is up to twice as much as individual coverage. Individuals who have a lapse in coverage of more than 63 days will be required to pay a 30 percent premium surcharge for 12 months when coverage is purchased.
  • Adult Coverage to Age 26 Covered: People who are under 26 years old can stay on their parents’ health insurance plan under both the ACA and the AHCA.
  • No Lifetime Cap: People who are under 26 years old can stay on their parents’ health insurance plan under both the ACA and the AHCA.

CHANGES

  • “Pay or Play”: Penalties for noncompliance with the “pay or play” coverage requirement (which mandates, in general, that employers with 50+  FT
    GOP Repeal & replace Provisions

    Click Image

     employees [including full-time equivalent employees] must offer affordable, minimum value coverage to their full-time employees, or pay a penalty tax) are zeroed outHowever, the Form 1094 & 1095 reporting requirements are unchanged by the bill.

  •  Individual Mandate: Penalties for noncompliance with the individual mandate are zeroed out, effectively repealing the mandate. In its place, the bill requires issuers in the individual or small group markets to impose a 30% penalty on the health insurance premiums of individuals who do not maintain continuous health insurance coverage.
  • Essential Health Benefits:   AHCA eliminates the requirement for Essential Health Benefits. The AHCA allows limited policies that are only in case of major illness or injury.
  •  HSA Contribution Limits: Limits on contributions to health savings accounts (HSAs) are increased to equal the inflation-adjusted annual out-of-pocket expenses limitation imposed on high deductible health plans (currently $6,550 (self-only coverage)/$13,100 (family coverage)).
  •   Health FSA Contribution Limits: Limits on contributions to health flexible spending arrangements (health FSAs) are eliminated.
  •  Tax Credits for Individual Coverage: Replaces the ACA’s premium tax credits for individual market coverage with advanceable, refundable tax credits adjusted for both age and income.
  •  Market Reforms: Permits states to seek waivers from the ACA’s essential health benefits and age and health status community rating requirements.
  • Medicaid: Allows states to elect to receive federal Medicaid funding via a block grant or per capita allotment, and alters the ACA’s Medicaid expansion.

The chart below summarizes some of the significant changes made by the AHCA.

Affordable Care Act (ACA)

American Health Care Act (AHCA)

Mandates

  • Individual mandate
  • Employer mandate on applicable large employers (ALEs)
  • No individual or employer mandate effective retroactive to Jan. 1, 2016
  • Insurers can impose a one year 30% surcharge on consumers with a lapse in continuous coverage (individual and small group market)

Assistance

  • Income-based subsidies for premiums that limit after-subsidy cost to a percent of income
  • Cost sharing reductions for out-of-pocket expenses
  • Age-based refundable tax credits for premiums, phased out for higher incomes
  • No cost sharing reductions for out-of-pocket expenses
  • ACA subsidies phased out after 2019; AHCA credits effective in 2020

Medicaid

  • Matching federal funds to states for anyone who qualifies
  • Expanded eligibility to 138% of poverty level income
  • Federal funds granted to states based on a capped, per-capita basis starting in 2020
  • States can choose to expand Medicaid eligibility, but would receive less federal support for those additional persons

Premium Age Differences

  • 3:1
  • 5:1 (and the MacArthur amendment would allow a higher ratio)

Health Savings Account Limits

  • $3,400/$6,750
  • Contribution limits increased to maximum out-of-pocket limit for HDHP coverage
  • $6,550/$13,100 (effective retroactively to Jan. 1, 2017)

“Cadillac” Tax

  • Cadillac tax on high-cost employer plans implemented in 2020
  •  Cadillac tax on high-cost employer plans delayed until 2026

Other Taxes

  • 3.8% tax on net investment income
  • Limit placed on contributions to flexible spending accounts
  • Annual health insurance provider tax
  • Over-the-counter medication excluded as qualified medical expense
  • 0.9% Medicare tax on individuals with an income higher than $200,000 or families with an income higher than $250,000
  • Repeal of these taxes retroactive to the beginning of 2017 (except for the repeal of the Medicare tax, which would begin in 2023)

Essential Health Benefits

  • Individual and small group plans are required to offer ten essential health benefits
  • Under the MacArthur amendment, individual and small group plans are required to offer the ten essential health benefits, but a waiver option is available
  • Some Medicaid plans are not required to offer mental health and substance abuse benefits

MacArthur Amendment

The following chart summarizes the changes made to the AHCA by the MacArthur amendment.

Insurance Market Provisions

The MacArthur amendment:

  • Reinstates Essential Health Benefits (EHB) as the federal standard (removes ability of states to define EHBs, but see waiver option)
  • Maintains the following provisions of the AHCA:
    • Prohibition on preexisting condition exclusions
    • Prohibition on discrimination based on gender
    • Guaranteed availability and renewability of coverage
    • Coverage of adult children to age 26
    • Community Rating rules (but see waiver option)
Limited Waiver Option States may obtain waivers from certain federal standards, in the interest of lowering premiums and expanding the number of enrollees. States could seek waivers from:

  • Essential Health Benefits (states could set their own definition of EHBs for the individual and small group markets starting in 2020, and increase the age rating ratio above 5:1 starting in 2018)
  • Community rating rules, except for the following categories, which are not waivable:
    • Gender
    • Health Status (unless the state has established a high-risk pool or is participating in a federal high risk pool)
Limited Waiver Requirements States must explain how the waiver will benefit the insurance market in their state, such as reducing average premiums, increasing enrollment, stabilizing premiums for individuals with pre-existing conditions, or increasing the choice of health plans.,Applications are automatically approved within 60 days unless denied by HHS.

 

As always, please contact us info@medicalsolutiosncorp.com for a compliance review of your benefits offering. Click here to read the American Health Care Act in its entirety.

Don’t Tax My Workplace Health Plan

Don’t Tax My Workplace Health Plan

Don’t Tax My Workplace Health Plan

Infographic_Employer_Exclusion_Final_160801ISSUE SUMMARY

Don’t Tax My Workplace Health Plan. Congress is currently considering healthcare reform proposals that would eliminate or place a cap on the employer-tax exclusion for health insurance. These proposals would undermine the employer-sponsored health insurance system that provides coverage for more than 175 million Americans. Eliminating the exclusion would eliminate most of the advantages of employer-sponsored insurance, while capping it would degrade the benefit and serve as a tax increase for middle-class Americans.

Lets highlight one particular issue of concern to most of our clients. Today, employers may deduct as a valid business expense the full cost of health insurance and other employee benefits. One of the considerations being discussed would restrict this tax-advantaged status.

The infographic  paints a picture of the importance of job-based health insurance and how valuable it is for employers as well as for American workers and their families.

Impact on American Workers

  • A study by the City University of New York School of Public Health  found that the “Cadillac Tax” will hit the middle class the hardest.
  • A study by the Economic Policy Institute found that because the tax is focused on high premiums, not high levels of coverage, companies that tend to pay higher premiums — such as small businesses and employers with a high proportion of sick workers — could wind up paying the tax even though their benefits are not particularly generous. Also, if employers try to avoid the tax by shifting to less generous plans, workers will likely suffer when it comes to their overall compensation, even if they get a boost in wages to make up for the lost health benefits.
  • The tax will disproportionately affect women, older employees and certain geographic areas. A 2014 report by actuarial and benefits consulting firm Millimani dentified that geography could potentially account for a 69.3% variation in premium. For example, a plan that would cost $9,189 in one area would cost $15,556 elsewhere. The report also demonstrates that the 40% tax’s age and gender adjustment fails to compensate for the impact those factors have on premiums when combined with a high-cost geographic area and/or lower provider discounts.
  • According to a 2014 study by Truven Health Analytics, the 40% tax will result in a cost increase of up to $480 per employee per year for plans that are expected to incur the tax. Early retirees are projected to incur the tax at a much higher rate than active employees, with 81% of such plans likely to trigger the tax.
  • A study by the American Health Policy Institute estimated the 40% tax “could cost 12.1 million employees an average of $1,050 in higher payroll and income taxes per year, if employers increase their taxable wages as they reduce the cost of health care benefits. Alternatively, these employees could see up to a $6,150 reduction in their health care benefits and little or no increase in their pay.”

Impact on Employers

  • An issue brief by the Kaiser Family Foundation found that “a meaningful percentage of employers would need to make changes in their health benefits” to avoid the 40% tax, and this percentage grows significantly over time unless employers are able to keep heath plan cost increases at low levels. In fact, 19 percent of employers already in 2015 have a plan that would exceed the threshold when flexible spending accounts are included in the calculation. These firms would need to reduce their current plan costs over the next several years to avoid the tax. By 2028, 42% of employers would have plans where costs would exceed the threshold for some or all employees. And if health plan premiums continue to grow faster than inflation, as expected, all employers will eventually be affected by the tax.
  • According to Tower-Watson survey48% of employers believe the plans they provide will be affected the first year the law is implemented. And that rises to 82% of employers by 2023, just five years later.
  • The Lockton Companies wrote in a 2015 benefits guidance document, “When we project five and ten years into the future, based on current guidance, the majority of our clients will eventually trigger the tax.”
  • Eventually, the 40% tax will apply to modest plans, not just high-cost coverage as intended. A recent study by actuarial and benefits consulting firm Mercer, found that the Federal Employees Health Benefits Program’s (FEHBP) Blue Cross Blue Shield standard option plan was projected to hit the 40% tax soon after it was originally set to go into effect.
  • A study by the American Bankers Association’s HSA Council found that “If your current HSA-qualified family health plan costs more than $17,000, including wellness programs, your firm is likely to incur excise tax liability in 2018 if anyone makes a maximum contribution.”

Impact on Health Benefits

  • The actuarial and benefits consulting firm Aon Hewitt reported in 2015 that 33% of employers surveyed are increasing deductibles and other cost-sharing, to avoid being on a trajectory to trigger the tax when it goes into effect. But fully 40% of employers expect at least one plan to unavoidably hit the tax threshold regardless.
  • A survey conducted by the National Business Group on Health found that 42% of employers said they will increase employee cost-sharing, and 37% said they will reduce spousal subsidies or implement a surcharge for covering them to minimize the impact of the excise tax.
  • A survey of 700 employers by Mercer in 2015 found that anticipation of the 40% tax is already leading many employers to consider excluding employees’ spouses from their health policies or imposing a surcharge for including them. The survey found that the tax has consistently been the primary concern of employers since passage of the Affordable Care Act.
  • The 40% tax is triggered when the value of an individual’s health plan exceeds the threshold — a supposedly high-end number for “Cadillac” plans. But a 2013 Mercer survey found that the average price of all employer-provided health plans in the state of Florida, for example, was already approaching the threshold — years before the tax is set to go into effect.

Because its thresholds are indexed to general inflation instead of faster-growing medical inflation, more plans will be hit by the tax every year. The tax thresholds are indexed to the Consumer Price Index, which the Congressional Budget Office (CBO) estimates will rise annually by 2.4% on average over the next decade. But the Centers for Medicare and Medicaid Services (CMS) projects private health care spending to rise 5.8% on average each year, as health care costs increase significantly faster than general inflation. This insufficient indexing of the thresholds means more and more plans will trigger the tax, and to a greater extent, over time.

Take Action Today:

  • Tell Congress to Oppose Eliminating or Capping the Employer Exclusion – click here
  • Join Fight the Cadillac Tax  – click here.

Contact Us Now    Learn how our Agency is helping buinsesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 

1095B and 6055 Reporting Requirements FAQ

1095B and 6055 Reporting Requirements FAQ

1095B and 6055 Reporting Requirements FAQ

Under Obamacare, the IRS needs to know if your coverage met health care reform standards.  The 1095-B is issued by Insurers on behalf of fully insured members directly to the IRS and send members a copy.  In short you don’t have to do anything other than reviewing the info and confirming accuracy. 1095B and 6055 Reporting Requirements FAQ

The IRS will accept any number of items to prove that a member had insurance including:

  1. insurance cards
  2. explanation of benefits  statements from your insurer
  3. W-2 Form or payroll statements reflecting health insurance deductions
  4. records of advance payments of the premium tax credit
  5. other statements indicating that you, or a member of your family, had health care coverage

6055 chart

What information is on the 1095-B form?

For each person covered on your policy, the 1095-B lists:

  • Name
  • Address
  • Date of birth
  • Taxpayer identification number (most likely a Social Security number)
  • Months of coverage with us

If you are missing the taxpayer ID or Social Security numbers for anyone on your policy, the Insurer send you a letter. It’ll explain why they need the information and how to send it to Insurers  securely.

How do I know if I should get a 1095-B form?

Insuerers send you a 1095-B form if:

  • You bought your coverage directly  and did NOT go through healthcare.gov.
  • You get employer coverage and it met the health care reform standards.
6055-1095-b-logo 6056-1095-c-logo
6055 Reporting on Form 1095-B 6056 Reporting on Form 1095-C
Provided by Insurer for insured medical plan; by employer for a self-insured medical plan Provided by applicable large employer (ALE)
Provided to each covered “responsible individual” (e.g., employee, COBRA QB, retiree) Provided to each full time employee
Provided by March 31, 2016 for coverage in prior calendar year Provided by March 31, 2016 for coverage offered in prior calendar year
Transmitted with employer’s Form 1094-B to IRS by May 31, 2016 (June 30, 2016 if filed electronically) Transmitted with employer’s Form 1094-C to IRS by May 31, 2016 (June 30, 2016 if filed electronically)
RESOURCE:
1095-B FAQ – Oxford 1095B reform-reporting-requirements-6055-external-FAQs copy
1096-C FAQ – https://medicalsolutionscorp.com/compliance-consulting/form-1095-c-faq/
See IRS Extends 1094 and 1095 DEADLINE – https://medicalsolutionscorp.com/irs-extends-1094-and-1095-deadlines/

If your organization can use a helpful audit on ACA, Payroll and HR please contact us today  (855) 667-4621 or info@medicalsolutionscorp.com.

 

This communication is not intended, nor should it be construed, as legal or tax advice. Please contact a competent legal or tax professional for legal advice, tax treatment and restrictions. Federal and state laws and regulations are subject to change.