A question about public insurance exchanges and tiny non-profits. Anyone
August 7, 2013 7:44 AM Subscribe
Can you help a small non-profit figure out our rights and opportunities with the public exchanges on October 1?
Hey everyone! I'm someone with a pretty good grasp on the PAaCA legislation, but the public exchanges get complicated a little bit for small businesses.
Long story short, we're a disability-focused non profit in WV with 8 total employees who have always had private insurance (that has sucked.) (One employee uses her husbands insurance.) This year, BCBS is smacking us with a 21% premium hike over last year, which is nuts because we basically had no utilization last year. That 21% hike constitutes an extra $15,000/year cost for the agency, which just can't happen. I'm aware that our size makes us exempt from the ACA, but we need, and want (and our boss and board want us to have) insurance. That's on top of our 20% employee contribution increase. (That's right, we're talking $72,000/year for 7 employees with a $2,500 deductible, plus the extra $3k a year we pay for any dependents.)
Our broker is telling us that if we drop commercial insurance, take that cash and apply it to individual purchases in the exchange, that we'll either find ourselves ineligible or financially penalized for dropping the private insurance. I trust him about as far as I can throw him, though.
So, the TL;DR version:
Can we drop our commercial insurances and hit the private exchange? Can our employer pay for it for us? Do they have to pay us extra each month? Any reason to believe it may be cheaper?
Hey everyone! I'm someone with a pretty good grasp on the PAaCA legislation, but the public exchanges get complicated a little bit for small businesses.
Long story short, we're a disability-focused non profit in WV with 8 total employees who have always had private insurance (that has sucked.) (One employee uses her husbands insurance.) This year, BCBS is smacking us with a 21% premium hike over last year, which is nuts because we basically had no utilization last year. That 21% hike constitutes an extra $15,000/year cost for the agency, which just can't happen. I'm aware that our size makes us exempt from the ACA, but we need, and want (and our boss and board want us to have) insurance. That's on top of our 20% employee contribution increase. (That's right, we're talking $72,000/year for 7 employees with a $2,500 deductible, plus the extra $3k a year we pay for any dependents.)
Our broker is telling us that if we drop commercial insurance, take that cash and apply it to individual purchases in the exchange, that we'll either find ourselves ineligible or financially penalized for dropping the private insurance. I trust him about as far as I can throw him, though.
So, the TL;DR version:
Can we drop our commercial insurances and hit the private exchange? Can our employer pay for it for us? Do they have to pay us extra each month? Any reason to believe it may be cheaper?
Response by poster: We're a non-profit, we don't pay tax. But thanks for the link.
posted by TomMelee at 11:32 AM on August 7, 2013
posted by TomMelee at 11:32 AM on August 7, 2013
Best answer: Enroll America has a ton of resources to help people enroll in the insurance exchanges. Most likely they will be able to help you out with this as options for insurance will vary from state to state.
They also have resources state-by-state for in-person navigators.
posted by forkisbetter at 11:37 AM on August 7, 2013
They also have resources state-by-state for in-person navigators.
posted by forkisbetter at 11:37 AM on August 7, 2013
I understand your question, and I don't have an answer, but if you find out from a source other than AskMetafilter, please share. I work for a small non-profit in Missouri and we are having the same discussion. We think our staff will be able to get cheaper, better insurance through the exchange than we can offer here. Our yearly increases have been similar to yours.
posted by hworth at 12:01 PM on August 7, 2013
posted by hworth at 12:01 PM on August 7, 2013
Response by poster: Well, I spent most of the day on this yesterday, and Mr.Know-it-some's link turned out to be pretty helpful. I'll check out the rest today and tomorrow.
Basically what I found out is that our broker lied to us, which is what I thought he was doing. I'm going to see if he can be penalized for it.
At the core I had 3 questions:
1. Can we switch without penalty
2. Which is better, the SHOP plans for small business or the individual plans.
3. If we choose individual, can our employer pay for all or some of them without jacking up our tax liability.
I now have the answer to two of them:
1. Yes. Just, period, yes. Remember that we have 8 employees, but anybody who is eligible can switch, period. (Businesses under 75 people as far as I can reckon.)
2. There is currently NO PRICING AVAILABLE. And there won't be any IDEAS until sometime next month, and nothing certain until October 1.
3. Unknown. I realize that personal contributions are going to be eligible for pretty much of a pure write-off, but our salaries plus deductions are already super low anyway. It would stink to make us uneligible or bump our bracket just to pay for healthcare.
As for the "penalty for switching" that our BS broker made up, that's just if you don't have coverage by March of 2014, NOT something that happens if people paying private insurance companies switch. Pools open October 1, benefits start January 1, period.
Regardless, my kingdom for a single-payer system. Too bad I'm such a dirty socialist.
posted by TomMelee at 7:20 AM on August 8, 2013
Basically what I found out is that our broker lied to us, which is what I thought he was doing. I'm going to see if he can be penalized for it.
At the core I had 3 questions:
1. Can we switch without penalty
2. Which is better, the SHOP plans for small business or the individual plans.
3. If we choose individual, can our employer pay for all or some of them without jacking up our tax liability.
I now have the answer to two of them:
1. Yes. Just, period, yes. Remember that we have 8 employees, but anybody who is eligible can switch, period. (Businesses under 75 people as far as I can reckon.)
2. There is currently NO PRICING AVAILABLE. And there won't be any IDEAS until sometime next month, and nothing certain until October 1.
3. Unknown. I realize that personal contributions are going to be eligible for pretty much of a pure write-off, but our salaries plus deductions are already super low anyway. It would stink to make us uneligible or bump our bracket just to pay for healthcare.
As for the "penalty for switching" that our BS broker made up, that's just if you don't have coverage by March of 2014, NOT something that happens if people paying private insurance companies switch. Pools open October 1, benefits start January 1, period.
Regardless, my kingdom for a single-payer system. Too bad I'm such a dirty socialist.
posted by TomMelee at 7:20 AM on August 8, 2013
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posted by Mr.Know-it-some at 8:44 AM on August 7, 2013