Health Care Reform: ACA Taxes

A little information about the new taxes to come in 2014 courtesy of Blue Shield:

What is it?

The Affordable Care Act (ACA) requires that taxes be collected in order to fund certain provisions of health reform. Beginning January 1, 2014, there are two new taxes that will go into effect. Below is a summary of what they are and how you can prepare.

The Health Insurer Tax – This annual tax is designed to offset a portion of the expenses related to providing premium subsidies and tax credits to qualified individuals purchasing coverage through exchanges. This tax will be applicable to all small groups effective January 1, 2014, and is expected to be approximately 2.3% of dues and/or premiums.

Transitional Reinsurance Contribution Program Tax – This tax will be used to fund transitional reinsurance programs in each state to help cover costs of the highest-risk individuals in the non-group market. It is effective from 2014 to 2016 and applies to all small groups as of January 1, 2014. In 2014, the tax is estimated to be $5.25 per Blue Shield member, which is approximately 1.5% of dues and/or premiums.

What does this mean to me and my employees?

When these taxes go into effect, customers’ dues and/or premiums will increase by an amount that covers the new taxes. Starting with January 2014 bills, the new taxes will be included as a percentage of the dues and/or premiums.

Small group employers will continue to have a 12-month rate guarantee and the plan base rates will continue to be in effect for 12 months. As mentioned above, however, in January 2014, the two taxes will be added to plan dues and/or premiums.

Health Care Reform: Open Enrollment Update

Some of you may already be aware, but the deadline to have a January 1 start date for the ACA has been bumped to December 23rd. So, if you need your insurance to start at the beginning of the year, you now have a little over a week longer to get signed up!

However, don’t forget that if you don’t need to have the insurance start immediately, Open Enrollment is going on through March 15th, so call us to schedule your appointment today!

For each month, signing up by the 15th gives you a start date of the 1st of the following month (e.g. If you enroll on February 12th, 2014, your insurance will start March 1st ).

Don’t fret! All of your Health Care Reform answers are just a phone call away with one of our Certified agents.

Top 10 ACA Points You Should Know

Are you wondering what the different parts of the ACA really mean? Straight from Blue Shield, here are the top 10 key issues you should know about.

1. Guaranteed Issue – No one will be denied healthcare due to health, age, gender, or other issues including pre-existing conditions.

2. The Individual Mandate – All individuals will be required to have coverage that qualifies as the minimum essential by January 2014, or risk paying a tax penalty.

Ind. Mandate table

3. Grandfathered Plans – People who have healthcare plans that were in effect prior to March 23, 2010, can keep their plans if they want. The only caveat is they are not subject to the ACA’s requirements.

4. New Marketplaces – Marketplaces (Exchanges) have been created as a place for people to explore and compare different health plans. You can access this marketplace directly through brokers and individual carriers just as before.

5. Open Enrollment – This Open Enrollment period began on October 1, 2013 and ends March 31, 2014.

6. Essential Health Benefits – All non-grandfathered plans for individuals and small businesses will include the following 10 categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioural health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including or and vision care

7. Metal Level Plans – All non-grandfathered health plans offered to individuals and small businesses will be required to provide coverage at a “metal level”—Platinum (90%), Gold (80%), Silver (70%), and Bronze (60%)—based on the actuarial value (E.g. With a gold plan, the Insured pays 20% of health care costs, while the plan covers 80%).

8. Federal Subsidies – Subsidies will be available starting 2014 for those whose annual income is between 134% and 400% of the Federal Poverty Level (FPL) and who meet the guidelines. Subsidies will help lower the costs of both premiums and out-of-pocket costs. Those who fall less than 134% below the poverty level may be eligible for Medi-Cal. Tax credits will also continue to be available to small businesses with 25 or less full-time equivalent employees to help cover the costs of providing coverage.

9. ACA Taxes – Taxes covering the ACA will start January 1, 2014. Click here for a downloadable copy of the ACA tax fact sheet

10. Play-or-Pay – As of January 1, 2014, the ACA requires companies over a certain size to offer affordable health coverage to full-time employees and their dependents or face paying a penalty if an employee receives federally-subsidized coverage through the Exchange.


Health Care Reform: Individual Tax Credits

Tax credits are
available for individuals and families who meet certain income requirements and
don’t have access to affordable health coverage through their employer. Below
are some key points you should know about tax credits.

  • The size of the tax credit is
    based on a sliding scale, with those who make less money getting larger
    financial support to lower their cost of insurance.
  • Individuals and families who
    make between 138 percent and 400 percent of the federal poverty level- an
    individual making up to $44,680 and a family of four making up to $92,200,
    are those who are eligible for tax credits and subsidies.
  • Tax credits lower the cost of
    your premium and can be used when you enroll, you do not need to wait
    until you file a tax return at the end of the year.
  • Tax credits are paid to your health plan monthly
    by the federal government.

In addition, as always, with any questions you have about Health Care Reform and what that can mean for your family, yourself, or your business, please feel free to either call or set up a meeting at Sweeney & Sweeney and Cheryl, Jamie, Dan, Shannon, Ellen, and/or John would be more than happy to assist with any concerns.

Health Care Reform: Health Insurance Plans at a Glance

What To Expect in 2014! 

Many of you are probably wondering what will change about your health insurance plans come January 2014. To get started, all Individual and Family Health Plans will disappear on January 1, 2014. If you have a Grand-Fathered plan that has been active and unchanged prior to March 23, 2010, then you are exempt from this requirement. The rest of us will be required to find a new plan that meets the required “Essential Health Benefits” law. Provided below is an image to show how the plans will be tiered.


You are now probably wondering what the plans must include
as “Essential Health Benefits”, as defined by the Health Care Reform.
Specifically, the plans must include these 10 categories of care:

  1. Ambulance Services
  2. Emergency Services
  3. Hospitalization
  4. Maternity and Newborn Care
  5. Mental Health, Substance Abuse, Behavioral Treatment
  6. Prescription Drugs
  7. Rehabilitative and Habilitative Services
  8. Laboratory Services
  9. Preventive and Wellness Services
  10. Pediatric

We are very excited to share with our community that
Sweeney & Sweeney will be offering health coverage inside and outside the
Exchange. Open Enrollment begins October 2013 and goes through March 2014.
Please be aware that this is the ONLY time you can obtain health coverage, and you must enroll by December 15, 2013 to have a January 1 start date for coverage. Call us for further information and stayed tuned for more to come! We still have appointments open for December!