Tired of political soundbites and opinions masquerading as news? Would you like to know What's REALLY going on in Texas about Obamacare. Would you like information that you can actually use to help you, your employees and your family decide what you should do, and when you should do it? Then you need to watch this presentation and call me, Michael Chapman, at (888)398-6246, or email me mtchapman@endeavorgroup.net, and let me help you make the best decision you can make and take action. I am a licensed, experienced and certified broker who will help you now and throughout the year with expert advice and support, and at no cost.

1. ACA: The Great Equalizer for Small
to Mid-Size Businesses (SMBs)
New Strategies On How to Use ACA to:
•
Benefit your Business
•
Benefit Your Employees
•
Disadvantage Your (Bigger) Competitors.
•
And how to keep more of what you make!
…Stuff your benefits consultant or broker
doesn’t know or doesn’t want you to know!

2. ACA: The Great Equalizer for Small
to Mid-Size Businesses (SMBs)
Find some ACA “Easter” Eggs for your biz!
…Stuff your benefits consultant or broker
doesn’t know or doesn’t want you to know!

5. US History Lesson
1935:
1965:
1985:
2003:
2010:
Social Security and Disability Created
Medicare Created
COBRA Created
Medicare Prescription Drug “Part D” Created
ACA (Obamacare) Created
Each of Above was Controversial Each Required
Education and Adjustment by Americans Each Bas Been
Modified Through Legislation None Has Ever Been
Repealed Each Quickly Became a “Right of Citizenship”
2014: ACA “Guaranteed Issue” Health Plans
– History Repeats Itself!

6. “The Good Ship
„Guaranteed Issue‟ Has Sailed”
• ACA can’t be defunded without
Senate vote to change ACA from a
Mandatory to Discretionary
Spending budget item.
• Future changes likely, but
“Guaranteed Issue” is here to stay

7. ACA Individual Plans:
“Better” than Group Plans
• Comprehensive, Essential Health Benefits
in all ACA Plans:
• Preventative, Wellness
• Maternity, Child Dental, Vision
• Serious mental, emotional, drug/alcohol
abuse, tobacco cessation, obesity
counseling.

8. Under Healthcare Reform,
Are Benefits Still Beneficial?
Why many employees will seek jobs
that do NOT offer group health
insurance starting in 2014, and how
SMBs can benefit…

9. Under Healthcare Reform,
Are Benefits Still Beneficial?
Under ACA, Bigger ≠ Better
• 2015 Employer Tax Penalties
• More Compliance
• More Legal, Administrative
In Fact, Being Smaller May Be
Better, More Profitable!

10. Under Healthcare Reform,
Are Benefits Still Beneficial?
“Benefit” of Getting Bigger:
• Self-Insure = Lower Cost under ACA
•
•
•
Less Mandates, Taxes
No Community Rating
More Control Over Employee Health
• 100+ (Healthy) Employees

11. A:

12. Why are they called “Benefits”?
Because They Benefit the Employee.
Four ways:
1. Employer Contribution – Nobody else is going to
pay for their health insurance
2. Tax Free – Receive benefits tax free, pay their portion
of premium tax free through 125 plan
3. Guaranteed Issue – Employees and dependents
cannot be denied coverage or charged more due to
medical conditions (big deal in Texas)
4. Mandated Benefits – Group plans cover services
not covered by individual plans (i.e. maternity –
although these benefits do drive up the costs)

13. Most of the “Benefits” are Gone
The “Benefits” of a Group Health Plan Are
Gone in 2014.
1. Employer Contribution – This now penalizes most
employees (More about this later)
2. Tax Free – Receive benefits tax free, pay their portion of
premiums tax free through 125 Cafeteria plan.
3. Guaranteed issue – Employees and dependents can
no longer be denied coverage or charged more due to
medical conditions with individual ACA plans
4. Mandated Benefits – Group plans cover services now
covered by individual plans (i.e. maternity).

14. Factors will be:
1.
2.
3.
Size of Business (# of Employees)
Average Income of Employees
Costs – Group Premium Vs. Penalty etc…

15. WHAT ARE BIG EMPLOYERS
DOING ABOUT ACA?
Reducing workforce
Reducing hours to
<30hrs/week
Dropping coverage

16. WHAT ARE BIG EMPLOYERS
DOING ABOUT ACA?
Cutbacks = not a place
you want to work
Part-time/revolving door =
mistakes & lost productivity
Cost increases passed on
to customers

17. Who Wants to Work
at a BIG Company?
Losing Advantage of
Size and Scale
Employer of Last Resort
+ No loyalty
Lower profits,
Customer satisfaction.

18. ACA advantages to SMBs
SMBs can become an
employer of choice
Stable, personal SMB =
customer, employee loyalty
Lower employee cost,
lower turnover, more talent

19. ACA Plan Rates:
•
•
•
•
•
•
•
•
ACA Plan N. TX Premiums:
Lowest cost PPO (Bronze) Plan for 40/50/60 yo:
•
$239.70/$354.22/$539.68
Lowest cost PPO (Silver) Plan for 40/50/60 yo:
$341.04/$488.51/$736.04
Lowest cost PPO (Gold) Plan for 40/50/60 yo:
$412.26/$590.52/$889.75
Lowest Cost HMO (Bronze) Plan for 40/50/60 yo:
$189.72/$271.82/$409.46

20. How Dropping Group Health Benefits
Helps “Most” Employees under ACA
IRS Tax Subsidies are
SMBs New Best
Friend.
(& Employees‟ New Best Friend.)

21. Household Size ~ Household Income ~ Annual Subsidy
Here’s The Link to Subsidy Calculator:
http://themedicalinsuranceexchange.com/oba
macare-subsidy-calculator/

22. Dropping Group Health Benefits Helps
“Most” Employees under ACA
For “Most” Employees, An
Employer Health Plan is NOT a
Benefit under ACA!
One Example:
• Median for HH Family of 4: $60,000
– Employer Pays 50% of Employee Only
Premium, $250 per month, $3,000/yr.
– Est. Cost to Insure Family = $11,500/yr.
– IRS Premium Tax Credit: $6,700

23. Big ACA “GOTCHA”:
• If Either Spouse‟s Employer
Offers a Group Health Plan for
Employees…
• Then Entire Household is
Disqualified from IRS
Premium Tax Credit!

24. Big ACA “GOTCHA”:
• The $ from the IRS
Premium Subsidy Likely
More than What
Employer Contributes
for Health Insurance!

25. No Tax Subsidies if a Group
Health Plan Available
This Is Why Unions Are So Mad!

26. Your Company Key Employees
“Experienced”
Employees
• Big Companies with
Big, Self-Insured
Health Plans Will
Continue to Shed
Older, Wiser
Employees
• BIG OPPORTUNITY
FOR SMBs to pick up
valuable talent
without risk of
medical claims
hurting company‟s
benefits.

27. What about your #1, And
Most Valuable Employee?

28. What about your #1,
Most Valuable Employee?
YOU!
Founder/CEO
• If Dropping Group Health
Insurance Saves Your
Employees $$ and gives
them better coverage
options…
• …What could dropping
Group Health do to
Benefit Your Business
and Benefit YOU?

29. What about your #1,
Most Valuable Employee?
YOU!
Founder/CEO
How Dropping Group
Health Ins. Can Benefit
Your Business:
• Reduces administrative
time + red tape.
• Eliminates your
company’s biggest
budget inflation item.
• Frees up $$ for other
uses in the business.

30. What about your #1,
Most Valuable Employee?
YOU!
Founder/CEO
How Dropping Group
Health Ins. Can Benefit
YOU:
• Increase profitability &
business valuation.
• Fund a Max. Retirement
/Profit Sharing
Contribution
• Fund ESOP to get your
equity out of business.

31. Do the Math: Employer
• SMB with 40 employees spends
minimum of $120,000/yr. on
group health insurance
premiums
• IF SMB makes 5% after tax
profit, it takes $2,400,000 in
extra sales just to pay for group
health insurance.

32. Do the Math: Employee
• SMB pays $3,000 towards per
employee with avg. annual wages
of $50,000.
• Est. IRS Premium Subsidy of $6,500
for employee with family of 4.
• The $3,500 extra from premium
subsidy is an extra six weeks
wages.

33. Do the Math:
Self-Employed
• Deductions reduce how much you
pay in IRS Taxes.
• Deductions could also increase
your IRS Insurance Subsidy.
• Premiums are deductible if selfemployed.
• By opting to pay full premiums, you
increase deductions, and increase
IRS Tax Credit Alternative (Silver
Plan or Better)

34. If Group Health Insurance Is No
Longer a Benefit, Then What is??
Other Ways to Attract &
Retain Employees:
• Taxable Benefits:
– Pay Increase
– Bonuses
• Tax-Favored Benefits:
–
–
–
–
Profit Sharing Plan
401K Contribution
Dental, vision, other ins.
ESOP

35. My Value Proposition
Here‟s How I Help Your SMB:
• Adjust Your Employee Benefits to
ACA Realities & Opportunities
• Educate Your Employees About The
New ACA Realities & About Your
New Benefits
• Enroll Your Employees In New
Benefits, Including Individual ACA
Health Plans

36. 3 Simple Steps for Employer:
Revise Benefits Plan
Employee Group Meeting
One on One Enrollment

37. 3 Simple Steps for Employee:
Apply for Subsidy
Shop for Health
Insurance
Employee Pays The
Difference

38. Business Advantages
A Private Health Insurance Exchange
Helps You Attract and
Retain Great Employees
Offer flexible and
affordable benefit plans
that all of your employees
qualify for
Reduces Benefits
Inflation & Admin Cost

39. How can I learn more about ACA?
IMPORTANT:
Don‟t Procrastinate!
• Get familiar with rates, networks,
etc.
• Decide on best plan now.
• If no subsidy, apply now
• If subsidy-eligible, decide now,
apply asap Healthcare.gov is fixed.

40. How can I learn more about ACA?
Deadlines:
1. 11/15/13: Last date for “preACA” plan (both individual
and Group) for 12/1/13
coverage.
•
•
•
Underwritten, no IRS subsidy
Rates fixed until 12/1/14
At that point, only (higher
cost) ACA plans available

41. How can I learn more about ACA?
Deadlines:
2. 12/15/13: Last date for ACA
plan (both individual and
Group) for 1/1/14 coverage
•
•
•
Guaranteed Issue
Higher Cost
But May Qualify for IRS
Subsidy.

42. How can I learn more about ACA?
Deadlines:
3. 3/31/14: Last date for ACA
plan (both individual and
Group.) for 5/1/14 coverage
•
•
•
Guaranteed Issue
Higher Cost
But May Qualify for IRS
Subsidy.

43. How can I learn more about ACA?
Healthcare.gov Issues
No Fix Until 11/30 (maybe)
•
•
•
•
No Subsidy until fixed
Decide on Health Plan Now
Narrow Window to apply by
12/15 for 1/1/14 coverage.

44. How can I learn more about ACA?
Seek Professional Advice
•
•
•
No cost to work with a
broker.
Saves Time, Better
Decisions, avoid costly
mistakes.
Help throughout the year
with claims, insurance
issues.

45. How can I learn more about ACA?
Want an Obamacare Quote?
1. Go to:
www.TheMedicalInsurance
Exchange.com
2. Click on “Quotes” button on
Left Hand Side.
3. Go to Subsidy Calculator for
Subsidy Estimate.

46. How can I learn more about ACA?
Call/Email Me to Discuss/Enroll
–
–
mtchapman@endeavorgroup.net
(214) 764-6315
•
•
Put “Obamacare Request” in subject line.
Will send documents you need to enroll,
along with updates.
Will follow up with request for appointment
a few days later.
•

47. How can I learn more about ACA?
What you‟ll get now:
•
•
11 page ACA FAQ Guide
Subsidy Chart
•
Pre-enrollment Checklist
•
TX Rate and Plan Guide
•
Updates

48. How You‟ll Benefit
What you‟ll get:
•
Cutting Edge Advice
•
Expertise in ACA and other
insurance/benefits
•
Keep more of what you earn
•
Support throughout the year.

49. A Stress-Free ACA Enrollment
• Save you, employees $$
• Pre-education, guidance
• Smooth, hassle-free
enrollment
• Year-round support

50. Value-Based No Cost Services
What this costs you:
• Absolutely no additional cost to
enroll through a broker.
• Costs you $$$ in missed
opportunities or extra medical
expenses from poor decisions.
• Saves valuable time working
with an expert, so you can focus
on your business.

51. Value-Based No Cost Services
What this costs you:
• Absolutely no additional cost to
enroll through a broker.
• Costs you $$$ in missed
opportunities or extra medical
expenses from poor decisions.
• Saves valuable time working
with an expert, so you can focus
on your business.

52. Next Steps
•
•
•
•
•
•
Schedule Appointment
Formulate Plan
Communicate Plan
Implement/Enroll
>December 15th
Quarterly Updates

53. How can I learn more about ACA?
Call/Email Me to Discuss/Enroll
–
–
mtchapman@endeavorgroup.net
(214) 764-6315
•
•
Put “Obamacare Request” in subject line.
Will send documents you need to enroll,
along with updates.
Will follow up with request for appointment
a few days later.
•