Get the tools and information you need to understand health care reform. FirstCare has gathered the best calculators, articles, and links from the most trusted sources in the industry to keep you informed on the latest developments.
Learn how health care reform will impact your community. We’ve asked local employers, insurance professionals, and health care providers to list their top concerns with providing affordable, quality health care to West Texans in 2014.
Find the answers you’re looking for in our FAQ section. We’ll be updating this list based on the conversations we have with our clients and partners, so check back often.
Can’t find what you’re looking for? We’re here to help.
Changes to Health Insurance
What is health care reform versus the Affordable Care Act?
The Affordable Care Act (ACA), commonly referred to as health care reform, is a United States federal statute that was signed into law in 2010. The ACA is designed to improve the quality of health care, increase access to care, and reduce costs. The ACA mandates began in 2010, but the most significant changes to health care and insurance will occur in 2014.
What is the Health Insurance Marketplace?
The Health Insurance Marketplace will be a new way for individuals, families, and small businesses to buy health insurance beginning in 2014. The Marketplace will list and compare health insurance companies that have applied with the Federal Government to be listed as a Qualified Health Plans (QHPs). As a QHP, an insurance company has agreed to offer comprehensive coverage from doctors to medications to hospital visits.
As an agent/broker, do I have to be certified to sell Marketplace plans?
As an agent/broker, do I have to be certified to sell Marketplace plans?
Yes. In order to enroll clients in a FirstCare Marketplace plan, agents must first register with the Centers for Medicare and Medicaid Services (CMS) and send the registration information to FirstCare using the
CMS Certified Agent Verification Form.
How do I become a CMS-certified agent?
• Complete CMS registration to obtain a federally-facilitated marketplace user ID
• Print a copy of the Certificate of Completion
• Complete the CMS Certified Agent Verification Form
• Fax or mail the completed form and copy of the Certificate of Completion to FirstCare to the address listed on the verification form
Am I eligible for commissions or a bonus for Marketplace plans?
Yes. Certified agents seeking compensation from FirstCare on our Marketplace plans must have their FFM user ID on file with FirstCare at the time of enrollment and the FFM user ID must be entered on the client’s enrollment application.
What is the Small Business Health Options Program
On July 5, 2013, The Centers for Medicare and Medicaid Services released updated guidance on the SHOP Marketplace. To learn how the SHOP will impact agents and small employers, please refer to the SHOP Issuer Frequently Asked Questions.
As an agent/broker, do I have to be certified to sell SHOP plans?
Yes. Agents and brokers must sign a privacy and security agreement with the Federally-facilitated SHOP in order to sell SHOP plans. Agents and brokers are also encouraged to take the free
CMS online training. For more information, visit
As an employer, do I have to purchase my company’s health insurance from the Health Insurance Marketplace?
No. Individuals and small businesses can continue to purchase coverage through agents or through insurance carriers, in addition to buying coverage through the Marketplace.
Coverage in 2014
When will I be able to purchase health insurance for 2014?
Beginning October 2013, individuals and families will be able to access information about all the plans available through the Marketplace. Individuals and families can enroll in health insurance plans for 2014 during the open enrollment period from October 1, 2013, to March 31, 2014. At that time, the Small Business Health Options Exchange, or SHOP Exchange, will be available to small businesses.
There is also a special enrollment period for individuals who experience a life-changing event (such as the loss of a job, death of a spouse, or birth of a child). They may enroll in a new plan within 60 days of the event.
How are health insurance plans changing in 2014?
In the individual and small business markets, health plans will have four different coverage levels. These new plans are often referred to as the "metal plans" since they are each named after a different type of metal (platinum, gold, silver, and bronze), similar to the Olympics. Each metal level has a different cost sharing.
In the individual market, there is also a catastrophic plan that works differently. Catastrophic plans will cover the essential health benefits (covered below), plus three primary care visits per year. The catastrophic plan is only available to consumers under age 30 and other consumers who are exempt from the individual mandate because of low income or other hardship.
How does the employer mandate apply to my business?
Beginning January 1, 2014, Applicable Employers (discussed below) will be required to offer minimum essential health coverage to their full-time employees that is affordable or face a possible penalty. Individuals can buy their own coverage and receive a premium subsidy from the government to help lower their out-of-pocket costs. The business pays a penalty if more than 30 of its employees buy their own insurance in the Marketplace. (The penalty will be $2,000 for each full time worker after the first 30 who receive subsidies.)
Keep in mind that some employees will not qualify for a subsidy and some will not buy insurance because they have coverage through a spouse.
Is my business an Applicable Employer?
Companies that have employed an average of 50 or more full-time and/or full-time equivalent employees during the preceding calendar year will qualify as Applicable Employers. Employers with fewer than 50 employees may be considered Applicable Employers because of the way the government determines full-time employee status.
How do I determine the number of full-time and equivalent (FTE) employees?
The IRS has a special method for calculating the number of full-time and equivalent employees you have. To find out if you qualify, use our
Full-time Equivalent Calculator
In 2015, will the SHOP automatically renew the plans for any group that enrolled or applied for the 2014 tax credit?
No. All 2015 plan year Federally-facilitated SHOP enrollments will take place via HealthCare.gov.
What are the Essential Health Benefits (EHB) and when will they be effective?
The EHB requirements become effective for each plan on the first day of the first plan year beginning on or after January 1, 2014. They apply only in the fully insured individual and small group market. Grandfathered plans and self-funded plans are excluded from the EHB requirements.
Do EHB requirements apply to self-funded plans?
No, self-funded plans are exempt from the EHB requirements.
What are preventive services and when will the requirement to provide them be effective?
Beginning in 2014, most health plans will provide coverage for preventive care without any member cost sharing (such as coinsurance, deductible, or copayment) as long as the services are provided in-network.
There are specific additional preventive services for children, women, and men. For a complete list,
What is the waiting period for new employees enrolled in a SHOP plan?
For 2014, there is a maximum 90-day waiting period for new employees.
Taxes and Credits
Are there health care reform taxes I need to be aware of?
If my company applied for a tax credit in 2014, is it considered a SHOP group?
Yes. Groups that have applied for the 2014 tax credit are considered to be part of the SHOP.
Am I eligible for tax credits?
If you are an employer with fewer than 25 employees and you provide health insurance, you may qualify for a small business tax credit this year of up to 35 percent to offset the cost of providing insurance. Non-profits may qualify for a small business tax credit up to 25 percent. To find out if you are eligible, use our
Small Business Tax Credit Calculator
or contact your tax professional.
Health care reform will affect each unique community in different ways.
That’s why we’ve been talking with employers in our community and the surrounding area, and with our agents, providers, and members to get their perspectives about the opportunities and challenges related to health care reform changes.
Coming Soon! We’re developing an answer line that will allow you to chat online with our health care reform specialists.