How the ACA’s insurance marketplace will affect employers Featured

3:43pm EDT September 2, 2013
Marty Hauser, CEO, SummaCare, Inc. Marty Hauser, CEO, SummaCare, Inc.

To learn more about health care reform, visit www.summacare.com/healthcarereform or www.healthcare.gov.

With the health insurance marketplace opening next month, the market is expected to be flooded with consumers trying to find a plan that works best for them and their budgets.

“The fact is people who have not previously had access to health insurance may be in shopping mode come Oct. 1 when the health insurance marketplace opens,” says Marty Hauser, CEO of SummaCare, Inc. “Our job as health insurers is to ensure employers and other consumers have access to the most accurate information available to them when it comes to choosing a carrier and a plan both on and off the marketplace.”

Smart Business spoke with Hauser about ways employers can assist employees shopping and applying for 2014 health insurance coverage on and off the marketplace.

What should employers that currently offer health insurance to their employees do when the marketplace opens?

Regardless of the company size, employers should communicate to employees if they will be offering employer-sponsored coverage next year and what type will be offered. Having this information will likely impact their employees’ decision on whether or not to shop for an individual plan on or off the marketplace.  

Are companies required to offer insurance to their employees in 2014?

While there are tax incentives for small group employers — those with two to 24 employees — to offer their employees health insurance benefits next year, it’s not required under the Affordable Care Act (ACA).  

Large group employers — those with 51 or more employees — however, are required to offer health insurance next year, but the penalty for not offering coverage has been delayed until 2015.

What can employers do if they are not offering insurance to employees next year?

If an employer chooses not to offer employer-sponsored coverage next year, they may want to consider a defined contribution health plan approach in which the employer decides how much to contribute to an employee’s health care expenses and the employees purchase health insurance on their own. Coverage can be purchased through the health insurance marketplace, direct from a health insurance company or through an individual insurance agent. Individuals can begin shopping Oct. 1 for plans effective Jan. 1, 2014.

How can employers not offering insurance help their employees get assistance in purchasing a health insurance policy?

Employers’ options include gathering and sharing information from their current insurer to share with employees, putting their employees in contact with a health insurance broker or making them aware of help offered by certified application counselors (CAC) and navigators. 

It’s also important to remember that employers are required to notify their employees of the availability of the health insurance marketplace by Oct. 1. 

What are CACs and Navigators?

CACs and navigators can assist individuals interested in enrolling through the marketplace, as both are trained to help with the application and enrollment process. Navigators receive grants for helping individuals and small employers shop and enroll in a health insurance plan, and they will conduct public education about the availability of qualified health plans, among other responsibilities. Navigators are held to detailed conflict of interest standards and eligibility requirements.

CACs are unpaid volunteers who typically work through organizations such as community health centers, social service organizations and hospitals. CACs are not subject to the same standards as navigators, but can still assist individuals. 

Where can employers go to learn more?

Health insurers and/or insurance brokers can help guide employers in learning more about their insurance options for 2014 and beyond. In addition, information about the health insurance marketplace and other provisions and mandates under the ACA may be available through your insurer’s website. For additional information, visit www.healthcare.gov.

Marty Hauser is CEO of SummaCare, Inc. Reach him at hauserm@summacare.com.

Insights Health Care is brought to you by SummaCare, Inc.