Ten Things I Learned About the Affordable Care Act this Weekend

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October 1st, 2013 has come and gone, and the Affordable Care Act, aka Obamacare, is the elephant in the room. It’s here, whether we like it or not. We can ignore it, criticize it and demonize it, but it’s now the law; being a licensed Life and Health Insurance Agent, I have to find ways to peacefully coexist with it, whether I’m in favor of it or not. I’ve received numerous calls from friends and clients, wanting to know how this is going to affect them. I’m ashamed to say that I didn’t have any answers for them; I was just as ignorant about the down ‘n’ dirty details of the ACA as they were. So this weekend I put on my investigator’s hat and got busy. Since most people fear what they don’t understand, this post is going to give you the “Reader’s Digest Condensed” version of ten of the most important things I’ve learned about the Affordable Care Act this weekend, and what’s in it for Individuals and Small Businesses. When you strip away the politics and look at the nuts and bolts of it, it’s really not as scary as you think.

(Note: This post isn’t meant to be a totally comprehensive and detailed reference on the ACA, just an overview of some of more interesting factoids I learned through the courses I took to get certified to do business through the Federally-facilitated Marketplace. For more information, check out Healthcare.gov)

1. There is now a requirement to maintain minimum essential coverage or make an annual payment with your tax return ($95 per adult, $47.50 per child, or 1% of your income for 2014, whichever is higher. That amount will rise to $695 or 2.5% in 2016). This is one detail of the ACA that has everyone up in arms. But the news isn’t all bad; you might qualify for an exemption from the payment requirement for a variety of reasons. And even if you don’t, you might qualify for a tax credit to help defray the cost of your monthly premium, as well as cost-sharing reductions to help with your out-of-pocket expenses.

Did you know…A smoker cannot be charged more than 1.5 times the premium of a non-smoker? On a SHOP policy, the tobacco surcharge may be eliminated if the insured participates in a wellness program!

2. In some states, Medicaid has been expanded to cover individuals under the age of 65 whose household incomes are less than 138% of the Federal Poverty Level (FPL). Translated into dollars and cents, in 2013 the FPL is $11,490 for an individual, and $23,550 for a family of four. In the past, you needed to visit several agencies to determine your eligibility for various benefit programs, but now that determination will be made via the one streamlined application you complete through the Marketplace. Once your information is submitted and verified, the Marketplace will determine your eligibility for Advance Premium Tax Credits, Cost Sharing Reductions, Medicaid, and CHIP (Child Health Insurance Program), a program to cover children of families whose income is too high for Medicaid, but they can’t afford health insurance.

Did you know…

– An older person cannot be charged more than 3 times the cost of the premium of a 21 year old?

3. As of 2012, Health Insurance issuers must use an average of 80 cents out of every premium dollar to pay customers’ medical claims and conduct activities that improve the quality of care – leaving the remaining 20 cents for salaries, administrative expenses and profits. Companies that aren’t spending enough of their premium dollars on health care expenses must provide rebates to insured individuals or policyholders.

4. Marketplaces will only offer health plans that are certified as Qualified Health Plans or QHP. These plans must meet certain criteria, including at a minimum, a set of ten essential health benefits (EHB), as well as non-discrimination requirements, limits on cost-sharing and provider network adequacy standards.

Did you know…Coverage limitations based on pre-existing conditions are now prohibited, as is charging a higher premium based on health status or gender.

5. The ten Essential Health Benefits include ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

6. There will be 5 levels of coverage or “generosity” available through the Marketplace: Catastrophic, Bronze, Silver, Gold and Platinum. The “metal levels” represent cost-sharing percentages: 60%, 70%, 80% and 90%. Catastrophic plans are limited to people under 30 years old OR those who qualify for a “hardship exemption” because the Marketplace determined that they are unable to afford health coverage.

7. Small businesses can be eligible to select a program through the Small Business Health Options Program (SHOP) if they have at least one full-time employee and no more than 50 full-time equivalent (FTE) employees, and the average annual salary doesn’t exceed $50,000. If the small business pays at least 50% of their employees’ health insurance premiums, and they have under 25 FTE employees, the business may qualify for a tax credit to help defray the cost of their contribution.

8. Employees who are participating in their employer’s plan will not be eligible for Advance Premium Tax Credits or Cost Sharing Reduction.

Did you know…Employer-provided health insurance is considered unaffordable if the individual premium exceeds 9.5% of your monthly household income.

9. There are several ways to learn about what you’re eligible for under the ACA, the Healthcare Marketplace (or Exchange) website, Healthcare.gov, the toll-free information number, 800-318-2596, or you can contact a certified agent or broker who can walk you through it all and assist you with your application (like me, for instance). ;o)

10. If you go through an agent or broker, our commission is going to be paid by the Insurance Provider – just like it always is – so don’t be concerned that having the help of a licensed agent or broker is going to cost you anything. It won’t raise your premium to have an agent; by the same token, it’s not going to reduce your premium if you go it alone.

So there you have it, ten things about the ACA that I learned this weekend (plus a few bonus factoids). I’ll be honest, I’ve never been a fan of mandated health insurance. If an individual wants to play the odds and forego coverage, that should be his or her prerogative. But I do think that the ACA has a lot going for it – moreso than I originally thought – and I was pleasantly surprised and more than a little relieved once I started taking the time to inform myself about it. The lesson here is that knowledge is empowering. Don’t depend on the press or snippets of politically charged rhetoric on Facebook to form your opinion on this very important subject. I’ve barely scratched the surface – dig in and find out what this law is going to mean to you and your family before you sing its praises or rip it to shreds. If you have questions, feel free to post them here and I’ll do my best to answer them.

Rosalie Diane Davis is a licensed Life and Health Insurance professional in the state of Tennessee, and is certified through the Centers for Medicare & Medicaid Services as a Health Insurance Marketplace in-person consumer assister.

6 Tips to Recover from Job Loss

Changes in your work environment can be devastating when they aren’t your idea. In today’s economic climate, so many businesses are downsizing or closing that professional upheaval is not always personal, but when you’re the one who’s losing your source of income it sure feels personal. Being laid off or forced to take retirement when you still feel you have a lot to contribute is demoralizing, but it’s not the end of the world. Here are some tips to overcome the doldrums when your job has come to an end:

* Give yourself a few days to mourn the loss of your job. BUT, don’t get mired in misery. It’s counter-productive to getting your life back in order.

* Don’t let your job loss define you. Let it be an opportunity to reinvent yourself as an entrepreneur, or an artist, or even a belly dancer. This is the time to let your imagination run wild! It doesn’t so much matter what you do, as long as you do something. A little creative action is a whole lot better than staying home in your jammies, watching The Price is Right.

* Don’t wait for someone else to decide to give you a job.Use the extra free time to create one for yourself. It will keep your mind occupied while you’re waiting for the perfect “next job” to come along and you might accidentally fall into a successful new career as your own boss.

* Don’t worry about what people will think if you choose a job that’s not as prestigious as the one you used to have.  Maybe you were a high-powered executive, a stockbroker or a systems analyst, but something inside of you longed to be a landscaper or a manicurist. The next chapter of your life could be the most satisfying one yet if you get in touch with what works for you. Don’t be afraid that people will compare your new enterprise to your previous career and wonder “what was he/she thinking???” In about 5 minutes they’ll get over it and move on to criticizing someone else.

* If you’ve made a career change and it was a mistake, don’t let your pride stand in the way of moving on to something that does work for you. Sure, it’s hard to admit that the job or business you were so enthusiastic about hasn’t worked out the way you planned. But in the interest of your sanity, don’t drag it out. Cut your losses and move on to something better for you.

* And in the same vein, Don’t condemn yourself if you try something new and it doesn’t work out. I know it sounds trite, but the only true failure lies in not trying. You just never know if your next venture might be the one that clicks. Think Thomas Edison and the light bulb. Edison and his associates made over three thousand attempts before they made an efficient incandescent light bulb. Aren’t you glad they didn’t give up?

Those are only a few things to keep in mind when your professional life is in upheaval. If you’ve found a creative way to reinvent your career, please feel free to share it here. Until next time, Be Fearless!

Don’t Like the Show? Change the Channel!

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I fell asleep early last night, despite the fact that I had caffeine after 4 p.m. When I woke up at 2 a.m. I had my netbook in my lap, glasses on my head, and the television on. There’s not a whole lot on the tube at that hour of the night, just a variety of infomercials, and pharmaceutical ads with their attendant warning statements, none of which suited my fancy. The problem was that I was under the covers, and the remote wasn’t. Frankly, I didn’t really feel like getting out of my warm, cozy bed just to change the channel or turn off the tv. So I pulled the blanket over my head to muffle the sound and went back to sleep.

Your mind is a lot like that tv with the annoying commercials and news programs with disturbing images that you don’t particularly want to see. The only difference is that you’re in charge of the programming. Those disturbing images and warning labels are sponsored by none other than Y-O-U. Are you going to pull the covers over your head and hope that those scary and annoying thoughts will quiet down long enough for you to get some sleep, or are you going to change the channel to a more entertaining, inspiring and encouraging show? Right now, vow that you won’t waste one more minute on mental programming that’s going to annoy, discourage or frighten you. If you don’t like the program that’s on the air in your mind, get off your imaginary couch and change your channel!

Reinventing Yourself as an Entrepreneur After Retirement

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You’ve gotten a luncheon and a “gold watch”, or maybe just a boot out the door, and if you’re lucky, you got a separation package. But now that you’re retired, what’s next?

If you were lucky enough to have worked for an organization that provides a pension, retirement can be a time of leisure activities and travel, but that benefit isn’t a prevalent now as it was in previous generations. In an economic climate where companies are keeping full time employees to a minimum in an effort to avoid the expense of benefit packages, pensions are a rarity, and Social Security was never intended to be one’s only source of income. That leaves many retirees facing the dilemma of how to make ends meet until they meet their end. With many workers retiring younger and living longer than ever before, that could be 20-25 years or longer, unlike earlier generations, whose life expectancy was approximately 6-7 years beyond retirement. I don’t know about you, but most people don’t have enough money saved up to last for the next 20 minutes, never mind 20 years. I know I’m going to have to do something to keep body and soul together once I reach that magic age, and I know I’m not alone. But what?

The cold, hard truth is that once you reach a certain age, employers are not going to be lining up to hire you, for a variety of reasons. Older workers are more expensive. They won’t work for minimum wage like their younger, less experienced counterparts. It’s more costly to provide health benefits, and if health benefits are provided, they’re more likely to use them. Then there’s the possibility that they’ll invest money on training, only to have the older employee leave just a few years down the road.

A prime example of the not-so thinly veiled attitudes toward older workers is the big-box tech retailer I worked for, just prior to their untimely demise. The first people they laid off were the ones who had been there the longest, were making the most money, and were using the health benefits – and all but two were over 40. One of the two younger employees had a child born prematurely and the healthcare expenses paid on his behalf totaled several hundred thousand dollars. Once these people were gone, I was the oldest employee at that location; at 52, I was twenty-five years older than the next-oldest employee who also happened to be the store manager. I was a reliable and productive employee, however I was the next to be laid off, while others who weren’t as experienced were kept on. Coincidentally, this was the week before I was eligible for health insurance. I got my benefit packet in the mail just a couple of days later.

It’s no wonder that a lot of retirees are creating businesses of their own as their second career. There are a lot of advantages to self-employment, especially for older workers:

– After years of punching a clock, it’s exhilarating to be in charge of your time and your life for a change. You can decide what hours you’re going to work; if you want to work overnight to meet a deadline, that’s your call to make, and by the same token, you have the choice to take time off whenever you want..

– Although customers and clients come and go, nobody is going to have the power to make your job disappear.

– Clients and customers appreciate the expertise you bring to the table, instead of writing you off because you’re not fresh out of college and willing to work for less.

– You have the final say about what you’re going to be paid. No more hoping that someone else will decide to give you a raise or a bonus.

– If your business is one that can be conducted virtually – online, or via phone, messaging or Skype – your place of business is wherever you happen to be, as long as you have internet or a phone signal.

When it comes to re-imagining your work life, what looks and feels like success to you? Is it having an opportunity to turn a beloved hobby or talent into a source of income? Is it the ability to work from home? Is it taking control over your time, or having more free time to enjoy family or leisure pursuits? When considering your options, make a “wish list” of factors to help you plot out your next move.

Approach the post-retirement phase of your life with a sense of adventure! It’s not “the end”, only the end of one chapter and the beginning of another one that holds the promise of being even better, because this time, YOU are in control. Don’t just let retirement just “happen” to you. Take it by the horns and show it who’s boss. Live by intention, not by chance!

Are you facing life or career changes and need to plan your next move? Check out our site at http://www.EliteSuccessCoaching.com to learn how Coaching can benefit you!

Why Do I Need a Success Coach?

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Have you ever tried to analyze your golf swing while your head is down, your feet shoulder-width apart and your club poised at the highest point of its arc? Unless you have a video camera and can step away in mid-swing to watch yourself on the display, it can’t be done. You’re too close to the situation. That’s why successful golfers enlist the services of a Coach, someone to help them take the talent and ability they already have and refine it into a game-winning technique. Not many golfers can say they’ve won the Masters Tournament without the help of a coach. The same can be said of Football, Basketball and Baseball. Very few players are in there coaching the team.

Sports and life are a lot alike. When you’re facing challenges and changes in your life, whether they stem from your career, relationship or other facet of your situation, you can’t just say, “everyone stop for a minute while I step outside the picture for a better look.” That’s where a Personal Coach comes in. Since he or she is removed from your situation, they can see it from an outsider’s perspective, and help you to identify areas where you might benefit from a change in technique, or help you gain clarity about the focus of your goals. Using the services of a Personal Success Coach could mean the difference between “competing on a local level or taking it all the way to the Masters” where your life is concerned! The objective is to help you meet your potential and become the best “you” out there.

If you would like to explore the possibilities that Personal Coaching could open up in your life, email Elite Success Coaching at elitempowerment@gmail.com or visit us on the web at EliteSuccessCoaching.com .

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