NONPROFITS AND THE AFFORDABLE CARE ACT: BASICS YOU SHOULD KNOW


By James D’AmbrosioJamesProfile1Twitter

The Affordable Care Act, what many have termed ‘Obamacare,’ is nearly upon us and will impact nonprofits and their employees. Therefore, it’s important to understand the basics, especially those agencies delivering health care services in the community since reforms will change how people served by nonprofits will access health insurance. To that end, The National Council of Nonprofits recently provided some excellent information I’ll share.

HEALTH INSURANCE EXCHANGES 

Every state will have an Affordable Insurance Exchange or ‘Marketplace,’ where individuals and small employers can look for and purchase affordable private health insurance. Enrollment through the Exchanges begins October 1, 2013 for coverage effective January 1, 2014. Nonprofits are not required to buy insurance for employees through the Exchanges; they can continue with their existing plan. Initially, Exchanges will be open to individuals buying their own coverage and employees of firms with 100 or less workers (50 or less in some states).

Most U.S. residents will continue receiving their health insurance through their employer, not through Exchanges. For those purchasing through Exchanges, plans are arranged into four categories based on level of coverage/benefits: bronze, silver, gold and platinum; there will also be a young adults’ plan. Costs will vary by type of plan and location. Most people purchasing through the Exchange will be eligible for subsidies; insurers cannot charge more based on gender or health status.

THE SHOP PROGRAM

There’s some good news for smaller nonprofits: if your agency has less than 50 full-time employees it’s considered a ‘small employer’ and will be eligible to purchase health insurance through state-specific SHOP programs (Small Business Health Options Program) making it easier to secure affordable health plans. 

Advantages of SHOP:

♦ Agencies can offer a single plan for all employees.

♦ Nonprofits can decide how much they want to contribute towards premiums.

♦ Nonprofits can collect employees’ share of premiums through payroll deduction.

♦ Premium contributions can be made with pre-tax dollars.

♦ Agencies can receive one (1) monthly invoice and make 1 (one) monthly payment.

INFORMING EMPLOYEES 

Since employees will soon be shopping for coverage (October 1), the Council suggests sharing information about the ACA with staff, especially whether or not your agency will be offering health insurance for employees. Here’s the basics you might want to present to staff:

1) All plans must cover doctor visits, hospitalizations, maternity/emergency room care, and prescriptions.

2) Some employees will be eligible for subsidies to help pay for a health insurance plan.

3) Insurance plans cannot deny coverage for employees with pre-existing conditions.

4) All plans have to show costs and what’s covered in plain language (no fine print).

5) Policies will be sold by private insurance companies that must follow rules and provide high-quality plans.

GET MORE INFORMATION

To be sure, there’s much more to the ACA than can be addressed here. Try these resources for further information:

Call: 1-800-706-7893 (Health Insurance Marketplace Small Employer Contact Center.)

E-mail questions to: aca101@hhs.gov

SHOP EXCHANGES

A GUIDE TO HEALTH INSURANCE EXCHANGES  (Kaiser Family Foundation)

_________________________________________________________________________________________

QUESTIONS TO READERS:

a) How will the ACA impact your agency? b) Have you been preparing for the changes ahead?

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