Healthcare Reform Issues

We want to share with our clients and friends some of the issues being discussed in the Insurance Industry. We will only post things that seem to be effecting you now or soon will. There are many many more areas of concern. These are just a few for conversation.

Key Feature of the Law

Individual Mandate began 1/1/14. State Exchanges  became active. You must enroll in either the annual Open Enrollment for the 1st of the year or have a Special Enrollment reason to qualify mid year. This is all NEW and different. Please inquire if you loose coverage mid year. Some states allow for Temporary coverages but the rules are different. This is what makes the law effective or not.

Areas of concern are Rights and Protections, Insurance Choices, Insurance Costs, 65 or Older, Employers coverage.

Concerns about State Exchanges for Individuals, Small Employers and Large Business are continuing to be exposed. One of our biggest concerns continues to be that of COMPLIANCE. Many employers will need to enhance their on-boarding packets or annual distribution of required forms. “Skinny Plans” have been created and reviewed. Many employers are attracted to the cost but are concerned about the coverage they provide. Many have even been questioned as to their meeting the 60% Min Actuarial Value test.


The part of the law for Employers that states “Pay or Play”  This ONLY applies to employers with 50 or more full time employees. But, don’t forget to calculate correctly for the part time and seasonal. There will be 2 types of penalties. One due to employer coverage that is “unaffordable” and the other is the employer fails to offer Minimum Essential Benefits (which includes not offering coverage at all).

“Un-affordable” means the employee pays over 9.5% of their wages for healthcare. If you believe you qualify for an exemption check out what the IRS SAYS.


  • Timeline of Healthcare Reform Changes can be found HERE.
  • Individual Tax Credit Calculator provided by Kaiser Foundation HERE This is very interesting if you test a few scenarios.
  • Check back for more updates.

Maryland Exchange Carriers

Maryland residents and small employers through Maryland Health Connection will start with the following list of carriers and breakdown of the markets they will serve. Each state has their own approved list of Carriers and plans.


2015 Changes

Welcome to 2015. Concerns this year will focus on Mandate and Reporting. We will see effects of the Pay or Play rules, Compliance with the rules over the past few years to include Section 6055 and 6056 (IRS Reporting on plans and participants) We still may see changes on these requirements and/or timing.






Patient Centered Outcomes Research Institute (PCORI)