The news continues to bring updates on health care reform initiatives under the U.S. Patient Protection and Affordable Care Act (PPACA). The state/federal insurance exchanges, now being called “marketplaces”, are scheduled to be available this fall and it seems everyone has questions about how these will be structured and what it means for individual coverage. You might wonder how PPACA will affect the benefits provided for your church staff.
What is the “marketplace”?
As part of the Patient Protection and Affordable Care Act, new health insurance marketplaces are being created where anyone can purchase coverage for themselves and their families. A marketplace is like an online insurance mega-mall. Based on where they live, participants will get insurance options to compare, and the marketplace will ensure insurance companies compete under fairly strict rules. These marketplaces will have open enrollment in October 2013, with coverage beginning January 1, 2014. Additional information regarding each state can be found at the Kaiser Health website http://kff.org/health-reform
If our church provides coverage for our staff through a group plan, could an individual staff still go to the marketplace to purchase coverage?
Yes, although the individual will not be eligible for any subsidy if the group plan offered through your church meets essential benefit and affordability guidelines. The answer would be no, if your church is providing group health coverage through the CRC denomination because the church signs an agreement to provide the denomination offered coverage for all eligible church staff.
If our church decides they will not provide insurance coverage will our staff be eligible for subsidies in the state/federal marketplace?
Yes, based on household income. Individuals and families with household adjusted gross income below 400% of the federal poverty level will qualify for subsidies that will decrease the cost of health insurance coverage.
Can the church send employees to the marketplace to purchase coverage and pay their premium directly?
No. The employee must be the purchaser of insurance through the marketplace.
Can a church reimburse a staff member who purchases coverage in the marketplace?
Yes, however, this “reimbursement” must be provided as taxable income, which will increase household income and could therefore impact that individual’s eligibility for the individual subsidy.
How would an individual find out what level of subsidy they would qualify for?
The Kaiser Family Foundation has developed a health reform subsidy calculator based on estimates of premiums prepared by the Congressional Budget Office; access the calculator at the Kaiser Family Foundation website http://kff.org/interactive/subsidy-calculator/. This tool allows you to enter expected income in 2014 and see an estimate of the tax credit available.
Has your church decided whether or not to continue offering health insurance for your full time staff?
What questions is your church council asking about the changing landscape of health insurance?