ACA 101
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Are you interested in learning how to sell Health Insurance Products during Health Care Reform? The health insurance industry has changed and Agent Pipeline's Experts can provide you the Basic Knowledge of Health Care Reform with this simplistic approach to selling on the Marketplace.
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ACA 101
- 1. ACA 101 Basics of the Marketplace
- 2. ACA 101 2 Today’s Agenda Who is Agent Pipeline The Basics of the Affordable Care Act Plan Benefit Specifics Carriers Available by Market Ways to Complete Enrollments What is the Opportunity? Why Agents Choose Agent Pipeline Next Steps to Success Q&A
- 3. ACA 101 Who is Agent Pipeline? 3
- 4. ACA 101 4 Who is Agent Pipeline? • Founded in 1988 • Original focus was on Individual & Group Health • Senior Market Expansion in 2001 • Began developing a National Footprint in 2002 • Launched ACA Division in 2010, Small Group Division in 2013 • Named #1 National Marketing Organization with Multiple Carriers • Size & Scope • 105 Employees • 30,000+ Licensed Agents • 61,000+ Agent Contracts Processed • 215,000 Medicare Advantage Enrollments • 133,000 Medicare Part D Enrollments • $91 Million in Medicare Supplement Production • $333 Million in ACA Production
- 5. ACA 101 5 Who is Agent Pipeline? Sales Teams • Works to perform weekly market analysis & reviews Agent Services Division • Assist with contract processing, ordering supplies, and commissions Marketing Team • Provides immediate updates on new products & important announcements Compliance Department • Industry Leading division providing GA Compliance Toolkits & Oversight Telesales Division • Maintains 9 Satellite Locations; employs 10 internal & 122 external agents
- 6. ACA 101 The Basics of the Affordable Care Act 6
- 7. ACA 101 7 The Basics of the Affordable Care Act Understanding the Law • The Patient Protection and Affordable Care Act (PPACA) was written in 2010 to reform the Healthcare System by providing more Americans with Affordable Quality Health coverage • Essential Health Benefits are required in all plans • No underwriting, pre-existing conditions are now accepted • 100% Coverage on Preventive Services & Immunizations • Extended Dependent Coverage Up to Age 26 • Requirement of Individuals to maintain Minimum Essential Coverage starting in 2014 • Penalties for not having Qualified Health Coverage • Introduction of Subsidies (Tax Credits) and Cost-Sharing Credits • Creation of Healthcare.gov – “On Market” vs. “Off Market” • Regulation on Insurance Premium Increases
- 8. ACA 101 8 The Basics of the Affordable Care Act The Top 5 Things You Should Know 1. Open Enrollment Period is the only time a client can enroll in a plan, unless they have a “qualifying life event” 2. Subsidies are available to anyone under 400% of the FPL; additional credits known as “cost-sharing” are available to those under 250% of the FPL 3. “On Market” is the only way to obtain qualification for subsidies 4. Short Term Medical or other ancillary plans will provide coverage, but not qualified coverage to avoid the penalty 5. Plans are classified by “Metal Tier” – Bronze, Silver, Gold, Platinum
- 10. ACA 101 10 ACA Definitions Health Insurance Marketplace • Online tool to compare & enroll in ACA health plans • State Based Marketplace or Federally Facilitated (Healthcare.gov) On Marketplace vs. Off Marketplace • On Marketplace – premium tax credits & cost sharing credits • Off Marketplace – guarantee issue, no “credits” Guarantee Issue • No underwriting, no declines. • Rate ups are now based on age, location, family size, Smoke (up to 50%) Enrollment Periods • Open Enrollment Period – November 1st, 2015 – January 31st, 2016 • Special Enrollment Period – February 1st, 2016 – October 31st, 2016
- 11. ACA 101 11 The Basics of the Affordable Care Act Qualifying Life Events • An event that allows individuals to change or enroll into an ACA plan outside of the Open Enrollment Period • Change in marital status • Adoption of a child • Birth of a child • Relocation • Loss of coverage • Entitlement to Medicare/Medicaid • Change in income • Employment Status • Judgements, decrees, or orders • Aging off of parent’s plan • Citizenship
- 12. ACA 101 12 The Basics of the Affordable Care Act Essential Health Benefits ‐ Outpatient & Inpatient Care ‐ Emergency Care Coverage ‐ Maternity Coverage ‐ Mental Health & Substance Abuse Disorder Services ‐ Prescription Drug Coverage ‐ Physical & Occupational Therapy ‐ Speech-Language Pathology, Psychiatric Rehabilitation ‐ 100% Coverage on Preventative Services ‐ Lab Tests & Services ‐ Pediatric Services; including dental & vision for children
- 13. ACA 101 13 The Basics of the Affordable Care Act Grandfathered Plans • Individual and group coverage in effect before March 23, 2010 • Must comply with certain ACA provisions • Plans may voluntary enhance benefits (now including preventive services) • If any major plan changes are made, lose grandfather status Opportunity in 2016: Grandfather conversions, moving individuals into ACA plans that now include the essential health benefits
- 14. ACA 101 14 The Basics of the Affordable Care Act Subsidies & Cost-Sharing Credits ‐ Based on the cost of the second Silver plan (benchmark) ‐ Clients under 400% of the Federal Poverty Level will qualify for some type of subsidy ‐ Clients under 250% of the Federal Poverty Level will additionally receive a credit to assist with out-of-pocket and co-insurance costs (enhancing gold plans to platinum)
- 15. ACA 101 15 Plan Benefit Specifics 2015 Federal Poverty Level Guidelines by Family Size
- 16. ACA 101 16 The Basics of the Affordable Care Act Training & Certification • Training is required to sell “On Market” (subsidy eligible) plans • Facilitated by CMS for Federal Marketplaces, Facilitated by DOI or third party for State Based Marketplace– includes training modules and an identity verification section • Receive your FFM User ID & Certification of Completion (must provide to carriers in order to receive compensation on your plans sold) • Certificate of Completion is not required if you are selling “Off Market” (direct from carrier) plans or supplemental plan options • Official Marketplace Training for 2016 OEP begins July 15, 2015
- 17. ACA 101 Plan Benefit Specifics 17
- 18. ACA 101 18 Plan Benefit Specifics Plans are now classified by a metal tier ranking.
- 19. ACA 101 19 Plan Benefit Specifics An additional plan classification is a “Catastrophic Plan”. • Must be under the age of 30 • And/or must receive a financial hardship to qualify • In order to complete enrollment documentation must be provided • Less than 60% coverage on costs
- 20. ACA 101 20 Plan Benefit Specifics
- 21. ACA 101 21 Plan Benefit Specifics
- 22. ACA 101 22 Plan Benefit Specifics
- 23. ACA 101 23 Plan Benefit Specifics
- 24. ACA 101 24 Plan Benefit Specifics
- 25. ACA 101 25 Plan Benefit Specifics
- 26. ACA 101 26 Plan Benefit Specifics
- 27. ACA 101 Ways to Complete Enrollments 27
- 28. ACA 101 28 Ways to Complete Enrollments 1. Healthcare.gov • Complete subsidy eligibility application • Wait time is usually 45 minutes • Create a client account & identity verification 2. Direct with the Carrier • Complete on Agent Portal • Redirects over to Healthcare.gov 3. Agent Pipeline’s Exclusive ACA Enrollment Platform • Enrollment time takes 10-15 minutes • Bypass Healthcare.gov; directly into verification • Keep track of client applications 4. Over the Phone
- 29. ACA 101 Carriers Available in the Market 29
- 30. 30 WA OR NM TX OK KS CO UT NV CA ID MT ND SD NE MN IA MO AR MS AL FL GA TN WI IL IN OH MI KY NJ NY RI MA NH ME WY PA VA WV DE. MD. VT SC NC CT LA AZ Available on market Available only off market Expansions in 2016 ACA 101
- 31. 31 WA OR NM TX OK KS CO UT NV CA ID MT ND SD NE MN IA MO AR MS AL FL GA TN WI IL IN OH MI KY NJ NY RI MA NH ME WY PA VA WV DE. MD. VT SC NC CT LA AZ ACA 101 Available on market Expansion in 2016 Available off market only
- 32. 32 WA OR NM TX OK KS CO UT NV CA ID MT ND SD NE MN IA MO AR MS AL FL GA TN WI IL IN OH MI KY NJ NY RI MA NH ME WY PA VA WV DE. MD. VT SC NC CT LA AZ ACA 101 Aetna available on market CoventryOne available on market Merging under CoventryOne name Expansion in 2016
- 34. ACA 101 Confusion, Opportunity, & Reasons to Sell 34
- 35. ACA 101 35 Market Confusion • Only 18% of people can define “The Affordable Care Act” • 83% of those eligible for Medicaid expansions are not aware • 56% of employers dropped sponsored coverage to create subsidy eligibility for their employees • 72% of those surveyed said their insurance agent is their “Most Trusted” source for questions regarding Health Care Reform/ACA.** **Source: eHealth – Small Employer Health Insurance Study
- 36. ACA 101 36 What is the Opportunity? Agent Commission: 5-10% Sample ACA Premium: $10,000 (Family of 4) Commission (at 7%) = $700 Total Commission at: • 25 Enrollments = $17,500 (2 per week during OEP) • 50 Enrollments = $35,000 (4 per week during OEP) • 100 Enrollments = $70,000 (8 per week during OEP) • 200 Enrollments = $140,000 (16 per week during OEP) Average Agent : $35,280 total commissions on ACA sales (60 enrollments) Top Agent: $235,200 total commissions on ACA sales (400 enrollments)
- 37. ACA 101 37 • Roughly 15% of the US population is 65 and older* • 85% of 318 million individuals need some type of health plan • ACA Health, Group Health, Short Term Medical *Source: Census.gov
- 38. ACA 101 38 Why should you sell ACA Products? Guarantee Issue – No more underwriting No rate ups, riders, or exclusions Standardized Plan Options 80% of individuals qualify for subsidies Simplified Application Process Full Commissions on Subsidized Penalties for not having Qualified Health Coverage • Penalties start at 2.5% of MAGI in 2016 Employer Coverage Ending or Changing Less Restrictive Marketing Regulations
- 39. ACA 101 Why Agents Choose Agent Pipeline 39
- 40. 40 Why Agents Choose Agent Pipeline • 27 Years of Serving Agents • National Leader in ACA & Medicare Sales • Business Consultants • Local Trained Market Experts • Agency Building & Individualized Growth Plans • Local GA Partnership Opportunities • Lead & Marketing Programs • Robust Agent Support Structure • Compliance Reviews & Assistance • Industry Leading Product Education & Training • Online Contracting System • Online Quoting & Enrollment Tools • Top Commission Contracts Available • Open Release Policy ACA 101
- 41. ACA 101 Next Steps to Success 41
- 42. 42 Next Steps to Success 1. Contact a Regional Sales Consultant following the presentation 2. Get Contracted Before July 31st and be qualified for leads, retail opportunities, bonus programs, and marketing support 3. Talk about your individualized growth plans & marketing options ACA 101
- 43. Q&A 43 More questions? Call us today! 1-800-962-4693