Ten Things You Should Know About Obama Care

1)      Who will be most impacted by Obama Care?

  • The Middle Class
  • People who receive Medicare

2)      Next year, you will have to pay income taxes on the family plan your employer provides.

3)      If you buy your own plan you can set up a Health Savings Account as long as the plan you buy is HSA compatible.  If so, depending upon the plan, an individual can set aside up to $6350 of before tax dollars and a family can set aside up to $12,700 of before tax dollars to pay their deductible plus any allowed out of pocket expenses.  You pay an HSA fee plus the fee for the plan.  HSA fees are relatively cheap.  The cost can be about $10 per month.  Otherwise you would have to pay these expenses with after tax dollars.  If you change carriers you must notify the bank and all plans you change to must be HSA compatible.

4)      Self Employed people have their choice of purchasing an individual plan or a group plan under the ACA.  Pricing differs so make sure you compare.

5)      With a few exceptions, all plans terminate at the end of this year.  Only a very limited number of plans are offering autorenewals on their current plans at the current price.   Group plans can be autorenewed in December but you will be rerated, so rates will go up.  Raises in rates are anticipated to be as much as 40%.  EX, One rich individual plan was $8,200 per month for a group of 15 and will be $12,000 per month for the group of 15 at the beginning of 2014.  Certain carriers have already increased their rates; so, if you buy a policy now, you will pay next year’s rates through the end of this year and for all of next year.

6)      If you don’t qualify for a subsidy ($45,960 for a household of 1, $62,040 for a household of 2, $78,120 for a household of 3, $94,200 for a household of 4), plans are expensive  and you are probably better off purchasing an individual or family policy outside of the exchange.

7)      All plans are required to provide “Essential Health Benefits”.  What are the essential health benefits?

  • Ambulatory Patient Services
  • Emergency Services
  • Maternity and Newborn Care
  • Prescription Drug Care
  • Hospitalization
  • Lab Services
  • Pediatric Oral, Vision but not dental
  • Rehabilitation and habilitative services plus devices
  • Preventative & Wellness Services
  • Chronic Disease Management
  • Mental Health and Substance Use Disorder Services

8)      You can apply for insurance On-line beginning October 1 at www.HealthCare.gov .  DO NOT USE ANOTHER SITE.  There is much fraud. Do not give your information to anyone you do not know; especially if they says they can save you money, get you a deal, etc.  DO NOT GIVE YOUR PERSONAL INFORMATION to anyone outside this site unless you have checked them out and know that they are reputable and licensed.

9)      If you earn $8 per hour, minimum wage in California, and work a 40 hour week, you do not qualify for Medicaid.  Your earnings are more than 133% times the poverty level.  (The threshold number is $7.35 for a 40 hour work week, 133% of Poverty Level is $15282.  Your wages are $16,640)

10)   Tax Credits for Small Business do not make economic sense.  People who offer benefits will do it because they want to not because they are incentivized to do so.  For a small business to qualify for a tax credit, they must have fewer than 25 full time equivalent employees for the tax year, pay employees an aver of less than $50,000 per year and contribute at least 50% toward employees premium cost.   If they have 10 or fewer full time equivalent employees with wages averaging $25,000 or less may be eligible for maximum amount of tax credits.  Non-profit or tax exempt employers must meet the same criteria as other businesses and their tax credits are somewhat lower. (2013 credits equal 35%/25%; 2014 credits equal 50%/35%)

10 Things Doctors Should Know Before They Sign a Concierge Contract

1)      The amount of the payments can be low, as little as a few hundred dollars per patient per year.

2)      You may have to say goodbye to your patients that to not choose to pay the fees required by the concierge management program with whom you contract.

3)      You may have locked in your fees, without the ability to raise your rates.   When the Concierge Company raises their prices, you may not be entitled to share in the increase.

4)      If you want to terminate your agreement you may be on the hook for paying the Concierge company substantial sums of money.  In one case, payment was required equaling $500 per patient for 600 patients for a period of 3 years, which equals  $300,000 per year for 3 years or $900,000.

5)      Most contracts set a maximum number of patients your practice can treat which limits the amount of revenue you can generate.

6)      Most contracts require that you pay a practice management fee to the Concierge Company which, in addition to the management fee, typically requires using the Concierge company’s software and pay an additional fee for its use. You may be on the hook for paying for goods and services that you already have and do not choose to change, including EMR, accounting, administrative fees, etc.

7)      Concierge companies do not promise to deliver to you any patients, but you are still obligated to comply with their exclusivity provisions and are typically prohibit from accepting patients from other sources.  The Concierge Company makes marketing efforts; but, if the results are poor, the person who suffers financially is the doctor.

8)      If the Concierge Company does not recruit for your practice any patients, you can still be obligated to pay them the management fee as well as additional fees previously mentioned.

9)      You need to validate the economics of the model and determine the number of patients you need to be referred under the concierge plan in order to earn the same income as you do currently.  Do the evaluation to determine the number of patients you need the Concierge Company to recruit in order to earn the same amount of money that your practice currently earns.

10)   You may not be able to accept certain referred patients because you are not a preferred provider under their plan.  If you decline such patients, you may owe the Concierge company money.