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CMS Product No 12057 CMS Product No 12057

CMS Product No 12057 - PDF document

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Uploaded On 2021-10-03

CMS Product No 12057 - PPT Presentation

October 2020Is your individual coverage Health Reimbursement 00U0U0D0Q0J0H0P0H0Q0W030110050012030R30H0U030D30R0U0G0D0E0O0H0Employers can reimburse employees for medical expenses through an accountbas ID: 894366

individual coverage enter hra coverage individual hra enter plan amount marketplace select income household step employer premium health notice

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1 CMS Product No. 12057 October 2020 Is yo
CMS Product No. 12057 October 2020 Is your individual coverage Health Reimbursement �$�U�U�D�Q�J�H�P�H�Q�W�� �+�5�$� ��R�H�U��D�R�U�G�D�E�O�H�"Employers can reimburse employees for medical expenses through an account-based plan that requires employees to also enroll in individual health insurance (like a Marketplace health plan or a plan you buy outside of the Marketplace, like directly through an insurance company), or to be covered by Medicare Parts A & B, or Medicare Part C. The account-based plan is called an “individual coverage HRA” in this worksheet, but your employer may call it something else. �(�P�S�O�R�\�H�U�V��F�D�Q�W��R�H�U��E�R�W�K��D� �W�U�D�G�L�W�L�R�Q�D�O ��M�R�E��E�D�V�H�G��F�R�Y�H�U�D�J�H��D�Q�G��D�Q��L�Q�G�L�Y�L�G�X�D�O��F�R�Y�H�U�D�J�H��+�5�$��W�R��W�K�H��V�D�P�H��H�P�S�O�R�\�H�H�–�I��\�R�X�U��H�P�S�O�R�\�H�U��L�V��R�H�U�L�Q�J��D�Q��L�Q�G�L�Y�L�G�X�D�O��F�R�Y�H�U�D�J�H��+�5�$���\�R�X�O�O��J�H�W��D��Q�R�W�L�F�H�������������\������������������������������W�K�H�U�H��D�U�H��G�L�H�U�H�Q�W��N�L�Q�G�V��R�I��+�5�$�V���E�X�W��W�K�H��+�5�$��E�H�L�Q�J��R�H�U�H�G��W�R��\�R�X��L�V��D�Q��L�Q�G�L�Y�L�G�X�D�O��F�R�Y�H�U�D�J�H��+�5�$��–�W�O�O��D�O�V�R��V�D�\��Z�K�H�W�K�H�U��W�K�H��+�5�$��R�H�U��H�[�W�H�Q�G�V��W�R��R�W�K�H�U��K�R�X�V�H�K�R�O�G��P�H�P�E�H�U�V�Read your employer’s notice carefully to understand the terms of your coverage. If you have an individual coverage HRA, your employer’s notice will explain that you (and any eligible household members) need to be enrolled in individual health insurance coverage or covered by Medicare to use the individual coverage HRA. If your employer �R�H�U�V��\�R�X��D�Q��L�Q�G�L�Y�L�G�X�D�O��F�R�Y�H�U�D�J�H��+�5�$��D�Q�G��\�R�X�U�H��F�R�Q�V�L�G�H�U�L�Q�J��D�S�S�O�\�L�Q�J��I�R�U��D��0�D�U�N�H�W�S�O�D�F�H��S�O�D�Q���\�R�X��F�D�Q��X�V�H��W�K�H�decision guide at HealthCare.gov/job-based-help or this worksheet to get an idea if it meets requirements �I�R�U� �D�R�U�G�D�E�L�O�L�W�\� �–�I��W�K�H��L�Q�G�L�Y�L�G�X�D�O��F�R�Y�H�U�D�J�H��+�5�$��G�R�H�V�Q�W��P�H�H�W��U�H�T�X�L�U�H�P�H�Q�W�V��I�R�U� �D�R�U�G�D�E�L�O�L�W�\� ��\�R�X��P�X�V�W��G�H�F�O�L�Q�H�(opt out of) the individual coverage HRA to qualify for the Marketplace premium tax credit to lower your monthly �L�Q�V�X�U�D�Q�F�H��S�D�\�P�H�Q�W��L�I��\�R�X�U�H��R�W�K�H�U�Z�L�V�H��H�O�L�J�L�E�O�H��–�I��W�K�H��L�Q�G�L�Y�L�G�X�D�O��F�R�Y�H�U�D�J�H��+�5�$��P�H�H�W�V��U�H�T�X�L�U�H�P�H�Q�W�V��I�R�U� �D�R�U�G�D�E�L�O�L�W�\� �or if you’re already covered by an individual coverage HRA and can no longer decline (opt out of it), you can’t get a premium tax credit to lower the cost of a Marketplace plan.STEP 1: Gather the information you need. • You’ll need access to HealthCare.gov and a few t

2 hings to complete this worksheet: • Your
hings to complete this worksheet: • Your most recent individual coverage HRA notice. You should’ve gotten this from your employer. If you didn’t,check with them. • The adjusted gross income amount from your most recent federal income tax return. You’ll need this todetermine your household income for the year the individual coverage HRA will start. You’ll need your householdincome for Step 3. For what to include, visit HealthCare.gov/income-and-household-information/income. • A calculator. Or, use the calculator function on your computer or mobile device.STEP 2: Enter your individual coverage HRA. a.�(�Q�W�H�U��W�K�H��\�H�D�U�O�\���V�H�O�I��R�Q�O�\��L�Q�G�L�Y�L�G�X�D�O��F�R�Y�H�U�D�J�H��+�5�$��D�P�R�X�Q�W��R�H�U�H�G��W�R��\�R�X��E�\your employer.If you didn’t get the full-year amount provided in the notice—like if you gainedemployment during the HRA’s plan year—enter the self-only amount that you’ll get.2a$ b. • If the individual coverage HRA is��R�H�U�H�G��W�R��\�R�X��I�R�U��W�K�H��H�Q�W�L�U�H��\�H�D�U� Divide 2a by 12. Enter the result here. • If the individual coverage HRA isn’t��R�H�U�H�G��W�R��\�R�X��I�R�U��W�K�H��H�Q�W�L�U�H��\�H�D�U� �'�L�Y�L�G�H���D��E�\��W�K�H��Q�X�P�E�H�U��R�I��P�R�Q�W�K�V��\�R�X�U�H��E�H�L�Q�J��R�H�U�H�G��W�K�H��L�Q�G�L�Y�L�G�X�D�Ocoverage HRA. Enter the result here.2b$ STEP 3: Enter your household income. a. Enter your expected household income for the year the individual coverage HRA will start. 3a $ b. Divide 3a by 12. Enter the result here. 3b $ c. Multiply 3b by 9.83% (.0983 on your calculator). Enter the result here. Note: The 9.83% applies only to individual coverage HRAs that start in 2021. 3c $ STEP 4: �&�D�O�F�X�O�D�W�H��L�I��W�K�H��L�Q�G�L�Y�L�G�X�D�O��F�R�Y�H�U�D�J�H��+�5�$��L�V��D�R�U�G�D�E�O�H� a. Enter the premium amount of the lowest cost Silver plan in the Marketplace. This may not be the plan you enroll in. You need to know the lowest cost Silver plan �S�U�H�P�L�X�P��W�R�4�J�X�U�H��R�X�W��L�I��\�R�X�U��L�Q�G�L�Y�L�G�X�D�O��+�5�$��P�H�H�W�V��U�H�T�X�L�U�H�P�H�Q�W�V��I�R�U� �D�R�U�G�D�E�L�O�L�W�\� To get this amount, follow these steps: • Visit HealthCare.gov/see-plans/ . • Enter your ZIP code and select “Continue.” • Select “Start” next to “Tell us about you & your household.” • Select “Skip” when asked if you’re currently enrolled in a Marketplace health plan. • When asked who’s in your household, select “Just you.” • Enter your current age and select your sex. • �&�K�H�F�N��R�Q�O�\��W�K�H��E�R�[��W�K�D�W��V�D�\�V�� �(�O�L�J�L�E�O�H��I�R�U��K�H�D�O�W�K��F�R�Y�H�U�D�J�H��W�K�U�R�X�J�K��D��M�R�E�� Medicare, Medicaid, or CHIP.” • To see the correct premium amount, leave the other boxes unchecked even if they apply to you. • Select “Continue.” • �:�K�H�Q��D�V�N�H�G��W�R��F�R�Q4�U�P��\�R�X�U��K�R�X�V�H�K�R�O�G��P�H�P�E�H�U�V���V�H�O�H�F�W� �&�R�Q4�U�P ��Z�L�W�K�R�X�W� adding a spouse or dependents. • When asked about your expected income for the current calendar year, select “See Plans Now.” Don’t enter your income information. • Close the “Help Comparing Plans” pop-up box. • Above the list of plans, make sure “Sort by” is set to “Premium” and select the green “Filter Plans” button. • Under “Health plan categories” check the box next to “Silver.” • Select the green “Apply Filters” button. • �/�R�R�N��I�R�U��W�K�H�4�U�V�W��S�O�D�Q��O�L�V�W�H�G� • �)�L�Q�G��W�K�H� �(�V�W�L�P�D�W�H�G��0�R�Q�W�K�O�\��3�U�H�P�L�X�P ��D�P�R�X�Q�W��I�U�R�P&

3 #0;�W�K�H�4�U
#0;�W�K�H�4�U�V�W��S�O�D�Q��O�L�V�W�H�G���D�Q�G� enter it here. 4a $ b. Enter the monthly premium minus your monthly, self-only individual coverage HRA amount. To get this amount, subtract 2b from 4a. 4b $ c. Enter the amount from 3c. 4c $ d. Is the 4b amount more than the 4c amount? Select Yes or No. 4d ��� No STEP 5: �&�K�H�F�N��D�R�U�G�D�E�L�O�L�W�\� • If 4d is Yes: Your individual coverage HRA doesn’t meet requirements for “affordability.” You must decline(opt out of) the individual coverage HRA to qualify for the premium tax credit with a Marketplace plan if you’reotherwise eligible. • If 4d is No (or if 4b and 4c are equal): Your individual coverage HRA meets requirements for “affordability.”����� �������\���������������������������������������������� �������������������������������������������������Marketplace coverage, even if you decline (opt out of) the individual coverage HRA. It’s a good idea to accept your�H�P�S�O�R�\�H�U�V��L�Q�G�L�Y�L�G�X�D�O��F�R�Y�H�U�D�J�H��+�5�$��R�H�U��W�R��K�H�O�S��S�D�\��\�R�X�U��S�U�H�P�L�X�P�V��D�Q�G��H�Q�U�R�O�O��L�Q��D��S�O�D�Q�STEP 6: Submit a Marketplace application. • �%�H��V�X�U�H��W�R��L�Q�F�O�X�G�H��L�Q�I�R�U�P�D�W�L�R�Q��D�E�R�X�W��\�R�X�U��L�Q�G�L�Y�L�G�X�D�O��F�R�Y�H�U�D�J�H��+�5�$��W�R�4�Q�G��R�X�W��I�R�U��V�X�U�H��Z�K�H�W�K�H�U��\�R�X�U��+�5�$��P�H�H�W�V�V�W�D�Q�G�D�U�G�V��I�R�U� �D�R�U�G�D�E�L�O�L�W�\� ��R�U��L�I��\�R�X��F�D�Q��T�X�D�O�L�I�\��I�R�U��D��W�D�[��F�U�H�G�L�W��W�R��X�V�H��L�Q�V�W�H�D�G�Note: You (and any eligible household members) may qualify for a Special Enrollment Period to enroll in or change Marketplace coverage outside the yearly Open Enrollment Period if you newly gained access to an individual �F�R�Y�H�U�D�J�H��+�5�$���*�H�Q�H�U�D�O�O�\���\�R�X�O�O��Q�H�H�G��W�R��V�X�E�P�L�W��D�Q��D�S�S�O�L�F�D�W�L�R�Q��D�Q�G��F�K�R�R�V�H��D��S�O�D�Q��L�Q��W�L�P�H��I�R�U��L�W��W�R��W�D�N�H��H�H�F�W��E�\��W�K�H��G�D�W�H��W�K�D�W��\�R�X�U��L�Q�G�L�Y�L�G�X�D�O��F�R�Y�H�U�D�J�H��+�5�$��V�W�D�U�W�V���%�X�W��\�R�X�U��H�P�S�O�R�\�H�U��P�L�J�K�W��R�H�U��G�L�H�U�H�Q�W��R�S�W�L�R�Q�V��I�R�U��Z�K�H�Q��\�R�X�U�individual coverage HRA can start to give you more time to enroll. Contact them or check your notice to see if this applies to you.�1�H�H�G��P�R�U�H��L�Q�I�R�U�P�D�W�L�R�Q�" • Visit the decision guide at HealthCare.gov/job-based-help to understand your options before you act. • �)�R�U��V�S�H�F�L4�F�V��R�Q��\�R�X�U��L�Q�G�L�Y�L�G�X�D�O��F�R�Y�H�U�D�J�H��+�5�$��R�H�U���O�L�N�H��L�W�V��V�W�D�U�W��G�D�W�H��D�Q�G��L�I��L�W��F�R�Y�H�U�V��G�H�S�H�Q�G�H�Q�W�V���F�K�H�F�N��\�R�X�Uindividual coverage HRA notice or contact your employer.