PPACA Tax Overview BenefitMall Reference Guide - (Page 13)
5.4
How will the Medicaid expansion post
the U.S. Supreme Court ruling impact
employers?
Employers may experience different cost obligations
depending on how each state adopts PPACA’s
new requirements for covering the underinsured
or uninsured individuals. Milliman provides some
insights to this question when it wrote:
The change to Medicaid expansion could also
complicate matters for employers. Under PPACA,
employers with over 50 employees may be
subject to additional plan affordability penalties
for employees under 133% FPL—unless these
individuals are Medicaid eligible. If a state does
not expand Medicaid, employers above 50 lives
may be subject to more plan affordability penalties
than they would be were their state to pursue
Medicaid expansion. In this sense, a state’s
decision to expand Medicaid may have cost
implications for employers.
More specifics will become available as each state
decides how to move forward with PPACA’s Medicaid
provisions.
PART B: Emphasis on Prevention & Related Services
5.5
Will preventive services be offered to
Medicaid and Medicare enrollees?
One of the more popular provisions of PPACA
concerns the preventive care services benefit. This
provision provides coverage for preventive services
and applies to those covered by private health
benefit plans as well as government health insurance
programs. Both Medicaid and Medicare programs
must now provide beneficiaries with preventive
services with no cost sharing, deductibles or copays.
Services such as an annual wellness visit, screenings
for various illnesses, and flu shots are covered under
the benefit.
5.6
What are some of the additional benefits
that Medicare will be offering?
Here are some examples of prevention and wellness
benefits that will be offered to Medicare enrollees:
• Initial preventive physical examination
• Annual wellness visit
• Cancer screenings
• Cardiovascular disease screening
• Diabetes screening and self-management training
• Glaucoma screening
• Human immunodeficiency virus (HIV) screening
• Immunizations
• Medical nutrition therapy (for beneficiaries with
diabetes or renal disease)
• Tobacco-use cessation counseling
• Screening for depression in adults
• Intensive behavioral therapy for obesity
5.7
What are some of the additional benefits
that Medicaid will offer?
Medicaid also now provides the following services:
• Benchmark Benefit Plans, including mental health
services and prescription drugs
• Family Planning – States have the option to begin
providing medical assistance for family planning
services and supplies
• Hospice Care for Children – Children enrolled
in Medicaid or the Children’s Health Insurance
Program (CHIP) are now assured hospice care
• Preventive and Obesity-Related Services – States
can choose to cover specified obesity-related
services at no cost to adult Medicaid enrollees
• Tobacco Cessation, including counseling and
pharmacotherapy
Other services will be offered as well. Some
customization will be likely at the state level since
Medicaid is a state/federal program.
5.8
How will employers be impacted by the
general expansion of preventive health
care services?
Generally speaking, premium increases will be
experienced both in the private and public sectors as
these new services are covered with little or no costsharing
requirements. Some actuaries say this will
reduce the overall costs to the health care system.
Others disagree. In the short term, employers will pay
more into the health care system through premium
increases and/or through increased taxes/penalties.
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Table of Contents for the Digital Edition of PPACA Tax Overview BenefitMall Reference Guide
PPACA Tax Overview BenefitMall Reference Guide
Table of Contents
Individual Mandate & Tax Implications
Premium Subsidies
Employer Requirements & Tax Implications
PART A: Small Employer Tax Credits
PART B: Large Employer Tax Penalties
PART C: Employer W-2 Reporting Requirements
PART D: Employer Deductions for Retiree Drug Coverage
Additional PPACA Tax Provisions Impacting Employers & Employees
PART A: The Unearned Income Medicare Contribution Tax
PART B: Excise Tax on Comprehensive, High-Cost Health Insurance Plans
PART C: Assessing the Impact of PPACA on HSAs, MSAs, FSAs, & HRAs
Medicaid & Medicare Changes & the Impact on Employers
PART A: The Expanding Medicaid Program
PART B: Emphasis on Prevention & Related Services
PART C: Medicare Part D Updates
PART D: Putting the Coverage Puzzle Together
PPACA Tax Overview BenefitMall Reference Guide
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