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Monday, October 15th, 2012

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As of
January 1, 2013, all Aetna Advantage Plans will contain coverage for women's health services.
Aetna added this benefit for new policies effective August 1, 2012. Starting January 1, 2013, existing members will begin receiving these benefits as well. The women's health services benefits will apply to existing members upon their policy renewal on or after January 1, 2013.
Members will be notified by mail throughout the month of October with the exception of Missouri members covered under grandfathered plans.
A grandfathered plan has an effective date prior to March 23, 2010.
Women's health services are considered preventive and therefore generally covered at no cost share, when provided in-network.
Women's preventive health benefits
- Well-woman visits like annual routine physical, annual routine GYN exam and prenatal visits
- Human Papillomavirus (HPV) DNA testing
- Screening for gestational diabetes
- Counseling for sexually transmitted infections
- Counseling and screening for human immunodeficiency virus (HIV)
- Screening and counseling for interpersonal and domestic violence
- Breastfeeding support, supplies and counseling
- Contraceptive methods and counseling
The federal health care reform legislation, known as the
Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010.
Some of the
Healthcare Reform (PPACA) provisions will impact health care this year but most of the remaining provisions will not take effect until 2014 and beyond.
For more information, you or your clients may visit www.healthcare.gov.
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Monday, October 8th, 2012

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Many parents find themselves drawn to the idea that with just a bit more parental elbow grease, we might turn out children with great talents and assured futures. This raises the question: Is there anything wrong with over parenting?
Decades of studies have found that the optimal parent is one who is responsive ,involved, who sets high expectations and respects child’s autonomy. These parents appear to hit the sweet spot of parental involvement and generally raise children who do better academically, psychologically and socially than children whose parents are less involved, permissive , or controlling and more involved.
Authoritative parents actually help cultivate motivation in their children. Authoritative parents raise more motivated, and thus more successful, children.
In a typical experiment, young children are put into a room and asked to solve a simple puzzle. Most do so with little difficulty. Then some of the children are told how very bright and capable they are. As it turns out, the children who are not told they’re smart are more motivated to tackle increasingly difficult puzzles. They also exhibit higher levels of confidence and show greater overall progress in puzzle-solving.
Praising children’s abilities and talents seems to rattle their confidence. The child who receives the praise may think tackling more difficult puzzles carries the risk of losing one’s status as “smart” and deprives kids of the thrill of choosing to work regardless of outcomes. Reasonably supporting a child’s autonomy and limiting interference results in better academic and emotional outcomes.
The most successful happiest children have parents who do not do for them what they are capable of doing, or almost capable of doing; and their parents do not do things for them that satisfy their own needs rather than the needs of the child.
If you treat your walking toddler as if she can’t walk, you diminish her confidence and distort reality. Ditto nightly “reviews” of homework, repetitive phone calls to checking in and writing or editing your child’s college application essay.
Once your child is capable of doing something, congratulate yourself on a job well done and move on letting the child do for themselves. Continued, unnecessary intervention makes your child feel bad about himself or angry at you and in the long run can cripple them latter in adulthood having a mentality of someone else should do it for me or a lazy mind set.
Think back to when your toddler learned to walk. The child would take a step or two then collapse and immediately look to you for your reaction. You were in thrall to those early attempts and would do everything possible to encourage for your child to get up again. You certainly didn’t chastise your child for failing or utter dire predictions about flipping burgers for the rest of his or her life if she fell again. You were present, alert and available to guide if necessary. But you didn’t pick your child up every time. You knew that your child had to get it wrong many times before he or she could get it right.
One of the greatest challenges of parenting is hanging back and allowing children to make mistakes. It’s easier when they’re young. The potential mistakes carry greater risks, and part of being a parent is minimizing risk for our children.
If there’s a predator loose in the neighborhood, your child doesn’t get to go to the mall. But under normal circumstances an 11-year-old girl is quite capable of taking care of themselves for a few hours in the company of friends. She may forget a package, overpay for an item or forget that she was supposed to call home at noon. Mastery of the world is an expanding geography for our kids and is where growth takes place. In this gray area of just beyond the comfortable is where resilience is born.
The small challenges that start in infancy present the opportunity for “successful failures,” that is, failures your child can live with and grow from. To rush in too quickly, to shield them, to deprive them of those challenges is to deprive them of the tools they will need to handle the inevitable, difficult, challenging and sometimes devastating demands of life.
While doing things for your child unnecessarily or prematurely can reduce motivation and increase dependency that is permanent it also forces them to circumvent the most critical task of childhood: to develop a self identity.
It is psychological control that damages a child’s developing identity. If pushing, direction, motivation and reward always come from the outside, the child never has the opportunity to craft an inside. Having tutors prep your anxious 3-year-old for a preschool interview because all your friends’ children are going to this particular school or pushing your exhausted child to take one more advanced-placement course because it will ensure her spot as class valedictorian is not involved parenting but toxic overparenting aimed at meeting the parents’ need for status or affirmation and not the child’s needs.
We must remember as parents that children thrive best in an environment that is reliable, available, consistent and noninterfering.
A loving parent is warm, willing to set limits and unwilling to breach a child’s psychological boundaries by invoking shame or guilt. Parents must acknowledge their own anxiety. Your job is to know your child well enough to make a good call about whether he can manage a particular situation. The child’s job is to grow, yours is to control your anxiety so it doesn’t get in the way of his reasonable moves toward autonomy.
Parents also have to be clear about their own values because Children watch us closely. If you want your children to be able to stand up for their values, you have to do the same. Parents also have to make sure their own lives are fulfilling. There is no parent more vulnerable to the excesses of overparenting than an unhappy parent. One of the most important things we do for our children is to present them with a version of adult life that is appealing and worth striving for.
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Monday, September 24th, 2012

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By law, states are required to implement Democratic President Barack Obama's health care overhaul.
Health officials in 24 Republican-controlled states are working behind the scenes to set up insurance exchanges that provide a market for individuals and small businesses to shop for affordable health coverage. Nov. 16 is the deadline for states to show they can do it, or the federal government steps in and does it for them.
Huge opposition is coming from republican governors and legislators who want states to do nothing until the national election on Nov. 6, hoping the party wins enough votes to repeal the law.
Conservatives believe that if the federal government is forced to set up many of the exchanges, the system would likely fail which would make the law easier to repeal if Republican nominee Mitt Romney defeats President Barack Obama in the election.
Insurance officials want a better contingency plan in case the Republicans lose, as the 10-day window between the election and the exchange deadline will not give them enough time to prepare an exchange.
The health care reform law passed in 2010 calls for health insurance exchanges to be in full operation by January 2014, helping to extend care to up to 16 million uninsured Americans.
13 mostly Democratic states have committed to establishing their own insurance exchanges, while a handful of others have said they would probably do it or agreed to form a partnership with the federal government. 7 states have outright refused.
In the remaining 24 states with Republican majorities in either legislative house, heated opposition means work on exchanges occurs haphazardly, behind the scenes and with fewer funds.
Half a dozen Republican state health officials interviewed by Reuters said they prefer to plan for exchanges now, rather than accept blame down the road for a federally run exchange that leaves voters worse off than their neighbors.
At least 15 others are also preparing for some kind of exchange, according to state planning documents, news articles and the Kaiser Family Foundation, which tracks states' actions.
Even setting up health exchanges is not easy and many states need new laws to create and fund an exchange; they have to study local needs through dozens of meetings, hire staff and find contractors to set up the technology.
Many insurers, such as Aetna, Wellpoint Inc, or United Healthcare would also prefer the states to control local insurance markets rather than submit to federal regulation.
Republicans working on exchanges have been accused of party disloyalty, and that opposition has intensified after the Supreme Court upheld the Affordable Care Act in late June.
Romney is unlikely to repeal exchanges if he is elected, even if he gets rid of other parts of the health law, since the system would be too complicated to dismantle, or he may not have enough votes in Congress.
Romney suggested as much during a recent interview with NBC's “Meet the Press,” saying he would keep some parts of Obamacare if he becomes president – though he did not mention exchanges specifically.
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Wednesday, September 19th, 2012

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National Prostate Cancer Awareness month is September. American Cancer Society has reported over 240,000 new cases of prostate cancer are diagnosed in the United States each year. Fortunately, there is a lot you can do to keep your prostate healthy as you age.
Eat more fruits and vegetables like watermelons, tomatoes, pink grapefruits, guava and papaya contain lycopene, a powerful antioxidant. Cruciferous vegetables such as cabbage, broccoli, cauliflower, kale, and Brussels sprouts, and also are good choices. Eat more selenium-rich foods such as tuna, wheat germ, herring and other seafood and shellfish, kidney, beef liver, eggs, sunflower and sesame seeds, mushrooms, cashews,garlic and onions. Selenium reduces risk of prostate cancer. Include more soy in your diet from sources such as tofu, soy nuts or soy flour or powders.
Exercise regularly and keep a healthy weight.
Let your doctor know if you have a family history of prostate cancer because this more than doubles a man’s risk of developing this disease.
Do not smoke.
Beginning at age 50, Get a PSA and/ or full lab work and rectal exam annually. Men at high risk, such as African American men or men with a strong family history of prostate cancer should begin testing at age 45.
The prostate is a small organ about the size of a walnut. It is found below the bladder (where urine is stored) and surrounds the tube that carries urine away from the bladder (urethra).
Prostate problems are common in men ages 50 and older. Doctors who are experts in diseases of the urinary tract (urologists) diagnose and treat prostate problems.
Signs of Prostate Problems
Frequent urge to urinate, Difficulty in urinating, Painful or burning urination, Difficulty in having an erection/ Painful ejaculation, Frequent pain or stiffness in lower back, hips, or upper thighs
If you have any of these symptoms, see your doctor right away to find out if you need treatment. If you don’t have one feel free to contact our Family Medicine group today.
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Tuesday, September 18th, 2012

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Whether you go to the hospital for an emergency or routine procedure, there are steps you can take to help avoid legal and medical complications down the road.
- Make sure your name and identifying information such as Insurance Information ID & Social is completely accurate during hospital check in. Some problems involving hospital care begin as clerical errors. A seemingly small error can create major issues. Reduce the chance of error by carefully reviewing your hospital admissions paperwork and checking your hospital wristband for errors. Even checking again on the back end with insurance company to make sure claims are being submitted and correctly filed.
- Have an up-to-date Medical Power of Attorney or a Living Will. This will entrust decisions about your care to a person you designate in the event you cannot make medical decisions yourself. Advise your family of your designation so that person is notified when decisions have to be made.
- Understand your health insurance coverage. It is important that you understand your deductible & coinsurance amounts. Make sure that all claims are filed through your insurance carrier for the discounts to be applied and credited to your deductible. Your policy may require you to obtain preauthorization for medical procedures. Review your health coverage now. It is too late to make critical changes after you get sick.
- Save any documents you receive regarding your care or billing. Retain all of your hospital and Insurance documentation in the event of a fee dispute, insurance dispute or medical malpractice claim. For every bill you receive; you should also receive a corresponding explanation of benefits from your carrier verifying that amount. Documents can be easily misplaced in the confusion of care and recovery. Ask someone you trust to help you keep your documentation organized.
- Ask for a second opinion if you are unsure about your diagnosis or treatment. You have the right to speak with another doctor or caregiver if you are uncomfortable with the diagnosis or treatment recommendations being made.
- Advocate for quality care. It is important to speak up for yourself in the hospital. If you have a concern about the quality of care you receive, speak to a doctor or nursing supervisor. If you are unable to advocate for yourself due to the nature of your illness, medications or treatments, have a friend or family member speak for you and stay with you if possible. Many hospitals have a designated advocate on staff. If you feel your concerns are not addressed ask to speak with a patient advocate.
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Tuesday, September 4th, 2012

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What if your hands and your finders could discover early signs of dangerous diseases you didn't yet know you had? It used to be common for doctors to look at the hands for important clues to overall health. Hands can tell you a great deal about circulation, hormones, and thyroid function.
Here are 7 important clues your hands can reveal about your overall health.
Palmar erythema, liver disease, can be a sign of your palms remain reddened over a long period of time One exception is if you're pregnant, red palms are normal, because increased blood flow causes redness in more than half of expecting women.
Inflammation of the liver begins to loose function and is no longer able to flush waste out of the body as efficiently. The result is an excess of hormones and causes the blood vessels in the hands and feet to dilate which makes them visible through the skin.
Other symptoms of liver disease include prominent veins on the upper torso and abdomen, swollen legs and abdomen, and fatigue. The most common tests for liver function are a liver enzyme count and bilirubin count.
Comparative finger length can tell the likelihood of having certain conditions. Men's ring fingers tend to be longer than their index fingers, while in women it's the opposite. Women with ring fingers longer than their index fingers are twice as likely to suffer from osteoarthritis. Osteoarthritis of the knees to be more common in both men and women with longer ring fingers and most pronounced in women. Longer index fingers are associated with a lower risk of prostate cancer in men and woman have a higher risk of breast cancer. A study found that men whose index fingers were noticeably longer than their ring fingers were 33 % less likely to develop prostate cancer.
Scientists aren't sure yet as to the reason why, but they believe finger length is affected by exposure to varying amounts of the hormones estrogen and testosterone in the womb. Longer index fingers suggest higher estrogen exposure and Longer ring fingers indicate greater prenatal exposure to testosterone. Breast cancer is estrogen fueled, longer index fingers correlate with higher breast cancer. In men, more testosterone is linked to a higher incidence of prostate cancer. As for the osteoarthritis, scientists don't have a definite explanation yet but think it may have something to do with the way hormones affect early bone growth.
Women who have longer ring fingers may want to watch out for weak or sore joints, particularly knees, and get injuries or soreness evaluated. Men who are at higher risk for prostate cancer should be proactive about PSA testing. Women should have regular mammograms for breast cancer screening.
Swollen fingers can happen for the simplest of reasons: Outside temperatures, its a woman's monthly menstruation period, or you just consumed something salty. But if your fingers feel swollen & stiff and your rings still won't fit after several days of drinking plenty of fluids and cutting back on salt , the swelling could suggest hypothyroidism.
A underactive thyroid is underactive produces less of the important hormones that regulate metabolism and keep your body functioning properly. When metabolism slows, the result is typically water accumulation and weight gain.
Ask your doctor for a routine thyroid check, which is a blood test that measures the level of thyroid-stimulating hormone (TSH). Make sure your doctor is aware of new screening guidelines, which state that TSH level should be between 0.3 and 3.0.
Under normal circumstances, if you press gently on your fingernails they turn white, and then when you release the pressure they turn pink again. If your nails stay white more than a minute after you press on them or look pale all the time, this can be a sign of anemia.
Anemia is iron deficiency and causes pale nails when there aren't enough red blood cells circulating in the bloodstream. Severe iron deficiency can also cause the nails to have a slightly concave shape.
Iron deficiency can lead to fatigue or heart problems, so you'll want to alert your doctor. You can try treating iron defienciency by increasing intake of iron-rich foods, like red meat, spinach/ dark greens, nuts, and taking an iron supplement. If iron typically cause digestive issues so take a nonconstipating formula such as Slow-Fe.Remember to take vitamin C at the same time, as it helps iron absorption.
splinter hemorrhages look like tiny red or brownish splinters under the nails, and are tiny areas of bleeding that can signal infection in the heart or blood. They run in the direction of nail growth, they resemble splinters that got stuck under the nail.
Splinter hemorrhages happen when tiny blood clots block blood flow in the capillaries beneath the nails and toe nails. They occur with an infection of the heart valves called subacute bacterial endocarditis. This condition typically occurs in someone with a heart murmur or underlying infection. If you just have a few red spots under the nails and have never been diagnosed with a heart problem it is most likely that these are from some other cause, probably injuries to the hands.
Bacterial endocarditis is typically accompanied by a low-grade fever. Get heart checked if concerned about these symptoms. Your doctor will run a series of tests to evaluate blood flow through the heart. If your heart's been given a clean bill of health, then heart valve infection is an unlikely cause and you can wait to see if the red spots clear up on their own.
Thickened fingertips that angle out above the last knuckle like miniature clubs can be a sign of heart or lung disease. You may also notice the nail rounding, so your fingers curve downward like the inside of a spoon.
If the circulatory systems of the heart or lungs are impaired oxygen levels in the blood are likely to drop. Over time, this causes the soft tissues of the fingertip pads to grow, so fingertips and the ends of toes appear to bulge outward.
If your fingers and toes are thickening other symptoms might be shortness of breath or chronic cough. Club Thickening also occurs with aortic valve disease causing fatigue and chest pain. See your doctor for a full heart and lung evaluation.
Raynaud's disease or Raynaud's syndrome is a Fingertips circulatory disorder that is indicated by gray- or blue-tinged or feel numb.
Raynaud's syndrome causes sudden temporary spasms in the blood vessels and arteries. Narrowed arteries constrict blood flow to the hands and fingers decreasing circulation. Symptoms include cold hands and numb fingertips. Between 5 and 10% of people have this condition. Raynaud's is more common in women than men, and it gets worse in cold weather and can be brought on by increased stress.
Sudden changes in temperature can bring on a Raynaud's attack. Wear gloves when you go outside in cold weather, since cold is one of the major triggers for Raynaud's. Temperatures below 60 degrees are a problem for many Raynaud's sufferers.
Raynaud's attacks can restrict circulation and overtime cause tissue damage. Some lifestyle changes to keep your circulation healthy and keep from having attacks. Smoking and caffeine both constrict blood vessels, so quit smoking and cut down on tea,coffee, and cola. Boost your aerobic exercise to raise your heart rate and get your blood pumping.
Some people suffer from "secondary" Raynaud's, brought on by another underlying condition. In this case, treating the underlying condition is the key to preventing Raynaud's attacks.
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Wednesday, August 22nd, 2012

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What is the PPACA Medicare tax increase?
Section 1411 of PPACA will impose an additional tax of 3.8% if certain conditions are met. Currently, individuals pay a Medicare tax of 2.9% of their wages. In addition to the current tax, the new tax expands the definition of income subject to Medicare taxes. The tax also applies to trusts and estates.
When does the tax become effective?
Begins after December 31, 2012
Who will be effected by this tax increase?
The tax will apply to single taxpayers gross income of $200,000 or higher and married taxpayers with a gross income of $250,000 or over. The tax also will apply to a married person filing separately whose gross income exceeds $125,000
How is the tax calculated?
The tax is calculated by multiplying 3.8% tax rate by the lower of either the net investment income for the year or the gross income over the threshold amount.
What is net investment income for the purpose of the new tax?
Items such as dividends, interest, capital gains, royalties, annuities, rents, and pass through income from a passive business (i.e. partnerships & S-corporations) are included. Items such as tax exempt nontaxable veteran’s benefits, municipal bond interest, capital gains excluded from the sale or a principal residence, distributions from IRAs, 403(b) plans, 401(k) plans, 457 plans, pensions, stock bonus plans, profit-sharing plans, or qualified annuity plans are not included in net investment income calculations.
What is modified adjusted gross income for the purpose of the tax?
The modified adjusted gross income includes wages, tips, salaries, other compensation, dividend and interest income, realized capital gains, business and form income, and income from other passive activities and the foreign earned income exclusion or foreign housing exclusion included.
What income is excluded from the new tax hike?
Income not subject to the modified adjusted gross income calculations includes income derived from: capital gains excluded from the sale of a principal residence, tax-exempt municipal bond interest, non-taxable veteran's benefits, and IRA, 403(b) plan, 401(k) plan, 457 plan, or pension distributions. Proceeds profit-sharing plans, stock bonus plans, or qualified annuity plans are also exempt.
Section II: Excise Tax on Comprehensive, High-Cost Health Insurance Plans
What is the new excise tax on comprehensive, high-cost insurance plans?
In an effort to penalize employers who offer excessively rich health benefit plans there is an excise tax on high-cost health plans referred to Cadillac health arrangements. This is a new non-deductible 40% excise tax that some experts have estimated will affect more than half of large employers’ active health plans by 2018.
The excise tax was included in PPACA to generate additional revenue
When does the excise tax become effective?
The tax becomes effective January 1, 2018.
How is the excise tax calculated?
The 40% nondeductible tax will be applied on employers and assessed against the annual value of any excess benefit provided under applicable employer-sponsored coverage. Excess benefit is defined as exceeding the aggregate of $10,200 for single coverage or $27,500 for family coverage in 2018. Those in high-risk professions and retirees are subject to higher thresholds.
What is excluded from the excise tax calculation?
Stand-alone dental and plan expenses are excluded from the calculation. Employers with a workforce of older or female workers who have higher-than-average health costs will be held to higher thresholds. Union plans are also exempt from the provisions of this tax.
How could this tax impact insurance premiums?
Employers subject to this tax in 2018 will either have premiums increased by the insurer on an insured health benefit plan or be subject to a surcharge applied by the administrator of a self-funded health benefit plan. Employers will be forced to either absorb the additional cost of the tax or pass the cost increase on to employees in the form of higher premiums or higher deductibles.
Ultimately, the cost of this tax will likely be passed on to the employees covered by the plan.
What are the long term implications of this tax?
While the thresholds for this tax may seem to be avoidable for now, the longer term implications are heavy. A Study found that the average 2010 cost of medical coverage for non-retiree single coverage was $5,184 and a non-retiree family plan was $14,988.
Using past levels of premium increases projected forward, the study estimates that many employer benefit plans will exceed the excise tax threshold.
How will PPACA change the way health saving accounts and similar financing arrangements operate?
PPACA establishes a new uniform standard for the preferred tax treatment of medicine and drug expenses for Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs), Medical Savings Accounts (MSAs) and Health Reimbursement Arrangements (HRAs). Effective January 1, 2011, only prescribed medicines or drugs including over-the-counter medicines and drugs that are prescribed will be considered qualifying medical expenses. Over the counter drugs purchased without a prescription will no longer qualify for tax deffered, and these accounts will no longer pay for or reimburse the cost of these items. PPACA increases the penalty tax for using HSA and MSA funds for nonmedical purposes to 20% beginning in 2011. PPACA also limits annual FSA contributions for health care to $2,500.
What, if any, medical supplies are exempt from this provision?
Insulin purchased with or without a prescription still qualifies for the preferred tax treatment. These provisions do not apply to durable medical equipment or other non-drug medical items acquired over the counter such as crutches, bandages, tape, and diagnostic items such as glucose monitors.
What verification is required to preserve the preferred tax treatment?
Individuals seeking reimbursement from an employer sponsored HSA, MSA, FSA or HRA should submit a copy of the prescription along with the receipt showing the date and amount of the purchase with the request for reimbursement.
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Monday, August 20th, 2012

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The Employer Mandate
As of January 1, 2014, Patient Protection and Affordable Care Act requires employers, known as the employer mandate, with more than 50 full-time equivalent employees to offer health insurance coverage to their employees. This limits annual cost-sharing to the high-deductible plan limit, limits the annual deductible for small group market plans to $2,000 for individuals and $4,000 for families, and does not require cost-sharing for preventive services or immunizations.
If a business has 50 or more full time employees and one or more of its employees receive a government subsidy to help purchase health insurance from a state Exchange, then the business will pay a penalty. An employee is eligible for a premium subsidy if he or she meets two conditions: the employee’s household income must be less than 400% of the Federal Poverty Level and the employee’s portion of the insurance premium on the employer’s plan exceeds 9.5% of the employee’s household income.
If a business owes an employer mandate penalty: if the business does not provide health insurance to its employees, the company's annual penalty equals [the total number of employees in the firm (subsidized and unsubsidized) minus 30] x $2,000; and if the business does provide health insurance and its annual penalty equals the lesser of [the number of subsidized employees] x $3,000 OR [the number of employees (subsidized and unsubsidized) minus 30] x $2,000.
Small Business Health Care Tax Credit
Small Business credit went into effect in 2010 andtTo qualify, a business must offer health insurance to its employees as part of their compensation and contribute at least half the total premium cost. The full amount of the credit is available only to an employer with 10 or fewer full time employees and whose employees have average annual full-time equivalent wages from the employer of less than $25,000. Employers with more full time wmployees or with higher average annual wages may still qualify for a smaller credit. In order to claim any amount of the credit, the business must have no more than 25 full time employees, and the employees must have annual full-time equivalent wages that average no more than $50,000.
W-2 Reporting for Large Employers
Beginning with the 2012 tax year, PPACA requires that employers that issue more than 250 W-2s report the cost of employer-provided coverage on W-2s issued in 2013. The entire cost of the benefits is to be included in the W-2 – both the employee portion and the employer portion. This amount will not include any salary reduction contributions made to flexible spending accounts, health savings accounts or Archer MSAs. This reporting is for informational purposes only; PPACA did not alter the tax-exempt nature of these benefits.
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Monday, August 20th, 2012

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Patient Protection and Affordable Care Act (PPACA):
Examine the tax implications of the Individual Mandate:
Individual Mandate provision applies to?
The tax will apply applicable individual who fails to maintain health insurance coverage for themselves and their dependents. In theory, this will help spread the risk and make sure everyone is participating. Massachusetts used a similar approach when implementing a tax-enforced insurance mandate imposed on its residents several years ago. PPACA’s mandate applies to anyone who is in the U.S. legally and who is not otherwise exempted from securing health insurance.
Who is exempted from the Individual Mandate?
• Those who already have qualified coverage through an employer-sponsored plan or through an exchange
• Those who are enrolled in a Medicaid or Medicare program
• Those who are covered by a military plan
•Those who are dependents of active military enrolled in a TriCare plan
•Those who express religious objection
• Those who are permanently incarcerated
• Those who are members of Indian tribes
An individual (or a family) will not be subject to the Individual Mandate requirements if they are without coverage for less than three months, or if the Secretary of HHS determines that obtaining coverage would constitute an extreme hardship for the individual. If an individual would be contributing more than 8% of their household income as a required contribution, that person is likewise excused from the Individual Mandate requirement.
What is
Minimum Essential Coverage?
An approved government program (e.g., Medicaid, Medicare)
An eligible employer-sponsored plan
A state’s health insurance exchange
A grandfathered plan
Other coverage may meet the minimum essential coverage as deemed appropriate by the Secretary of HHS after consulting with the Secretary of the Treasury.
How will you be taxed/penalized if you opt out of an approved health plan?
The annual tax, formerly known as a penalty, for not obtaining minimum essential coverage will be the greater of a flat dollar tax amount per individual or percentage of the individual's texable income.
The applicable flat dollar amount for 2014 for a tax filer with no dependents will be $95 and the amount for 2015 will increase to $325.
Each tax filer is also responsible for the tax due on any dependents, including children younger than 18 who will be assessed one-half the adult amount.
How about families?
Each adult will pay the rate of an individual, and then you need to add the dependent at the 50% rate. For example, in 2016 a couple with one child under 18 would be assessed a flat dollar penalty of $1,737.50 (two adults x $695 plus one child at $347.50 -- one half of adult penalty).
A family of four (one couple with two children over 18) would only be required to pay the 300% cap in 2016. Three hundred percent of the $695 flat amount for 2016 is equal to $2,085. This amount is less than the flat amount that could be charged if the cap were not in place (two adults + two children over 18 = $695 x 4 = $2,780).
How will income impact the tax rate?
There are many nuances on how to calculate the amount of tax owed if an individual has a high income and declines to purchase insurance.
PPACA establishes a minimum amount of income that triggers the requirement of a tax payer to file a federal income tax return. As with the flat dollar calculations, there is also a maximum applied to the overall penalty. Under a sliding scale, the taxable income is an amount equal to a percentage of a household’s income (as defined by PPACA) that is in excess of the tax filing threshold (phased in at 1% in 2014; 2% in 2015; 2.5% in 2016).
that the yearly individual premiums for a Bronze plan may average between $4,500 and $5,000. The estimated yearly family premium for 2015 may be $12,000 and $12,500.
Can you clarify further how the individual mandate tax will work?
Penalties begin in 2014 and rise in years following. In each new year, the penalty consists of the higher of a dollar amount or a percentage of household income. For a given household, the penalty applies to each individual, up to a maximum of three. Following is the schedule of penalties:
2014: The higher of $95 or 1.0% of taxable income. Maximum $285 (=3 x $95) per household.
2015: The higher of $325 or 2.0% of taxable income. Maximum $975 (=3 x $325) per household.
2016: The higher of $695 or 2.5% of taxable income. Maximum $2,085 (=3 x $695) per household.
000A(f).
The amount of this tax penalty is specified in IRC § 5000A(c)(2), which provides that the monthly tax penalty is equal to one-twelfth of the greater of either a fixed "flat dollar amount" or an amount based on a percentage of the taxpayer’s household income.
or more information about the tax amount assessed against children under 18, please see IRC § 5000A(c)(3)(C).
If the tax penalty is assessed as a portion of household income, we then turn to Section 5000A(c)(2)(B).
What types of premium subsidies will be available for individuals?
Beginning in 2014, PPACA will provide subsidies for individuals with incomes between 133% and 399% of the federal poverty level (FPL). Individuals eligible for government programs are not eligible for health insurance premium subsidies. Likewise, individuals who are offered employer health benefits coverage are not eligible for premium tax credits unless the employer plan does not comply with at least a 60% actuarial value, or unless the individual’s share of the premium for employer-sponsored health insurance exceeds 9.5% of their income. The subsidy offered is tied to the second lowest cost Silver level benefit plan offered by the exchange. This plan is estimated to cover 70% of the average person’s health care expenditures for one year.
| Individuals who have coverage that fails to meet the thresholds are eligible for the followings subsidies:Premiums and Cost Sharing Subsidies Under the Affordable Care Act |
| Reported Income (% poverty level) |
Premium Subsidies (% of income cap) |
Actuarial Value |
Out-of-Pocket Maximum |
| <133 |
0% |
100% |
— |
| 133–149 |
3%–4% |
94% |
$1,983 |
| 150–199 |
4%–6.3% |
87% |
$1,983 |
| 200–249 |
6.3%–8.05% |
73% |
$2,975 |
| 250–299 |
8.05%–9.5% |
70% |
$2,975 |
| 300–399 |
9.5% |
70% |
$3,967 |
| >400 |
— |
60% |
$5,950 |
Although the premium subsidies will greatly assist individuals with lower incomes, these subsidies will likely prove extraordinarily complex for these individuals to understand, and to use to their advantage. Likewise, the process of enforcing the subsidies and tax credits will consume a great deal of time and resources for the IRS.
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Monday, August 13th, 2012

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The two presidential candidates have more to agree on than they would have you believe.
Romney and President Barack Obama debates over sending more jobs offshore will continue, of course. But what about issues such as what is the optimum size and role of government & what is the best way to reduce trillion-dollar annual deficits and $15 trillion in total debt? With a rapidly ageing population can Medicare’s growth be stopped without impoverishing senior citizens and is it time to raise taxes, even on the middle class?
Romney would shrink the government, cut taxes, semi-privatize Medicare and turn Medicaid, considered to be the health-care program for the poor, into block grants to states.
On Federal Safety Net :
Romney refers to the federal safety net as hammock that lulls able-bodied people into lives of complacency and dependency. Obama refers to the safety net a basic measure of security against hard times that could strike even hard- working people.
Both Obama and Romney would attack red ink by moving broadly in the same direction, albeit at different speeds.
Medicare:
Romney, in his 2013 budget proposal, he offers seniors a choice between vouchers and the traditional program. This would give seniors a fixed amount of money with which to buy private coverage. Competition among health insurers for seniors’ business will bring down costs.
The Congressional Budget Office projects that Medicare will run out of money in 9 years. This would limit Medicare spending to the growth of the economy plus 0.5 % more than inflation, the same cap as Obama’s medicare plan. The Congressional Budget Office estimates that, by 2030, spending on the average Medicare beneficiary in the Romney plan would be $7,400, which is 14 % lower than current law.
Domestic spending:
Romney would protect the Pentagon from significant cuts and calls for dramatic reductions in food stamps and other programs for low-income Americans. The current administration has expanded funding for Pell college tuition grants while Romney will seek reductions. Overall, Romney/Ryan cuts nondefense spending accounting for 12 % of the budget.
Comparing Cuts
Tax cuts: Obama would raise taxes on high-earners while Romney/Ryan would collapse the number of tax brackets to two from six, dropping the top rate to 25 % from next year’s 39.6 % and setting the other rate at just 10 %. Corporate taxes would be cut to 25 % from 35 % under Romney/Ryan’s plan and to 28 % by Obama. The 2001 & 2003 tax cuts under the George W. Bush administration would be extended by Romney; Obama would continue them only on household earnings up to $250,000. Both canidates would limit the ability of high-earners to take advantage of tax expenditures.
Altogether, Romney/Ryan would cut revenue by $4 trillion and spending by about $6 trillion over the next decade. Obama would cut spending and raise taxes by $4 trillion over 12 years, bumping tax revenue to 19.8 % , up from 15 % now. Revenue under Romney/Ryan’s plan would rise to 18.75 % of the economy, less than Obama but more than the historical average of 18 %.
According to the Congressional Budget Office , the 2022 deficit under Obama’s fiscal 2013 budget proposal would be about 3% of GDP, down from about 8.1 %this year. Romney/Ryan would bring the deficit to 1.25% of GDP by 2023.
Romney/Ryan’s plans are not clear on spelling out which tax breaks he would end, other than to say well-to-do Americans should bear the brunt. The math would seem to dictate major cuts in most popular tax expenditures, including deductions for mortgage interest and company-paid health insurance. The center also says plans such as Ryan/Romney’s would ultimately leave all but the richest taxpayers carrying a heavier load compared to now.
Health-care reform: Obama & health-care reform law establishes exchanges based by state for insurance plans that compete for the business of individuals and small- business owners, some whom will qualify for premium subsidy. Romney/Ryan would seek to repeal the Affordable Care Act, but establish exchanges in which health plans compete for the business of Medicare- eligible seniors, who would get a premium subsidy. It wouldn't be a stretch to combine the two approaches by establishing competitive exchanges under which health plans market themselves to one and all, with the government setting minimum coverage standards and offering subsidies to the poor, disabled and elderly.
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