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Expert: Small businesses renewing policies, not sending employees to ACA exchanges

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Employers who offer health insurance to their employees are largely staying the course and continuing to provide that coverage, rather than dropping health benefits and sending their employees out to shop for their own plans at the healthcare.gov site created under the Affordable Care Act, according to John Bucsek, managing director at MetLife Solutions Group.

Bucsek said his firm advises about 3,000 New Jersey employers on their selection of health insurance plans for their workers. And most, he said, are staying the course.

Bucsek said the cost of those plans increases each year and "employers are passing on a bit more of the cost to their employees, but for the most part they're staying put" and continuing to offer health benefits.

"Most employers are making decisions that are in the best interests of their employees," Bucsek said.

Starting this year, under the ACA, individuals can purchase their own health insurance via healthcare.gov, where they may qualify for federal subsidies to help them pay for their policy. The subsidies are on a sliding scale by income and phase out completely at four times the federal poverty level, or $45,960 for a single individual and $94,200 for a family of four.

"I don't know really of any situations where (employers) are saying, 'Okay, we're going to save a couple thousand dollars per employee by dropping our coverage and allowing them to go to the exchange,'" Bucsek said.

Under the ACA, Employers with fewer than 50 workers don't have to offer health insurance, while those over 50 will either have to offer coverage or pay fines in 2015, when the ACA's "employer mandate" kicks in. Most U.S. citizens and permanent residents are required to either have health coverage or pay a fine, which in 2014 is either $95 or 1 percent of their income, whichever is higher.

Bucsek said to cope with rising health insurance costs, employers are continuing to do what they've been doing for years: redesigning their health plans, often by raising deductibles and co-pays and thus shifting more of the cost to employees. He said MetLife Solutions works with employers to analyze how workers utilize health care to find ways to tweak coverage and hold down the premiums.

"We look at what the cost is, and how much people actually spend (on health care)," Bucsek said.

For example, Bucsek said employees with low health-care spending may only use a portion of their deductible; in those cases, he said, it might make sense to raise the deductible so we can bring down the premium.
Bucsek said employers are usually reluctant to switch from one health insurance carrier to another in their quest for lower premiums.

"Because when you change carriers, sometimes your employees have to change their doctors," he said.

Employers should make sure workers are aware that even if their deductibles increase, there are provisions of the ACA that will limit their out-of-pocket expenses starting in 2014.

The ACA mandates that certain preventive services, including colonoscopies and mammograms, are provided by the health plan without co-pays and are not subject to the health plan's deductible — meaning individuals and their families have no out-of-pocket expenses for these services.

Preventive services that must be provided free of charge to health plan members include flu shots and other vaccines and screening for high blood pressure, diabetes, high cholesterol, depression, HIV and osteoporosis, among others.

These ACA provisions are designed to encourage more people to get preventive care.

"I really believe this is a benefit of the ACA," Bucsek. "It is very much a positive that (employers) should point to their employees."




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Beth Fitzgerald

Beth Fitzgerald

Beth Fitzgerald reports on health care, small business and higher education. She joined NJBIZ in 2008 after a 34-year career at the Star-Ledger and has been reporting on business in New Jersey since 1978. Her email is beth@njbiz.com and she is @bethfitzgerald8 on Twitter.

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