1 / 22

Illinois Health Insurance Marketplace

Illinois Health Insurance Marketplace. October 2013. Affordable Care Act: The Promise & Impact. The Promise. The Impact. Health insurance coverage for 26 million Americans, including 1 million Illinoisans Insurance reforms Right care…Right time…Right setting Better health and wellnes s.

rea
Download Presentation

Illinois Health Insurance Marketplace

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Illinois Health Insurance Marketplace October 2013

  2. Affordable Care Act: The Promise & Impact The Promise The Impact • Health insurance coverage for 26 million Americans, including 1 million Illinoisans • Insurance reforms • Right care…Right time…Right setting • Better health and wellness • $7.8B+ contribution from Illinois hospitals over 10 years • In exchange, more insured patient volume • 410,000 of 1.7Mcurrently uninsured Illinoisans expected to obtain coverage on Marketplace by 2015 • Additional 342,000 to become Medicaid eligible by 2015 Source: State of Illinois

  3. ACA’s Path to Getting Uninsured Covered • Establishes Health Insurance Marketplaces • A Travelocity-type online market to compare and pick a private health insurance plan with financial assistance available to help make coverage more affordable • Enrollment began October 1, 2013 • Incentivizes states to expand Medicaid • Federal government will pay 100% for new “ACA adults” to 2017; phase down to 90% by 2020 • Illinois Senate Bill 26/Public Act 98-104 signed into law on July 22, 2013 • Encourages states to create better, more convenient systems for signing up individuals • Illinois’ Application for Benefits Eligibility (ABE)—Medicaid

  4. Illinois Health Insurance Marketplace Options Four Coverage Levels Same Essential Benefits • Bronze • Lowest monthly premiums • Highest out-of-pocket costs—40% • Silver • 30% out-of- pocket costs • Gold • 20% out-of-pocket costs • Platinum • Highest monthly premiums • Lowest out-of-pocket costs—10% • Prevention/wellness screenings • Doctor visits • Rx drugs • Emergency services • Hospitalization

  5. Medicaid Eligibility Changes for 2014 For the 1st time, Medicaid will be broadly available to all low-income adults regardless of parenting or health status • New “ACA Adult” group • Adults 19-64 years of age without dependent children • Incomes at or below 138% of Federal Poverty Level (FPL) • Monthly: $ 1,321/individual; $1,748/couple • Annually: $15,860/individual; $21,400/couple • Former foster children • Children 18-25 who were on Medicaid when exited foster care because of their age • Eligible regardless of income

  6. Illinois Landing Page is Critical to Enrollment GetCoveredIllinois.gov Will Get Consumers to the Right Application—Marketplace or Medicaid GetCoveredIllinois.gov 1-866-311-1119 Medicaid Marketplace Healthcare.gov Abe.Illinois.gov

  7. Illinois Health Insurance Marketplace Basics • State/federal partnership • Shift to state marketplace in 2015, if legislated • Under the partnership, Illinois is responsible for plan management and consumer assistance • Federal roles include general oversight, funding, exchange governance, enrollment/eligibility, selection and funding of navigators • Began accepting new enrollees on 10/1/13 • Insurance purchased through Marketplace by 12/15/13 to become effective 1/1/14

  8. Linking Illinoisans to Coverage: Our New World on January 1, 2014 FPL 400% 300% 200% 138% Newly Eligible Medicaid 100% Current Medicaid

  9. Eligibility and Financial Assistance for Marketplace Eligibility Assistance Penalty • Must be a current resident of Illinois • Must be a U.S. citizen or national, or be lawfully present in the U.S. • Federal tax credits available • Income up to 400% FPL ($45,960 for individuals; and $94,200 for family of four) • Based on a sliding income scale • Tax credit for small businesses with less than 25 FTEs who make an average of $50K/year (or less) • In 2014, the penalty for not getting health coverage for an individual is $95 or 1% of income • For a family, the penalty is capped at $285 in 2014 • By 2016, this penalty increases to $695or 2.5% of income for an individual, and for a family, the penalty increases to $2,085

  10. Choices in 13 Rating Areas of State; 4-7 Health Insurers, Offering 39 – 80 Plans Source: Illinois Department of Insurance

  11. Sample Rates Submitted: Non-Smoker Source: Illinois Department of Insurance

  12. Sample Rates Submitted: Tobacco User Source: Illinois Department of Insurance

  13. Sample Rates, Including Subsidies & Tax Credits (Example 1) • Based on household income (HHI), the individual may qualify for premium subsidies to limit net cost for a 2nd lowest cost silver plan to ~$121 per month Single 30-year-old, HHI $23,000 Source: Illinois Department of Insurance 9/30/13

  14. Sample Rates, Including Subsidies & Tax Credits (Example 2) • Based on household income (HHI), the couple may qualify for premium subsidies to limit net cost for a 2nd lowest cost silver plan to ~$276 per month Couple, both 55, HHI $40,000 Source: Illinois Department of Insurance 9/30/13

  15. Sample Rates, Including Subsidies & Tax Credits (Example 3) Family of 4, parents age 40, 2 children, HHI $60,000 • Based on household income (HHI), the family may qualify for premium subsidies to limit net cost for a 2nd lowest cost silver plan to ~$410 per month Source: Illinois Department of Insurance (IDOI) 9/30/13

  16. How the Marketplace Works • Enroll • Choose a plan that meets your needs and enroll • 1st open enrollment is 10/1/13 through 3/31/14 • Coverage of Essential Health Benefits starts on 1/1/14, if enrolled by 12/15/13 • Pick a Plan • View and compare all the plans side-by-side • Find out if eligible for financial assistance • Create an Account • Enter name, income, household size

  17. Small Businesses and the ACA • SHOP: Small Business Health Options Program • Insurance Marketplace for small businesses with 50 or fewer FTEs • Similar to individual insurance Marketplace • Online enrollment starts 11/1/13 • Small businesses with fewer than 25 employees providing health insurance for workers receive tax credits up to 50% of employer’s contribution, if purchasing through SHOP

  18. Implications for Consumers • Individual Mandate • Illinoisans who qualify for coverage must buy health insurance or pay a penalty • NO denials for pre-existing conditions • NO lifetime limits • All plans, same essential health benefits • Differing deductibles based upon plan choice

  19. Implications for Hospitals/Health Systems • Reimbursement for those previously uninsured • Opportunity to participate in new payer networks • Opportunity for community outreach • Potential increase in bad debt with high deductibles • Potential churning between Marketplace & Medicaid

  20. IHA Response: Enrolling Uninsured is Paramount Spread the Word • If someone already has private health insurance, Medicaid or Medicare, they don’t need to do anything • If someone does not have coverage, then new health coverage options will be available in 2014 • Thanks to a grant from AHA, IHA published a customizable Need Health Insurance? brochure that is available for all member hospitals to order at no cost. Go to illinoisinsurancemarketplace.org

  21. Key Dates for Health Insurance Marketplace Marketplace opens for business. Consumers can start to shop, compare and enroll in the Marketplace; or enroll in Medicaid 10/1/13 Enroll by Dec. 15 for coverage on Jan. 1, 2014 12/15/13 Insurance purchased by Dec.15 will become effective on Jan.1, 2014 1/1/14 Get Covered Illinois Open enrollment ends on Mar. 31, 2014 3/31/14 Next open enrollment period begins 10/1/14

  22. Resources • www.GetCoveredIllinois.gov • Get Covered Illinois Help Desk 1-866-311-1119 • www.HealthCare.gov • www.healthcarereform.illinois.gov • www.EnrollAmerica.org • www.GetCoveredAmerica.org

More Related