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Nebraska Appleseed

Nebraska Appleseed. Justice and Opportunity for All Nebraskans. Open for Business: Health Insurance Marketplace. October 4, 2013. Health Insurance Today. Currently, people get insurance through: Their employer Medicaid and/or Medicare The individual market. Health Insurance Today.

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Nebraska Appleseed

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  1. Nebraska Appleseed Justice and Opportunity for All Nebraskans

  2. Open for Business: Health Insurance Marketplace October 4, 2013

  3. Health Insurance Today • Currently, people get insurance through: • Their employer • Medicaid and/or Medicare • The individual market

  4. Health Insurance Today Insurance companies do not have to sell to you, and may deny you insurance on the basis of a pre-existing condition, or not cover certain services or treatments

  5. In 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA). The Supreme Court upheld the ACA on June 28, 2012, but ruled that the new Medicaid program was optional for states. Health Care Reform

  6. Health Care Reform The ACA focuses on four main areas: • How to find and access insurance coverage • Health Insurance Marketplace • New Medicaid Program • How to afford coverage • How to ensure the insurance system is fair and that people get value for their premium dollar • How to change our health care delivery system to control costs and focus on prevention

  7. Accessing Coverage People will access coverage through: • Employers • Creation of Health Insurance Marketplaces • Nebraska has opted for a federally facilitated Marketplace • Expansion of Medicaid • Nebraska has not yet opted in to the new Medicaid program

  8. Certain consumer protections are already in effect: Ends denial of coverage for pre-existing conditions for children Bans co-pays and out-of-pocket expenses for preventive care and immunizations on new plans Prohibits lifetime benefit limits in all plans Extends dependent coverage to age 26 in all plans Insurers cannot drop you when you get sick Coverage with Value

  9. Coverage With Value Insurance Reforms and Consumer Protections • Prohibits denial of coverage for pre-existing conditions for everyone by 2014 • Changes what insurers can look at when setting premiums: • They can no longer set different rates based on your health status or gender • Can only look at age (3:1), geographic area, family composition, and tobacco use (1.5:1)

  10. Coverage With Value • Insurance Reform and Consumer Protections • Guaranteed issue and renewability in 2014– insurers can’t refuse to sell • Prohibits annual limits for ten essential services • Creates a standard benefit plan for all new policies (does not apply to existing individual and employer-sponsored plans) • Eliminates waiting periods for coverage more than 90 days

  11. Essential Health Benefits • The ACA requires that all plans sold inside the new Health Insurance Marketplace, and most plans outside the Marketplace, to cover ten essential health benefits (EHBs)

  12. Accessing Coverage The new Health Insurance Marketplace • The Health Insurance Marketplace is a one-stop shop for people for private coverage, Medicaid coverage, and accessing tax credits • The Marketplace is accessible for individuals and small businesses with up to 50 employees • Nebraska has chosen to have a federally facilitated Marketplace—one that will be run by the federal government in place of the state

  13. Accessing Coverage The new Health Insurance Marketplace • Four insurance carriers offer plans • Blue Cross/Blue Shield, CoOpportunity, Health Alliance, Coventry • All plans must cover essential health benefits • Four levels of plans will be available • Bronze, Silver, Gold, Platinum

  14. Accessing Coverage The new Health Insurance Marketplace • Help paying for the cost of coverage (tax credits) • Eligible incomes are between 100% and 400% of the federal poverty level (FPL) ($19,090 to $76,360 for a family of three) • Individuals are not eligible for tax credits if they are offered coverage by their employer unless • The employer plan does not meet certain minimum standards and the employee share of (individual) premiums is 9.5% of income

  15. Accessing Coverage The new Health Insurance Marketplace • The process • Start the process at healthcare.gov • Series of screens/questions • If eligible for tax credit, credit is applied • Compare and select a plan • Enroll

  16. Medicaid and the Marketplace • Medicaid was intended to be the foundation of coverage for low income adults, because it is much cheaper to cover people under Medicaid than to subsidize their insurance • Therefore, those who are making under 100% FPL can’t get tax credits through the Exchange, and will have no path to coverage, creating a large gap

  17. Outreach and Enrollment Source: 2010 Small Area Health Insurance Estimates, U.S. Census Bureau • 184,429 Nebraskans under 400% FPL are uninsured • Household of 4 making less than $94,200 • 12% of total population

  18. Timelines for Enrolling*October 1, 2013- March 31, 2014 • You may be eligible for a Special Enrollment Period if you: • Move to a new state • Have certain changes in income • Change your family size • Belong to a federally recognized Tribe

  19. Consumer Assistance Framework • Enrollment Assisters • Navigators • CACs (Hospitals, doctors offices, libraries, etc.) • Agents/Brokers • Call-Center Representatives • Educators • Partners & Stakeholders • Local government branches & employees • Connect community to www.healthcare.gov and enrollment assisters.

  20. Consumer Assistance Framework Assisters Educators Create awareness of the Marketplace Drive consumers to Customer Service channels (www.healthcare.gov & assisters) Conduct outreach events and activities Provide basic information about the Marketplace and where to get help • Help consumers fill out the application • Help consumers compare plans & make an enrollment selection • Provide education about the application and plan compare process • May conduct local outreach to bring consumers to assistance.

  21. Enroll Nebraska Goal: To equip and connect assisters and educators with resources to enroll Nebraska’s uninsured. Visit www.enroll-ne.org for latest materials

  22. How can you engage your community? • Link with other organizations in your area to organize education and enrollment events • Share tools and resources with Enroll Nebraska and other organizations • Questions to consider: • What are you currently doing? • What are the challenges? • What resources already exist? • www.healthcare.gov • www.canhelp.org • www.enroll-ne.org

  23. Questions? Nebraska Appleseed Justice and Opportunity for All Nebraskans

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