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Affordable Care Act & You: What every consumer should know

Affordable Care Act & You: What every consumer should know. What is the ACA (“ Obamacare ”) ?. The Patient Protection and Affordable Care Act (ACA) ACA will reform our complex health care system

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Affordable Care Act & You: What every consumer should know

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  1. Affordable Care Act & You:What every consumer should know

  2. What is the ACA (“Obamacare”)? The Patient Protection and Affordable Care Act(ACA) • ACA will reform our complex health care system • If you are not insured, or want to purchase insurance, a new Florida-based system will help you get coverage • ACA makes healthcare care more accessible and affordable • Preventive care • Family planning • Related services • No discrimination due to pre-existing conditions or gender • Other benefits

  3. How the ACA Works • Uninsured consumers can enroll in a Qualified Health Plan (QHP) through the “Marketplace” • The Marketplace helps consumers choose the plan that best suits their needs by allowing them to compare available plan options including monthly premiums, co-pays, deductibles, service networks, etc. • There is a single, streamlined application for health plan, Medicaid and CHIP options. • ACA requires most people to have coverage by January 2014 • Penalty in 2014 is $95 per individual; $285 per family; or 1 percent of family income, whichever is higher. • A number of exemptions are also available.

  4. How the Marketplace Works https://www.healthcare.gov/marketplace/individual

  5. Application Process Enroll in Qualified Health Plan Submit application to the Marketplace Eligibility determined and verified Eligibility determined for Qualified Health Plan, Medicaid or CHIP Enroll in Medicaid or CHIP • Online • By Phone • In Person Supported by Data Services Hub

  6. Ways to Apply • Online: www.HealthCare.gov • By Phone (24/7, 150 languages): 1-800-318-2596 • In Person: Certified Application Counselors & Navigators Visit your nearest federally qualified health center or go to www.LocalHelp.HealthCare.govor call 1-800-318-2596 to be connected.

  7. Eligibility • Eligibility: • Live in the service area • US citizen orlawfully residing non-citizen for the period of enrollment • Not incarcerated

  8. Affordable Coverage • A refundable or Advanced Premium Tax Credit (APTC): • Can only be used to buy insurance from the Marketplace • Paid directly to insurer on your behalf • Can reduce your monthly premium, depending on income level • Eligibility for the APTC is based on: • Family size and household income • Household income between 100%-400% Federal Poverty Level • If consumer is ineligible for other coverage such asgovernment or employer insurance

  9. Federal Poverty Level Table • Households earning less than 100% FPL will not be eligible for APTC. • Households earning more than 400% FPL will not be eligible for APTC. • Medicaid was not expanded in Florida.

  10. Types of Plans • Types of health plans • Platinum • 90% of covered costs paid by plan • Maximum services • Lower deductible, higher premiums • Gold • 80% of covered costs paid by plan • Silver • 70% of covered costs paid by plan • Bronze • 60% of covered costs paid by plan • Minimum services • Higher deductible, lower premiums • Catastrophic coverage is also available for adults under age 30 and/or those who obtain a hardship waiver.

  11. Essential Health Benefits • Each plan must include, at a minimum, 10 essential health benefits (below) • More expensive plans offer additional benefits

  12. Enrollment • Open enrollment through the Marketplace is October 1, 2013 through March 31, 2014. • Health coverage is effective January 1, 2014if purchased by December 15, 2013.

  13. For more information …. In Person: • [insert CAC name & contact info] By Phone: • Marketplace Call Center at 1 (800) 318-2596 On-line: • www.HealthCare.gov

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