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The Affordable Care Act & Access to Health Care Along the Gulf Coast: A Symposium. Morning Plenary: Implementation of The Affordable Care Act . Presented by: Johnston Associates Sponsored by: Alliance Institute November 15, 2013. We need Access to Affordable Health Care on the Gulf Coast.
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The Affordable Care Act & Access to Health Care Along the Gulf Coast: A Symposium Morning Plenary: Implementation of The Affordable Care Act Presented by: Johnston Associates Sponsored by: Alliance Institute November 15, 2013
Morning Plenary: Panelists Marjorie Petty Regional Director Region VI US Department of HHS Tony Garr Enroll America Oscar Gomez Health Outreach Partners Moderated by: Philip W. Johnston
Presented by Marjorie Petty, HHS Regional Director, Region VI Health InsuranceMarketplace 101 The Marketplaceisopen! Findhealth optionsthat meet needsandfit care your your budget. November2013
GEOGRAPHIC DIVERSITY OF THE UNINSURED Number Uninsured PercentUninsured
ch2010,President Obama signed the The Health Care Law In Mar Affordable Care Act into lawallowing • Youngadults up toage 26to their parents’ plan Additionaldrug coverage for withMedicare stayon • people • • More freepreventiveservices Lifetime limitsremovedfromhealth insurance And morestartingJanuary1,2014 • November 2013 HealthInsuranceMarketplace101 2
What’snewon January1, 2014? Discriminationduetopre-existingconditionsor gender is prohibited AnnualLimits onInsuranceCoverageareeliminated AdvancedPremium TaxCreditsareavailable The SmallBusinessTax Creditwillincrease More peopleareeligiblefor Medicaid (in some states) Coveragethrough begins the Health Insurance Marketplace • As early as January 1,2014 November 2013 3 HealthInsuranceMarketplace101
Whatis the HealthInsuranceMarketplace? Part of theAffordableCare Actof 2010 • Wherequalified individuals directly compareprivate insuranceoptions Known asQualified Health Plans(QHPs) Candirectly compareonthe basisof price, benefits, quality, and otherfactors Alsoknownas Exchanges orObamacare health • • SmallBusinessHealthOptionsProgram(SHOP) • Marketplace for smallbusinesses November 2013 HealthInsuranceMarketplace101 4
The Marketplace… It’s a waytoshopforhealth coverage • • Simplifiesthe search Withone streamlined applicationan individual orfamily canexplore everyqualifiedinsurance plan inthe area Most people areabletoget a break on costs • 90%of peoplewhoare currentlyuninsuredwillqualify for savings onhealth insurance Clearoptionswith apples-to-applescomparisons • Allhealth insuranceplansin the Marketplacepresenttheir price and benefitinformationinplainlanguage November 2013 HealthInsuranceMarketplace101 5
MarketplaceEstablishment Eachstatecan chooseto • • Createandrunits ownMarketplace Partner with theFederalGovernmenttorunsome Marketplace functions • Have a Marketplace established theFederalGovernment and operated by November 2013 HealthInsuranceMarketplace101 6
QualifiedHealthPlansCover EssentialHealthBenefits EssentialHealthBenefitsincludeatleastthese10 categories • Ambulatory Patient Services • Emergencyservices • Hospitalization • Maternityandnewborn care • Mentalhealthandsubstanceuse disorderservices, includingbehavioral healthtreatment • Prescription drugs • Rehabilitativeandhabilitativeservicesanddevices • Laboratoryservices • Preventiveandwellness servicesandchronic diseasemanagement • Pediatricservices, includingoraland vision care (pediatricoral servicesmaybe providedby stand-aloneplan) 7 November 2013 HealthInsuranceMarketplace101
How QualifiedHealthPlans Can Vary Someplansmaycoveradditionalbenefits Youmayhavetoseecertainprovidersorusecertain hospitals Thepremiums,copays,andcoinsurancearedifferent differentplans Thequalityofcarecanvary Thecoveragelevel canvarywithineachplan Somespecialtypesofplansarestructureddifferently in • Like high-deductible(catastrophic)plans November 2013 HealthInsuranceMarketplace101 8
PlanLevels of Coverage LowestPremiums HighestOut-of-Pocket HighestPremiums Costs Lowest Out-of-Pocket Costs 60% Covered 70% Percent of 80% Total Costof 90% CareCovered November 2013 HealthInsuranceMarketplace101 9
CatastrophicPlans What is catastrophiccoverage? • • • Planswithhigh deductiblesand lowerpremiums You pay allmedicalcostsup toacertain amount Includes coverage of 3primary care visits per year preventiveserviceswithno out-of-pocket costs Protectsconsumers fromhighout-of-pocket costs and • Whois eligible? • • Youngadults under30years of age Thosewhoobtainahardshipexemption from the Marketplace November 2013 HealthInsuranceMarketplace101 10
Small BusinessHealthOptionsProgram (SHOP) Marketplace Astreamlined wayforsmallbusinesses health insurance Part of theMarketplace Offers accesstoQualifiedHealth Plans Works with new insurancereforms and to offer tax credits to lower barriers toofferinghealth insurance SHOPMarketplace Help Deskforemployers • 1-800-706-7893(TTY 1-800-706-7915) November 2013 HealthInsuranceMarketplace101 11
Eligibilityinthe IndividualMarketplace Marketplace eligibility requiresyouto • • • Liveinits service area,and BeaU.S.citizenornational,or Beanon-citizenwhoislawfullypresentin theU.S.for theentireperiodforwhichenrollmentissought Notbeincarcerated • Canapply charge Canapply forMarketplaceifpendingdisposition of forMedicaid/CHIPatanytime November 2013 HealthInsuranceMarketplace101 12
Lower Premium Costs A refundableorAdvancedPremium thecostofQualifiedHealthPlans Eligibilityisbasedon TaxCredit (APTC)lowers • Householdincome,and familysize (atendofyear) Incomebetween100%to400%ofthe federalpovertylevel(FPL) ($23,550–$94,200forafamilyoffourin2013) Obtainingqualified health insurancethroughthe Marketplace Ineligibilityforgovernment-sponsoredcoverage, affordable employer-sponsoredinsurance,orcertain otherminimum essential coverage • • November 2013 HealthInsuranceMarketplace101 13
Ways to Use a Premium Tax Credit Willyou get a Willyou haveto Is your monthly crediton Federal payback Ifyou chooseto… premiumlower? tax return? money?* Use all ofyour premiumtax credit Use partofyour premiumtax credit Use none ofyour premiumtax credit Yes Notlikely Maybe Yes Maybe Notlikely No Yes No *Youshouldreportchangesinhouseholdsize andincomeassoonaspossibleto ensureyouaregetting the right premiumtaxcreditamountandavoidhavingto payanythingback. November 2013 HealthInsuranceMarketplace101 14
Who is Eligiblefora Cost-Sharing Reduction? Eligibilityforreducedcostsharingisbased on • Income at or below250%of theFPL ($58,875 annually fora family offour in 2013) ReceivingthePremium Tax Credit Enrollmentina Marketplace Silver-level plan • • MembersofFederally-recognizedIndianTribes • Nocostsharingif income is <300%FPL November 2013 HealthInsuranceMarketplace101 15
MedicaidEligibilityin2014 StateshavetheoptiontoexpandMedicaideligibilityto • Adults ages 19– 64withincomesup to133%of the federal poverty level(FPL)($15,282/yearforan individual, $31,322/yearforafamilyof 4(2013amounts)) EnsuresMedicaidcoverageforallchildren •Withincomesup to133%of theFPL Shiftstosimplifiedwayofcalculatingincometodetermine Medicaid/CHIPeligibility • Known asModified AdjustedGrossIncome(MAGI)-based method November 2013 HealthInsuranceMarketplace101 16
Startingin2014, everyonemusteither: 1.HaveMinimum 2.HaveaCoverage 3.Pay afee Essential Exemption (Shared OR OR Coverage Theyare already coveredand don’t needtodo anything. November 2013 Theydon’thave to getcoverage and won’thavetopay a feefornothaving coverage. HealthInsuranceMarketplace101 Responsibility Payment) Theyshould consider getting coverage.If they don’t,they willpay a fee. 17
1. Whatis MinimumEssentialCoverage? Ifyouhavecoveragefromanyofthefollowing, youare coveredanddon’thaveto doanything • • • • • • • Employer-sponsored,including COBRAand retiree Medicare Medicaid Children’s Health Insurance Program(CHIP) Marketplace Coverage IndividualCoverage (outsidethe Marketplace) TRICAREorcertain types of VAcoverage coverage About85%ofAmericansalreadyhave MinimumEssential Coverage. November 2013 HealthInsuranceMarketplace101 18
2. Who cangeta coverageexemption nothave to pay a fee? and Youmaygetacoverageexemptionifyou • • • • • • • Are Are Are conscientiouslyopposed(religiousconscience) a member ofa recognizedhealth caresharingministry a member ofa FederallyrecognizedIndiantribe Don’tmakethe minimumincome required tofile taxes Have ashortcoveragegap(>3 consecutivemonths) Suffered a hardship Didnothaveaccessto affordablecoverage (costof available coverage>8% ofhousehold income) • • Were Were incarcerated (unlesspendingdispositionof charges) notlawfullypresent HealthInsuranceMarketplace101 November 2013 19
3. You May Pay a Fee You may pay a feewhen youfileyour 2014 Federaltax returnin 2015(andthereafter) • If you don’thave minimumessential coverage, and You don’t qualify foran exemption • Paying the coverage fee does not provide health Less than 2%ofAmericans areexpected to havetopay the fee. November 2013 HealthInsuranceMarketplace101 20
You May Pay a Fee (Continued) You pay the greater of the flat dollar amount or the percentage of income 2014 2015 2016 andbeyond Flatdollar $95 peradult $325 peradult $695 peradult** amount 50%ifunder18* 50%ifunder18* 50%ifunder18* (annual) Or Or Or Percentageof 1%ofhousehold 2%ofhousehold 2.5% of income income income household (annual) income *Maximumof$285 perfamilyin2014(appliestothoseforwhomthe$95 per adult/$47.50 perchildis lessthan1%ofincome).Higherinsubsequentyears. **After 2016-Plusanincreasebasedoncost ofliving November 2013 HealthInsuranceMarketplace101 21
WhenYouCanEnroll inthe IndividualMarket MarketplaceInitialOpenEnrollmentPeriod • October1,2013-March31,2014 AnnualOpenEnrollmentPeriods • 2014andbeyond,October 15-December 7 SpecialEnrollmentPeriods • Availableincertain circumstances during the year November 2013 HealthInsuranceMarketplace101 22
How the Marketplace Works HealthInsuranceMarketplace101 November 2013 23
4 Ways to Get Marketplace Coverage November 2013 HealthInsuranceMarketplace101 24
InPerson Assistance Marketplaceinpersonhelpisavailable • CertifiedAssisters Navigators Non-Navigatorassistancepersonnel CertifiedApplicationCounselors Agents andbrokers To find assistance inyour area,go to Localhelp.HealthCare.gov • • Visit Marketplace.cms.gov forinformationonyour becomingaChampion forCoverage organization November 2013 HealthInsuranceMarketplace101 25
MarketplaceandPeopleWith… Medicare • Medicareisn’tpartof the Marketplaceso you don’t needtodo anything COBRA • You can dropCOBRAandenrollinthe Marketplace Duringthe MarketplaceOpen EnrollmentPeriod Within60 daysof COBRAexpiring(SpecialEnrollmentPeriod) Pre-existing ConditionInsurance Plan(PCIP) • • EndsDecember31,2013 Need toapplyfor Marketplacecoverageby December15, 2013, to avoid abreakincoverage(noautomatictransition) November 2013 HealthInsuranceMarketplace101 26
Key Pointsto Remember TheMarketplaceisanewwaytofindandbuy insurance Qualifiedindividualsandsmallbusinessescan healthinsurancethatfitstheirbudget health shopfor States haveflexibilitytoestablishtheirownMarketplace Individualsandfamiliesmaybeeligibleforlowercosts theirmonthlypremiumsandout-of-pocketcosts Thereisassistanceavailabletohelpyougetthebest coverageforyourneeds on November 2013 HealthInsuranceMarketplace101 27
RemembertheMarketplace’s Important Dates Open Enrollment Started October 1, 2013 Lastdayto enrollforcoverageto beginJanuary1, 2014 December15,2013 Coveragecanstartas earlyas January1, 2014 Open enrollment ends March 31,2014 November 2013 HealthInsuranceMarketplace101 After March31,2014, you canonly enrollaftera qualifyingevent or duringthe nextannual open enrollment (Oct15,2014– Dec7,2014). 28
Marketplace.cms.gov Get thelatest resourcestohelp people apply, enroll, andget coverage 2014 in Click “Get Training” for helpfulvideos November 2013 HealthInsuranceMarketplace101 29
onnected Want moreinformation about the Marketplace? Stay Connected • Signup togetemailand textalerts at HealthCare.gov/subscribe CuidadoDeSalud.gov forSpanish • Updates and resourcesforpartner available atMarketplace.cms.gov Twitter@HealthCareGov Facebook.com/Healthcare.gov organizations are • • November 2013 HealthInsuranceMarketplace101 30
Alliance Institute: ACA DiscussionNovember 15, 2013 Tony Garr Southeast State Assistance Manage
Enroll America’s Mission: Maximize Coverage For Uninsured Americans Enroll America is executing a national education and enrollment campaign 1. Educate and Engage 2. Mobilize to Enroll 3. Work with Partners to Ensure System works Successful implementation of ACA requires all-out effort by government, not-for-profits, insurers, hospitals, community health centers, health providers, and others
State Presence As of September 23, 2013 Staff on the ground Working with partners Alaska Hawaii
Alabama Assistance Coordinating Organization: Alabama Arise http://www.arisecitizens.org/index.php/policy-research-topmenu-71/health-topmenu-29 Requesting Enrollment Assistance: • AIDS Alabama, Enroll Alabama: http://www.enrollala.com/ • Access Alabama: http://www.alaaccess.com/AHA_Home.aspx • Alabama Primary Health Care Assn Outreach & Enrollment: http://www.alaaccess.com/AHA_Home.aspx • Healthcare.gov –https://www.healthcare.gov/ • Find Local Help: https://localhelp.healthcare.gov/ • Call Center: 1-800-318-2596; TTY: 1-855-889-4325 • Enroll America: http://www.getcoveredamerica.org/
Florida Assistance Coordinating Organization: Florida Primary Care Association: http://www.fachc.org/ Requesting Enrollment Assistance: • Florida Consumer Services: 1-877-693-5236 • Healthcare.gov –https://www.healthcare.gov/ • Find Local Help: https://localhelp.healthcare.gov/ • Call Center: 1-800-318-2596; TTY: 1-855-889-4325 • Enroll America: http://www.getcoveredamerica.org/
Louisiana Assistance Coordinating Organization: Southwest Louisiana AHEC - http://lahealthcarenav.com/ Requesting Assistance: • Reach us by Email at: info@lahealthcarenav.com • By Phone: North LA - Toll Free - 1-877-946-4644; Central LA - 318-443-2855;Southwest – Toll Free - 1-800-435-2432; Southeast – Toll Free - 1-866-428-4173 • Enrollment Assistance: http://lahealthcarenav.com/request-enrollment-assistance/ • Louisiana Primary Care Assn Outreach & Enrollment: http://lpca.net/main/inside.php?page=Outreach_and_Enrollment • Events in Your Area: http://lahealthcarenav.com/events/ • Healthcare.gov –https://www.healthcare.gov/ • Find Local Help: https://localhelp.healthcare.gov/ • Call Center: 1-800-318-2596; TTY: 1-855-889-4325 • Enroll America: http://www.getcoveredamerica.org/
Mississippi Assistance Coordinating Organization: Cover Mississippi - http://coverms.org/ Requesting Enrollment Assistance: • Coordinator: Morgan Miller, miller@mhap.org or 601-355.0025 (p) • Cover Mississippi: http://coverms.org/index.php/site/help • Mississippi Primary Care Assn Outreach & Enrollment: http://www.mphca.com/outreach-and-enrollment-resources • Events in Your Area: http://coverms.org/index.php/events • Healthcare.gov –https://www.healthcare.gov/ • Find Local Help: https://localhelp.healthcare.gov/ • Call Center: 1-800-318-2596; TTY: 1-855-889-4325 • Enroll America: http://www.getcoveredamerica.org/
As A Result, Enrollment Will Be A Challenge To Overcome Many of the uninsured still don’t know about their options November 2012 August 2013 of the uninsured don’t know about the new health insurance options of the uninsured don’t know about the new health insurance marketplace options 78% 43% Enroll America still has work to do, but the uninsured are hearing more and more about the new options available to them Source: Enroll America, November 2012 Source: Kaiser Family Foundation, August 2013 Lack of awareness provides opportunity for education with effective messaging