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Coverage is Good Medicine f or Oregon Health Insurance for You and Your Family

Coverage is Good Medicine f or Oregon Health Insurance for You and Your Family. Last updated: 8/8/2013. On March 23, 2010, the Affordable Care Act became law. Health care is more secure for millions of people. If you have insurance:

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Coverage is Good Medicine f or Oregon Health Insurance for You and Your Family

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  1. Coverage is Good Medicinefor OregonHealth Insurance for You and Your Family Last updated: 8/8/2013

  2. On March 23, 2010,the Affordable Care Act became law.

  3. Health care is more secure for millions of people. If you have insurance: You don’t have to pay extra for preventive care like annual check ups and shots

  4. Health care is more secure for millions of people. If you have insurance: No lifetime limits on how much of your care insurance companies will cover No dropping your coverage when you get sick

  5. Health care is more secure for millions of people. Get a rebate if your insurance company collects too much money in premiums and only spends 80% on medical care. 8.5 million people got checks in 2013 http://thechart.blogs.cnn.com/2012/07/27/checks-come-as-surprise-under-obamacare/

  6. 3.1 million young adults are covered through their parents’ insurance

  7. 6.6 million seniors have saved $7 billion on prescription drugs ($1060 per person average)

  8. 500 new doctors and 600 new nurses are being trained, including a focus on primary care

  9. Hospitals have incentives to coordinate care, decrease complications, and improve quality.

  10. Now, health care is more secure for millions of people. Starting January 1, 2014, if you have a pre-existing condition, you will not be charged more or get denied coverage for it. Half of Americans have a pre-existing condition and will be safe.

  11. However, in America, 1 in 7 people has no health insurance right now At some point in 2012, nearly 1 in 2 adults had no insurance or was underinsured. http://www.commonwealthfund.org/News/News-Releases/2013/Apr/New-Health-Insurance-Survey.aspx (accessed 8/5/2013)

  12. In Oregon, 1 in 5 people has no health insurance. That’s 640,000 people. http://www.enrollamerica.org/maps

  13. 2013-2014: A Historic Opportunity Health insurance for millions of people Largest expansion of coverage since Medicare in 1965.

  14. Millions will have a chance to sign up for coverage. October 1, 2013: First day to sign up for new health insurance options. January 1, 2014: Coverage starts! March 31, 2014: Last day to sign up until October, 2014. 78% of uninsured people don’t know about this!

  15. Three *New* Ways to Get Covered Expanded Medicaid* In participating states only Lowest Income Insurance Marketplace (private insurance) Higher Income Small Business Marketplace (private insurance) Small Business

  16. Supreme Court Decision: States have a choice of whether to expand Medicaid http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/05/florida-rejects-medicaid-expansion-leaves-1-3-million-uninsured/(accessed 8/5/2013)

  17. Medicaid Expansion • State-run, mostly federally-funded health insurance for people with the lowest income. • Who Qualifies:

  18. Health Insurance Marketplace • A supermarket where health insurance companies compete for your business. • Clear Information: • What’s covered • What it costs • Simple language • No fine print allowed

  19. Health Insurance Marketplace • Insurance companies have to offer you a plan even if you’ve been denied before • Only these will affect your premium: • How old you are • Where you live • Number and age of people in your family • Whether you smoke

  20. Health Insurance Marketplace All insurance plans will cover the basics. Doctor Visits Hospital Stays Maternity and Newborn Care ER Visits Blood Tests Prescriptions Pediatrics with vision and dental Mental Health and Substance Abuse Physical Therapy Prevention (shots, cancer screenings)

  21. Most people will get a tax credit to help pay for your insurance. • Employer doesn’t offer affordable insurance (you would have to pay more than 9.5% of your income) • You’re not on Medicare • Must buy insurance on the marketplace.

  22. Here’s how it would work. • $50,000 annual income • Ages: 35, 32, 8, and 7 • Total estimated cost per month: $924.25 • Federal tax credit covers: $643.83 • You pay (estimated): $280.42 Kaiser Calculator: kff.org/interactive/subsidy-calculator

  23. Health Insurance Marketplace • You CAN shop at the marketplace if you: • Live in the U.S. • Are a U.S. Citizen or legal resident • Are not in prison

  24. Health Insurance Marketplace • You MUST shop here if you: • Are a member of Congress or his/her staff

  25. Choose the Plan that Fits Your Needs “Catastrophic” Plan – for people under 30 What You Pay Lowest Monthly Premiums (fees) You get 3 primary care visits and preventive care for free. You pay for 100% of your other care until you reach the limit (exact amount depends on your income). Who Might Choose Catastrophic Healthy. No or low expected medical costs. Ok with taking a financial risk. Can’t afford anything else. Must be younger than 30.

  26. Choose the Plan that Fits Your NeedsBronze, Silver, Gold, or Platinum Plans Bronze Plans What You Pay • Lower monthly premium (fee). • Preventive care is covered. • Insurance covers about 60% of your total medical costs. Who Might Choose Bronze Healthy. Don’t expect to use a lot of health care. Willing to take a financial risk. Can’t afford a higher level plan.

  27. Choose the Plan that Fits Your NeedsBronze, Silver, Gold, or Platinum Plans What You Pay Highest monthly premium (fee). Preventive care is covered. Insurance covers about 90% of your total medical costs. Who Might Choose Platinum Expect to use more health care. Already have medical problems. Don’t want to take a financial risk. Can afford it. Platinum Plans

  28. What If I Don’t Get Insured? You’ll pay a fine: • In 2014: $95 (or 1% of your income) • In 2016: $695 (or 2.5% of your income) • Plus the cost of health care ($2500 for a broken ankle) Exceptions: • Uninsured for less than 3 months in a row • All available insurance options cost more than 9.8% of your income • Undocumented immigrant • Belong to an exempt religious sect Why? Hospitals will save your life in an emergency – even if you have no insurance. If you can’t pay your hospital bills, people with insurance and the government (taxpayers) get charged more.

  29. Small Business Marketplace (SHOP) How Many Employees Do You Have? 1 to 49 50 or More Shop on the small business marketplace. Buy insurance the way you always did. More information at BusinessUSA.gov

  30. Small Business Marketplace (SHOP) Shop on the Small Business Marketplace 1 to 49 employees 2014 Coming Soon Pick ONE plan for all employees. Pick a VARIETY of plans for all employees. Pay one lump sum to the SHOP exchange More information at BusinessUSA.gov

  31. Small Business MarketplaceTax Credits • 2-24 full-time equivalent employees • You pay at least 50% of premiums • Average wages less than $50,000/year • Up to 50% tax credit for premiums

  32. Large Employer Penalties (delayed till 2015) • More than 50 full-time equivalent employees • You don’t offer insurance OR employees can’t afford the insurance you offer (they have to pay more than 9.5% of their income) • One employee needs help from taxpayers (Medicaid or a tax credit) to be able to afford health care • You pay ($2000-$3000 per year) x (# of full-time employees) *Would affect 1% of all employers.

  33. It’s Easy to Sign Up (starting October 1) STEP 1: You can apply in 3 ways ONLINE coveroregon.com PHONE 1-855-268-3767 IN PERSON Search HealthCare.gov for locations *Note: If your state is running its own marketplace, you will be redirected to your state’s website and hotline.

  34. STEP 2: Fill out the form. (5-7 minutes for an individual) • All you need is: • Basic information about you and your family (age, address, employer, social security number) • Your income (W-2 or pay stubs) • If you have insurance or your employer offers insurance, you also need: • Your insurance policy number • Information about your employer’s insurance ONLINE coveroregon.com PHONE 1-855-268-3767 IN PERSON Search HealthCare.gov for locations

  35. IRS will verify your income based on last year’s tax return. Depending in income, you will qualify for: STEP 3: Submit the form. Insurance marketplace with a tax credit. Insurance marketplace withouta tax credit. Medicaid ONLINE coveroregon.com PHONE 1-855-268-3767 IN PERSON Search HealthCare.gov for locations

  36. STEP 4: Pick Your Insurance Plan! Or enroll in Medicaid. You’ve Signed Up! Pay your premium and wait 15 days. Then get a doctor, and get the care you need! ONLINE coveroregon.com PHONE 1-855-268-3767 IN PERSON Search HealthCare.gov for locations

  37. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” ― Martin Luther King Jr.

  38. Spread the Word: Coveroregon.com 1-855-268-3767 October 1, 2013 to March 31, 2014 For more resources, visit www.drsforamerica.org

  39. Supplemental slides

  40. Governors and state legislators can choose to expand Medicaid at any time. http://kaiserfamilyfoundation.files.wordpress.com/2013/07/8458-analyzing-the-impact-of-state-medicaid-expansion-decisions2.pdf (accessed 8/5/2013)

  41. Paying for Reform 1st 10-year net deficit reduction = $140 billion Taxes • Industry (insurance, pharmaceutical, medical devices) • On individuals • Payroll: additional 0.9% Medicare payroll take on wages >$250,000 (couple), >$200,000 (individual) • Capital gains: 3.8% tax on unearned income (interest, dividends) ONLY for those w/ income >$250,000 • “Cadillac Tax”: insurance plans >$27,500 (family) and >$10,200 (individual) taxed starting in 2018 • Tanning tax 10%

  42. Medicare is saving $716 Billion. Bottom Line: The ACA increases benefits for seniors and the disabled. • Medicare reimbursements rise at a lower rate, lower quality providers reimbursed less ($415B) • Less uncompensated care (more people with insurance) means Medicare could slow the rate of growth of reimbursements. • Hospitals have a financial incentive to improve care. • Medicare subsidies to private insurance companies are decreased to equal what we spend to take care of regular Medicare patients ($156B)

  43. Medicare is saving $716 Billion. Bottom Line: The ACA increases benefits for seniors and the disabled. • Medicare pays lower subsidies to hospitals that were taking care of uninsured patients, now that many will be insured ($56B) • All other, including enhanced fraud prevention ($89B)

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