Affordable Care for a Healthy Columbus

1. Affordable Care for a Healthy Columbus FREE – AACS can help you apply for Medicaid or Health Insurance

2. The Affordable Care Act • Also known as “ACA” or “Obamacare” • Signed into law in 2010 • Introduced reforms to improve both patient protection and health care access and affordability in the United States

3. Why was ACA needed? • Millions of Americans living without health insurance, and millions more living with inadequate coverag • People with pre-existing conditions were denied coverage • Insurance premiums more than doubled over the last decade • Medical bills contributing to more than 60% of all bankruptcies • Health care costs skyrocketing in the U.S. – at unsustainable rate • Health care system relies on treatment instead of prevention • Health outcomes in U.S. worse than in other industrialized countries – 24th of 30 “developed” countries.

4. It’s the Law! Beginning in 2014, most people will need to purchase or obtain health insurance coverage – this is the mandate. If you don’t obtain health insurance coverage by March 31, 2014, you may be charged a fine. Some people will be exempt from this rule.

5. How does the fee go up each year? Your taxable income is below 133% of the federal poverty level you are exempt from this tax. 2014=$95/person/year or 1% of your income 2015=$325/person/year or 2% of your income 2016=$695/person/year or 2.5% of your income 2017=Tax Penalty will increase by the rate of inflation going forward, or 2.5% of your income

6. How Can You Obtain Coverage? Beginning in 2014, most individuals will need to purchase or obtain health insurance coverage. • Employer-sponsoredinsurance • Individual private insurance • Young adults under age 26 on parent’s insurance • TRICARE/Veterans Affairs • Medicare • Medicaid/CHIP • Health Insurance Marketplace* • *financial help through subsidies will be available

7. Ohio Medicaid Expansion in 2014 • Ohio has expanded Medicaid to 138% of the FPL • Beginning January 1, 2014, more low-income Ohioans will be eligible for Medicaid coverage.

8. Applying for Medicaid In-person: Job and Family Services 2. By phone: Ohio Medicaid Consumer Hotline (800-324-8680) 3. Online: benefits.ohio.gov

9. The Health Insurance Marketplace

10. The Health Insurance Marketplace • A new way to purchase health insurance • Provides qualified individuals and employers: • Access to affordable coverage options • Ability to buy certain private health insurance, often with financial assistance • Access to health insurance information • Allows for apples-to-apples comparison of Qualified Health Plans (QHPs)

11. Who is Marketplace-eligible? Marketplace eligibility requires consumers to: • Live in its service area, and • Be a U.S. citizen or national, or • Be a non-citizen who is lawfully present in the U.S. for the entire period for which enrollment is sought, and • Not be incarcerated (in prison)

12. Medicare & The Marketplace Medicare is NOT a part of the Marketplace. • People who are on Medicare or eligible for Medicare are not affected by the marketplace. • If you have Medicare, you are covered. • The Marketplace won’t affect your Medicare choices. • Medicare benefits won’t be changing. • To learn more about Medicare eligibility, see: www.Medicare.gov

13. All Qualified Health Plans will cover these 10 Essential Health Benefits *Not required in benefit package if a stand-alone dental plan is in the Marketplace in which the plan operates. Ambulatory patient services Emergency services Hospitalization Maternity & newborn care Mental health and substance abuse disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral* and vision care

14. Marketplace - Consumer Choice *In addition to monthly premium.

15. Marketplace - Affordability Financial help is available for working families: • Tax credits to lower monthly premium payments for qualified individuals • Income between 100%-400% FPL (Federal Poverty Level) • Cost-sharing reductions to lower out-of-pocket spending for health care services • Income at or below 250% FPL

16. How Much is an Advance Premium Tax Credit? • The amount of the Advance Premium Tax Credit depends on: • Household income as a percentage of the FPL • A sliding scale that increases the taxpayer’s own contribution towards the premium cost as a household income as a percentage of the FPL increases

17. Do I have to wait until I file my taxes to receive the tax credit? • You can reduce your premium amount up front • You can choose to use an APTC to purchase an insurance plan • Advanced payments are paid directly to the insurance company on your behalf • The amount is based on projected household income • Reconciled at tax time against the actual Premium Tax Credit amount you are eligible for • Changes in circumstances, such as new family members or decreased income, should be reported to ensure the tax credit is still accurate and the recipient does not end up owing additional taxes when filing.

18. Cost-Sharing Reductions • Cost-sharing reductions are available for those who: • Have incomes at or below 250% FPL • Receive a Premium Tax Credit • Enroll in a Marketplace Silver-level QHP

20. Marketplace Takeaways • It’s an easier way to shop for health insurance • Simplifies the search for health insurance • One application, one time, and an individual or family can explore every qualified insurance plan in the area • Most people will be able to get a break on costs • 90% of people who are currently uninsured will qualify for discounted or free health insurance • Clear options with apples-to-apples comparisons • All health insurance plans in the Marketplace present their price and benefit information in plain language

21. Enrollment Assistance: Help is available! • Healthcare.gov • The Marketplace 24/7 Toll-Free Call Center • 1-800-318-2596 (TTY 1-855-889-4325) • Certified In-Person Assisters • Navigators • Certified Application Counselors • Agents and brokers • Federally-Qualified Health Centers

22. Tips to Prepare for Marketplace Enrollment • Start gathering basic information about your household income. Most people will qualify to get a break on costs, and you’ll need income information to find out how much you’re eligible for. • Set your budget. There will be different types of health plans to meet a variety of needs and budgets, and breaking them down by cost can help narrow your choices. 

23. Tips to Prepare for Marketplace Enrollment • Find out from your employer whether they plan to offer health insurance, especially if you work for a small business. • Explore current options. You may be able to get help with insurance now, through existing programs or changes that are in effect already from the new health care law.

24. Things to Think About When You are Choosing a Plan • Provider Network • Prescription Drug Formulary • Visit Limits and Other Details of Specific Benefits • Insurer Participation in both the Marketplace and Medicaid (for people with low incomes likely to move back and forth in their eligibility) Understand what these terms mean by visiting the CMS Uniform Glossary of Terms: https://www.healthcare.gov/glossary/

25. The Basics of Health Insurance • Designed to protect you and your family against the high costs of health care • People purchase health care coverage by paying a monthly payment called a premium • When you or your family need care, your health insurance plan will cover some or all of the associated costs

26. How does Health Insurance Work? Imagine you have a $100,000 heart surgery, which is a covered medical expense under your health insurance plan, and let’s say this health insurance plan has: • $1,000 annual deductible, • 20% coinsurance after deductible • $2,000 out-of-pocket limit per year.

27. What is a Deductible? A deductibleis the amount of money you must pay each year before your health insurance plan starts to pay for covered medical expenses. So with a $1,000 annual deductible on your plan and $100,000 heart surgery bill, you are responsible for paying the first $1,000.After this $1,000 deductible is met, the insurance company will pay a percentage of the bill in what is called the coinsurance.

28. What is Coinsurance? Coinsurance is a form of cost-sharing in which you are responsible for paying a certain percentage and the insurance company will pay the remaining percentage of the covered medical expenses after your deductible is met. For a health insurance plan with 20% coinsurance, once the deductible is met, the insurance company will pay 80% of the covered expenses while you pay the remaining 20% until your out-of-pocket limit is reached for the year.

29. What is an Out-of-Pocket Limit? The out-of-pocket limit is the maximum amount you will pay out of your own pocket for covered medical expenses in a given year. For a plan with a $2,000 out-of-pocket limit, you will pay a $1,000 deductible and $1,000 coinsurance while the insurance company covers the remaining $98,000 of the heart surgery bill. Even if you are hospitalized again in the same year, the insurance company will pay 100% of your covered expenses.

30. What is a Co-payment? A co-payment or co-pay is a specific flat fee you pay for each medical service, such as $30 for an office visit, after which the insurance company often pays the remainder of the covered medical charges.