ACA and Vets & Families

1. ACA and Vets & Families NASW IL Conference Oct 28 2013

2. ACA 101

3. ACA 101

4. ACA 101: Key Components Available Now… 2014 and Beyond… • Extended dependent coverage to age 26 • No pre-existing condition exclusion for children • Preventive services without cost sharing • CountyCare-the early expansion of Medicaid in Cook County • No lifetime limits on care • Small business tax credits • No insurance rescissions except in cases of fraud/intentional misrepresentation • New Marketplace to buy insurance and receive financial help to pay for it • New Medicaid Adult Group available to adults under 138% FPL • Financial Assistance to purchase private insurance • Medicaid available to former foster children up to age 26 at any income level • No pre-existing condition exclusion for adults • All plans must cover Essential Health Benefits • No annual limits on care • No gender rating • Closing Medicare Part D donut hole • Individual and Employer Responsibility

5. ACA 101: Preventive Care • No Cost Sharingfor certain preventive services, if provided in-network. However, there may still be some costs for the doctor’s visit if the visit includes other services besides the preventive service. • List of covered services the same for all plans and includes immunizations, cancer screenings, access to birth control, and a range of other services. • The full list is available at healthcare.gov/prevention

6. ACA 101: Highlights of Preventive Care

7. ACA 101: Essential Health Benefits All health plans in the Marketplace, individual & small group, are qualified health plans (QHP). • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services including chronic disease management • Pediatric services including oral and vision care Illinois’ Benchmark

8. ACA 101: New Pathways to Coverage

9. Healthcare Coverage Pathwaysfor Veterans and their Families • Marketplace and Medicaid • VA • Tricare

10. Important Dates • OCTOBER 1, 2013 - Open Enrollment in the Marketplace/New Medicaid Begins. • DECEMBER 15, 2013 - Must be enrolled by this date for Marketplace health coverage to begin by 1/1/14 • JANUARY 1, 2014 - New Medicaid Adult Group Coverage begins. (No backdating before this date.) • MARCH 31, 2014 - Open Enrollment for Marketplace ends (Medicaid is always open).

11. Marketplace in IL

12. Marketplace in IL: Overview • Web shopping tool for individuals and small business to purchase private and public health insurance. • Gives consumers the tools and power to have control over their insurance decisions • Apples-to-apples comparison of plans • Find the right fit! • www.getcoveredillinois.gov

13. Marketplace in IL: Eligibility & Application • The applications for Medicaid and Financial Assistance in the Marketplace will ask for information about: • Illinois Residency • Citizenship/immigration status • Income/Tax filing status • Dependents and household composition • Information will be electronically verified.

14. Eligibility: Income • Modified adjusted gross income (MAGI) guides paths to health coverage • Why MAGI? • It will standardize the calculation of income across all insurance affordability programs  • It is used both by the Marketplace and Medicaid to determine eligibility. • Income is compared to program limits to determine source of health coverage • MAGI is an income counting methodology, it is not a number on a tax form • When using MAGI, resources/assets are not a consideration • Veterans benefits are not counted

15. Application: Household Composition

16. Application: Household Composition Marketplace Medicaid • Household information is provided to the Marketplace based on whether a person files taxes, plans to file taxes or is claimed as a dependent • Tax information is used to determine the group size to compare income to the FPL and determine eligibility and amount of tax credits and subsidy • Application for health coverage can be for all persons who file taxes together • Medicaid programs use tax information to determine the group size and income eligibility for Medicaid benefits • Eligibility for Medicaid is determined by income limits for the type of Medicaid program considered • Application for health coverage is generally for persons living in the house together

17. Veterans and their Families

18. VA Health Care Information

19. VA and Families • Families members of Vets enrolled in VA health care cannot receive VA health benefits • Exception: Civilian Health and Medical Program (CHAMPVA); Spina Bifida Health Care Program • Options for families: Tricare, Marketplace (Medicaid)

20. CHAMPVA Eligibility Definitions

21. Tricare and ACA • Two Beneficiary categories: Sponsor (SM) and Dependents (family members) • Some Tricare Plans qualify for Minimum Essential Coverage (MEC) and others don’t • Tricare Prime; Reserve Select; Young Adult = yes • Tricare for dependent parents and in-laws = no • If electing Tricare, then no tax credit or subsidy through the marketplace

22. Tricare Eligibility • Eligibility depends on military status • Active Duty • Reserve/National Guard • SMs and Families are eligible so long as the SM is attending drills • Families • Survivors’ remaining eligible when a sponsor dies depends on • If the sponsor was AD or not • If the survivor is a spouse or child

23. Tricare’s differences • Tricare Young Adult • Tricare’s current age limit for children: 21 or age 23 if in school full-time • Young Adult is a Tricare option that the child (or parent) may purchase for additional coverage • Mental health and substance use disorder coverage limits may not meet the requirements for parity • Other costs

24. Medicaid Expansion in 2014 • In 2014, anyone up to 138% (133% plus 5% income disregard) FPL is eligible for Medicaid, called “newly eligible” Medicaid. • No disability requirement. • Must be under 65, not entitled to or enrolled in Medicare A or enrolled in Part B. • Modified gross income (MAGI) and no asset test, which is different from current Medicaid and All Kids Programs. • Federal government pays for much greater percentage of this expansion. • Veterans Benefits are not countable income

25. Additional information and Resources • Visit http://getcoveredillinois.gov • Talk to a navigator: http://getcoveredillinois.gov/get-help/ • http://tricare.mil • www.va.gov • www.Illinoishealthmatters.org