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Introduction to the Affordable Care Act: Are you Ready?

Introduction to the Affordable Care Act: Are you Ready?. Presented by the DuPage Federation on Human Services Reform July 24, 2013. Goals/Objectives. DuPage Federation on Human Services Reform An affiliate of NIU Center for Governmental Studies. Why Do Health Care Reform?.

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Introduction to the Affordable Care Act: Are you Ready?

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  1. Introduction to the Affordable Care Act: Are you Ready? Presented by the DuPage Federation on Human Services ReformJuly 24, 2013

  2. Goals/Objectives DuPage Federation on Human Services Reform An affiliate of NIU Center for Governmental Studies

  3. Why Do Health Care Reform?

  4. Number of Uninsured by State

  5. ACA Background DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  6. ACA Key Components DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  7. ACA Key Components: Essential Health Benefits DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  8. Essential Health (continued)

  9. ACA Key Components: What is available now? DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  10. How Does the ACA Impact Prevention Services?

  11. ACA Key Components: What begins in 2014? DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  12. States Approved for Insurance CO-OP (Consumer Oriented and Operated Planswith average of 93% of cost goes into coverage)

  13. ACA Key Component: Individual Responsibility DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  14. Individual Responsibility (continued)

  15. Non-Citizen Status and ACA Special Populations

  16. So who is a Qualified Non-citizen and who is Lawfully Present? Includes all Qualified non-citizens plus Authorized non-citizens in U.S. under 5 years Individuals with approved visa petitions who have applied for adjustment to LPR status Non-immigrants with visas that authorize the person to live and work in the U.S. (tourists, students, etc.) • Lawful Permanent Resident (LPR) in U.S. for 5 yrs. or more • Member of a special immigrant group e.g. • Refugee or Asylee • U.S. military or veteran and their dependents • Admitted under VAWA (Violence Against Woman Act) • Cuban or Haitian • And More…… Special Populations

  17. Benefits Available Based on Status Special Populations

  18. ACA Key Component: Employer Responsibility DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  19. What is a Health Insurance Marketplace? DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  20. Marketplace Decisions by State Source: Kaiser Family Foundation

  21. Who Can Use the Marketplace?

  22. Who in the U.S. qualifies for the Marketplace?

  23. More about Marketplaces DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  24. Income Eligibilities Eligible for Advanced Premium Tax Credit Marketplace * Lawful residents who do not qualify for Medicaid may qualify

  25. Marketplace Plans: Individuals DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  26. Member Cost Share • Member pays • Out-of-Pocket • Coinsurance • Deductibles • Plan pays • Platinum • Gold • Silver • Bronze Platinum Gold

  27. Catastrophic coverage DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  28. How Federal Subsidies to Purchase Private Insurance Work Payment: Premium tax credit is paid in advance on a monthly basis directly to health plan Premium Tax Credit (100-400% FPL) Application – person applies for tax credit & cost sharing reductions during marketplace open enrollment w/ recent tax return or other documentation of income Reconciliation: person files federal tax return, under or overpayments are reconciled (overpayments capped based on income) Reconciliation: none CostSharing Reduction (100-250% FPL) Payment: Cost-sharing reductions are paid directly to the plan. Source: NASTAD.org “Health Reform Issue Brief”

  29. Covering the Cost: Premium Tax Credit Example – Johnson Family w/ Annual Income of $35,300 (150% FPL) • Choose Qualified Health Plan in Health Insurance Marketplace • Assume Annual Premium for Silver Plan = $12,500 • Out of Pocket Costs = 4% of income ($35,300 X .04 = $1,412)

  30. Medicaid Expansion: Coverage Groups DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies Source: Illinois Health Matters

  31. Understanding MAGI Modified Adjusted Gross Income

  32. Which Populations Are Part of MAGI? MAGI Non-MAGI Children (under 19) Adults (19-64) Pregnant Women Medicare Cost Share Other Aged, Blind, Disabled Foster Care • Coverage groups • AABD (Aged, Blind or Disabled) including Spend Down/Medically Needy • Long Term Care (Nursing Home, Community Based Waivers etc.,) • Medicare Savings Program • Children receiving foster care or adoption assistance • Persons who age out of foster care • Coverage Groups • Medicaid Programs • Family Health Plans • ACA Adult Group • Children under 19 (CHIP) \

  33. What about States that do not expand Medicaid? Same options as currently available Are persons eligible for Medicaid, Medicare, Veterans’ Health Care? Can employer offer insurance now? Free Clinics? Access Programs? EMTALA?

  34. There are options for employers DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies • Insured plans on the Exchange • Insured plans off the Exchange • Co-Op • Private exchanges • Self-funded

  35. Marketplace Plans: Employers DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  36. Marketplace Application Process DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  37. More about Marketplace Applications Beginning October 1, 2013, find assistance online at HealthCare.gov DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  38. Who works with the Marketplace? DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  39. Assistance Options DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  40. More about In-Person Assistance DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  41. Navigators & In-Person Counselors What will they do? Engagement and outreach Facilitate eligibility Explain insurance Assist, inform and guide Follow up Problem solve Refer Preparations • Integrates with Federal • Comprehensive training • Certification • Technology • Procedures, ethics and limits

  42. Preparing Consumers DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  43. Miscellaneous DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

  44. Questions? Resources Presenter Contact Information: Candace King, Executive Director DuPage Federation on Human Services Reform cking@dupagefederation.org DuPage Federation on Human Services Reform an affiliate of NIU Center for Governmental Studies

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