Transcript Health - Illinois Hospital Association

The Patient Protection and
Affordable Care Act
The Promise of Health Care Reform
• Primary Goal: Health Insurance Coverage for
approximately 26 million Americans – over 1
million Illinoisans
• Right Care, Right Time, Right Setting
• Better Health
What This Means for Illinois
• 2013: 1.7 million uninsured Illinoisans
• By 2015:
– More than 400,000 will gain coverage in the
Health Insurance Marketplace
– Nearly 350,000 will be covered under Medicaid
What Health Care Reform Does
• Establishes Health Insurance Marketplace
• Allows states to expand Medicaid effective
January 1, 2014
– Illinois opted in under Senate Bill 26 /
Public Act 98-104 – signed into law July 22
Options for Consumers
• If you already have private insurance, Medicare, Medicaid or VA
coverage
– Don’t do anything
• If you are a legal resident under age 65, earning less than $15,302
(individual) or $31,155 (family of 4)
– Enroll in Medicaid
• If you earn more than the above limits, up to 400% of the federal
poverty level [$45,960 (individual) or $94,200 (family of 4)]
– Receive financial help (premium subsidies) and buy insurance in
the Health Insurance Marketplace
Health Coverage with Good Benefits
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Prescription drugs
Hospitalization
Doctor visits
Preventive care/wellness services
Mental health & substance abuse disorder
services
• Pediatric services – incl. oral & vision care
• NO denials for pre-existing conditions
When & How Do Consumers Sign Up
Health Insurance Marketplace:
• ILLINOIS Marketplace to be launched by Oct. 1, 2013
• Open enrollment starts Oct. 1, 2013 and ends March 31,
2014
• Create your own account – enter information about you
and your family, including income, household size
• Review and compare health plans and premiums
• Find out if you will receive financial help with premiums
• Choose a plan
• Coverage begins as soon as Jan. 1, 2014 if you enroll by
Dec. 15, 2013
When & How Do Consumers Sign Up
New Illinois Medicaid Enrollment Website:
ABE or Application for Benefits Eligibility
• URL: ABE.illinois.gov
• Sign up starting Oct. 1, 2013
• Sign up also available on walk-in basis at Dept. of Human Services
offices
• Coverage for newly eligible Medicaid population starts Jan. 1, 2014
BOTH Marketplace and Medicaid
• Can sign up online, by phone, by mail or in-person with help of
“Assister” or “Navigator”
Where Consumers Can Get Help
Community–based “Assisters”
• In-Person Counselors – outreach, education and
enrollment assistance
• Navigators – outreach, education and enrollment
assistance
• Certified Application Counselors (includes
hospitals)
• All “Assisters” will help consumers apply for
Insurance Marketplace coverage and Medicaid
Website Resources
• www.HealthCare.gov
• www.healthcarereform.illinois.gov
• www.EnrollAmerica.org
• www.GetCoveredAmerica.org