Transcript The Affordable Care Act and our Role

What is the ACA (“Obamacare”)?
The Patient Protection and Affordable Care Act (ACA)
 ACA will reform our complex health care system
 If you are not insured, or want to purchase insurance, a new
Florida-based system will help you get coverage
 ACA makes healthcare care more accessible and affordable
 Preventive care
 Family planning
 Related services
 No discrimination due to pre-existing conditions or gender
 Other benefits
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How the ACA Works
 Uninsured consumers can enroll in a Qualified Health Plan
(QHP) through the “Marketplace”
 The Marketplace helps consumers choose the plan that best suits
their needs by allowing them to compare available plan options
including monthly premiums, co-pays, deductibles, service
networks, etc.
 There is a single, streamlined application for health plan,
Medicaid and CHIP options.
 ACA requires most people to have coverage by January 2014
 Penalty in 2014 is $95 per individual; $285 per family; or 1
percent of family income, whichever is higher.
 A number of exemptions are also available.
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How the Marketplace Works
https://www.healthcare.gov/marketplace/individual
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Application Process
Submit
application to
the
Marketplace
•Online
•By Phone
•In Person
Eligibility
determined
and verified
Supported
by Data
Services
Hub
Eligibility
determined
for Qualified
Health Plan,
Medicaid or
CHIP
Enroll in
Qualified
Health Plan
Enroll in
Medicaid or
CHIP
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Ways to Apply
 Online:
www.HealthCare.gov
 By Phone (24/7, 150 languages):
1-800-318-2596
 In Person:
Certified Application Counselors & Navigators
Visit your nearest federally qualified health center or
go to www.LocalHelp.HealthCare.gov or
call 1-800-318-2596 to be connected.
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Eligibility
 Eligibility:
 Live in the service area
 US citizen or
lawfully residing non-citizen
for the period of enrollment
 Not incarcerated
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Affordable Coverage
 A refundable or Advanced Premium Tax Credit (APTC):
 Can only be used to buy insurance from the Marketplace
 Paid directly to insurer on your behalf
 Can reduce your monthly premium, depending on income level
 Eligibility for the APTC is based on:
 Family size and household income
 Household income between 100%-400% Federal Poverty Level
 If consumer is ineligible for other coverage such as
government or employer insurance
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Federal Poverty Level Table
Household
Size
100%
133%
150%
200%
300%
400%
1
$11,490
$15,282
$17,235
$22,980
$34,470
$45,960
2
15,510
20,628
23,265
31,020
46,530
62,040
3
19,530
25,975
29,295
39,060
58,590
78,120
4
23,550
31,322
35,325
47,100
70,650
94,200
5
27,570
36,668
41,355
55,140
82,710
110,280
6
31,590
42,015
47,385
63,180
94,770
126,360
7
35,610
47,361
53,415
71,220
106,830
142,440
8
39,630
52,708
59,445
79,260
118,890
158,520
For each
additional
person, add
$4,020
$5,347
$6,030
$8,040
$12,060
$16,080
1. Households earning less than 100% FPL will not be eligible for APTC.
2. Households earning more than 400% FPL will not be eligible for APTC.
3. Medicaid was not expanded in Florida.
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Types of Plans
 Types of health plans
 Platinum
 90% of covered costs paid by plan
 Maximum services
 Lower deductible, higher premiums
 Gold
 80% of covered costs paid by plan
 Silver
 70% of covered costs paid by plan
 Bronze
 60% of covered costs paid by plan
 Minimum services
 Higher deductible, lower premiums
 Catastrophic coverage is also available for adults under
age 30 and/or those who obtain a hardship waiver.
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Essential Health Benefits
 Each plan must include, at a minimum, 10 essential health benefits (below)
 More expensive plans offer additional benefits
Ambulatory Patient Services
Prescription Drugs
Emergency Services
Rehabilitative Services and Devices
Hospitalization
Laboratory Services
Maternity and Newborn Care
Preventive & Wellness Services and Chronic
Disease Management
Mental Health and Substance Use Disorder
Services (to include behavioral health care)
Pediatric services, including oral & vision
care (pediatric oral services may be provided
by stand-alone plan)
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Enrollment
 Open enrollment through the Marketplace
is October 1, 2013 through March 31, 2014.
 Health coverage is effective January 1, 2014
if purchased by December 15, 2013.
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For more information ….
In Person:
 [insert CAC name & contact info]
By Phone:
 Marketplace Call Center at 1 (800) 318-2596
On-line:
 www.HealthCare.gov
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