Transcript Nebraska Appleseed - Nebraska Cancer Coalition
Nebraska Appleseed
Justice and Opportunity for All Nebraskans
Open for Business: Health Insurance Marketplace
October 4, 2013
Health Insurance Today
Currently, people get insurance through: Their employer Medicaid and/or Medicare The individual market
Health Insurance Today
Insurance companies do not have to sell to you, and may deny you insurance on the basis of a pre existing condition, or not cover certain services or treatments
•
Health Care Reform
In 2010, President Obama signed into law the
Patient Protection and Affordable Care Act
(ACA).
• The Supreme Court upheld the ACA on June 28, 2012, but ruled that the new Medicaid program was optional for states.
Health Care Reform
• • • •
The ACA focuses on four main areas:
• •
How to find and access insurance coverage
Health Insurance Marketplace New Medicaid Program
How to afford coverage
How to ensure the insurance system is fair and that people get value for their premium dollar How to change our health care delivery system to control costs and focus on prevention
Accessing Coverage
People will access coverage through:
• Employers • Creation of Health Insurance Marketplaces • Nebraska has opted for a federally facilitated Marketplace • Expansion of Medicaid • Nebraska has not yet opted in to the new Medicaid program
Coverage with Value
Certain consumer protections are already in effect:
• Ends denial of coverage for pre-existing conditions for children • Bans co-pays and out-of-pocket expenses for preventive care and immunizations on new plans • Prohibits lifetime benefit limits in all plans • Extends dependent coverage to age 26 in all plans • Insurers cannot drop you when you get sick
Coverage With Value
Insurance Reforms and Consumer Protections
• Prohibits denial of coverage for pre-existing conditions for everyone by 2014 • Changes what insurers can look at when setting premiums: • They can no longer set different rates based on your health status or gender • Can only look at age (3:1), geographic area, family composition, and tobacco use (1.5:1)
Coverage With Value
Insurance Reform and Consumer Protections
• Guaranteed issue and renewability in 2014– insurers can ’ t refuse to sell • Prohibits annual limits for ten essential services • Creates a standard benefit plan for all new policies (does not apply to existing individual and employer-sponsored plans) • Eliminates waiting periods for coverage more than 90 days
Essential Health Benefits
The ACA requires that all plans sold inside the new Health Insurance Marketplace, and most plans outside the Marketplace, to cover ten essential health benefits (EHBs)
Accessing Coverage
The new Health Insurance Marketplace
• The Health Insurance Marketplace is a one-stop shop for people for private coverage, Medicaid coverage, and accessing tax credits • The Marketplace is accessible for individuals and small businesses with up to 50 employees • Nebraska has chosen to have a federally facilitated Marketplace—one that will be run by the federal government in place of the state
Accessing Coverage
•
The new Health Insurance Marketplace
Four insurance carriers offer plans • Blue Cross/Blue Shield, CoOpportunity, Health Alliance, Coventry • All plans must cover essential health benefits • Four levels of plans will be available • Bronze, Silver, Gold, Platinum
Accessing Coverage
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The new Health Insurance Marketplace
Help paying for the cost of coverage (tax credits) • Eligible incomes are between 100% and 400% of the federal poverty level (FPL) ($19,090 to $76,360 for a family of three) • Individuals are not eligible for tax credits if they are offered coverage by their employer unless • The employer plan does not meet certain minimum standards and the employee share of (individual) premiums is 9.5% of income
Accessing Coverage
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The new Health Insurance Marketplace
The process • Start the process at healthcare.gov
• Series of screens/questions • If eligible for tax credit, credit is applied • Compare and select a plan • Enroll
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Medicaid and the Marketplace
Medicaid was intended to be the foundation of coverage for low income adults, because it is much cheaper to cover people under Medicaid than to subsidize their insurance • Therefore, those who are making under 100% FPL can’t get tax credits through the Exchange, and will have no path to coverage, creating a large gap
Outreach and Enrollment
184,429 Nebraskans under 400% FPL are uninsured Household of 4 making less than $94,200 64% 6% 24% 6% Hispanic Black White Undefined Source: 2010 Small Area Health Insurance Estimates, U.S. Census Bureau
Timelines for Enrolling *October 1, 2013- March 31, 2014
Enrollment Date
Oct. 1, 2013-Dec. 15, 2013 Dec. 16, 2013-Jan. 15, 2014 Jan. 16, 2014-Feb. 15, 2014 Feb. 16, 2014-March 15, 2014 Mar. 16, 2014-March 31, 2014
Effective Date of Coverage
January 1, 2014 February 1, 2014 March 1, 2014 April 1, 2014 May 1, 2014 • • • • You may be eligible for a Special Enrollment Period if you: Move to a new state Have certain changes in income Change your family size Belong to a federally recognized Tribe
Consumer Assistance Framework
Enrollment Assisters Navigators CACs (Hospitals, doctors offices, libraries, etc.) Agents/Brokers Call-Center Representatives Educators Partners & Stakeholders Local government branches & employees Connect community to www.healthcare.gov
enrollment assisters. and
Consumer Assistance Framework
Assisters
Help consumers fill out the application Help consumers compare plans & make an enrollment selection Provide education about the application and plan compare process May conduct local outreach to bring consumers to assistance.
Educators
Create awareness of the Marketplace Drive consumers to Customer Service channels ( www.healthcare.gov
& assisters) Conduct outreach events and activities Provide basic information about the Marketplace and where to get help
Enroll Nebraska
Goal: To equip and connect assisters and educators with resources to enroll Nebraska’s uninsured.
• • • • • • •
Equip
Policy Updates Sample Press Releases FAQ’s Sample Outreach Plans Troubleshooting Calendar of Events Strategies for community engagement • • •
Connect
Identifying and linking resources between organizations Referrals Facilitating collaboration Visit www.enroll-ne.org
for latest materials
How can you engage your community?
Link with other organizations in your area to organize education and enrollment events Share tools and resources with Enroll Nebraska and other organizations Questions to consider: What are you currently doing?
What are the challenges? What resources already exist?
www.healthcare.gov
www.canhelp.org
www.enroll-ne.org
Questions?
Nebraska Appleseed
Justice and Opportunity for All Nebraskans