Transcript Affordable Care Act in Illinois Oct 2013 CCU Training

Affordable Care Act
in Illinois
Oct 2013
CCU Training
John Spears
IL Dept of Healthcare & Family Services
The Affordable Care Act (ACA)
Principal Goal
1.
Establishes Health Insurance
Marketplace - A place to compare and pick
a private health insurance plan with financial
help available to help make coverage more
affordable.
2.
Encourages States to expand Medicaid
3.
Encourages States to create better,
more convenient systems for signing
up - Illinois’ ABE (Application for Benefits
Eligibility)
The Affordable Care Act (ACA)
If you have Medicare or
Medicaid, you are covered!
You do not need to do anything.
(Nor can you get a better deal by applying.)
Existing Coverage
ABE or
Marketplace
Navigators & Assistors
Certified Application Counselors
Telephone application
Paper application
In-Person application for
Medicaid
How to Apply
Marketplace
Eligible
Medicaid
Eligible
State Intake
Eligibility
System
Federal
Marketplace
State or Federal – No Wrong Door
The Health Insurance Marketplace
Create an account online: Starting 10/1/2013
enter information about you & your family, including
your income, household size, and more.
 Pick a plan: Next you’ll see all the plans and
programs you’re eligible for and can compare them
side-by-side. You’ll also see if you get financial help
with premiums and out-of-pocket costs.
 Enroll: Choose a plan that meets your needs and
enroll!
First open Enrollment is 10/1/13 - 3/31/14.

Coverage starts on 1/1/2014 if you enroll by 12/15/2013.
Illinois Health Insurance Marketplace
How Does It Work?
Every Plan must cover:
doctor visits
emergency services
hospitalization,
maternity and newborn care,
mental health and substance use disorder
services,
 prescription drugs,
 rehabilitative services and devices,
 laboratory services,
 preventive and wellness services and chronic
disease management, and
 pediatric services, including oral and vision care.
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Illinois Health Insurance Marketplace
What Benefits Do You Get?

A sliding scale that increases the taxpayer’s
own contribution towards the premium cost as
household income as a percentage of the FPL
increases
Income Level

Consumer Premium Payment as a Percent of Income
100- 133% FPL
2% of income
133-150% FPL
3 – 4% of income
150-200% FPL
4 – 6.3% of income
200-250% FPL
6.3 – 8.05% of income
250-300% FPL
8.05 – 9.5% of income
300-400% FPL
9.5% of income
Advance payments are paid directly to the
insurer on your behalf and reconciled at tax
time
Premium Tax Credits
Medicaid Coverage
New ACA Eligible Adults
 Adults,
age 19-64, not receiving Medicare
Individuals under 138% will be eligible in a new
Medicaid group ($1,321 per month or about $15,850 annual for 1)
 Former
Foster Care - children under 26 who were on
Medicaid when they aged-out of foster care.
Medicaid Eligibility Changes for
2014
Program
1 person
2 in family
Family Care
$1,321
$1,784
Aged, Blind or Disabled*
$958
$1,293
Health Benefits for Workers with
Disabilities**
$3,351
$4,524
Medicare Savings Program***
$1,292
$1,744
ACA Adults
$1,321
$1,784
Marketplace Insurance Subsidy
$3,832
$5,172
*$2,000 resource test for 1, $3,000 for 2
**$25,0000 resource test, retirement accts exempt
***$7,080 resource test for 1, $10,620 for 2
Monthly Income Standards
6/30/2016
15
Resources
Check out these websites:

Illinois’ Health Care Reform site
www.healthcarereform.illinois.gov

Federal Health Care Reform sites
www.HealthCare.gov (Health Insurance Marketplace
info)

Marketplace.cms.gov/help-us/cac.html (to begin
federal process of signing up to be a Certified
Application Counselor (CAC))

Marketplace.cms.gov/training/get-training.html (to
access federal computer based training even if not
registering to be a CAC)