NavigatorInperson Assister Program T odays Agenda History of the Affordable Care Act ACA Highlights of the Affordable Care Act Impact of the Affordable Care Act 2 Purpose and objectives ID: 659704
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Slide1
Affordable Care Act 101Summer 2013
Navigator/In-person Assister ProgramSlide2
Today’s Agenda
History of the Affordable Care Act (ACA)
Highlights of the Affordable Care Act
Impact of the Affordable Care Act
2Slide3
Purpose and objectivesPurposeThis webinar is to provide an overview of the Affordable Care Act (ACA)
Objectives
Upon completion of this presentation you will:
Understand how the Affordable Care Act applies to you and others
Understand how the Affordable Care Act is being implemented in Washington State
3Slide4
What is the ACA?Patient Protection and Affordable Care Act (PPACA) Affordable Care Act (ACA)
Health Care Reform Law
Obamacare
Health Care and Education Reconciliation Act of 2010 (HCERA)
4Slide5
Why the rush to reform health care?
1912
–
President Theodore “Teddy” Roosevelt -
P
roposal
1935
– President Franklin Roosevelt
-
Social Security
1942
– President Franklin Roosevelt
- Established Price Controls
5Slide6
Why the rush to reform health care?1945 – President Harry Truman –
Proposal
1965
– President Lyndon Johnson – Medicare
1974
- President Richard Nixon
-
Proposal
6Slide7
Why the rush to reform health care?1993 – President Bill Clinton - Proposal
2005
– President George W. Bush - Medicare Part D
2010
– President Barack
Obama -
Health Care Reform
7Slide8
After 100+ years, why now? 8Slide9
Highlights of the ACA Expand
health care coverage to 32 million Americans who are uninsured.
Slow
down the rising cost of health care
which accounted for almost
18% of the Gross Domestic Product (
GDP) in 2010.
9Slide10
Impact Of The Affordable Care Act
Changes to private insurance, e.g.,
Kids can’t be denied health coverage if they are sick
Young adults on parents’ policies to age 26
Prohibit lifetime monetary caps
Minimum medical loss ratio
Closes the Medicare prescription “doughnut hole”
Expands coverage + imposes individual mandate in 2014
Expands Medicaid to 138%* of FPL
Exchanges
10
*ACA
133% = 138% due to across the board income disregardsSlide11
Ten essential Health benefits
1. Ambulatory
services
6. Prescription drugs
2. Emergency services
7. Rehabilitative
and habilitative services and devices
3. Hospitalization
8. Laboratory
services
4. Maternity and newborn care
9. Preventive and wellness services and chronic disease management
5. Mental health and substance use disorder services, including behavioral health treatment
10. Pediatric services, including oral and vision care
11Slide12
How Will People get health Care Coverage?The ACA will expand health care coverage in the following ways:
Individual
Mandate
Small Business Tax Incentives Medicaid
Expansion
Premium
Subsidies
Large Employer Mandate
12Slide13
Individual mandateRequire
all citizens and legal residents (there are some exceptions) to have health coverage
in 2014. What happens if someone does not meet this deadline?
Will
they go to jail?
NO
!
13Slide14
the Mandate does not apply For SomeWhen any
of the following
apply:
Religious objections
Undocumented immigrant
Incarcerated
American Indians and Alaskan
Natives
Income
below the tax filing
threshold
The lowest cost plan option exceeds
9.5 percent of an individual’s income14
No penalty for being without health insurance.Slide15
the Mandate IS SATISFIED WHEN
You were insured for the whole year through a combination of any of the following sources:
Medicare
TRICAREThe veteran’s health programA plan offered by an employer
Medicaid or the Children’s Health Insurance Program (CHIP)
Insurance bought on your own that is at least at the Bronze level
A grandfathered health plan in existence before the health reform law was enacted
15
No Penalty. The requirement to have health insurance is satisfied Slide16
What is the penalty?
2014: $95 per adult
and $47.50 per child (up to $285 for a family)
or 1% of income, whichever is greater
2015: $325
per adult and $162.50 per child (up to $975 for a family) or 2%, whichever is greater
2016: $695 per adult and $347.50 per child (up to $2,085 for a family)
or 2.5% of family income, whichever is greater
16Slide17
Health Insurance Premium Tax CreditsDesigned to make premiums affordable for individuals and families with lower incomes
Only available to individuals and families with income up to 400% Federal Poverty Level (FPL)
Can be used to reduce monthly premiums
Can be claimed as a credit on annual tax return Must apply through Washington
Healthplanfinder
17Slide18
2013 Federal Poverty Levels by Annual Income
18
Federal Poverty Level
Annual Income: Individual
Annual Income:
Family of 3
100%
$11,496
$19,536
133%
$15,288
$25,980
138%
$15,864
$26,952
200%
$22,980
$39,060
300%
$34,476
$58,596
400%
$45,960
$78,120
Source
:
http://aspe.hhs.gov/poverty/13poverty.cfm
Per HHS directive, after inflation adjustment, the guidelines are rounded and adjusted to standardize the differences between family sizes.Slide19
Health Insurance Premium Tax Credit and
Cost Sharing Reductions
Income Level
Premium as Percent of Income
Up to 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
Income Level
Reduction in Out-of-Pocket Liability
100-150% FPL
94% of the actuarial value*
150-200% FPL
87% of the actuarial value
200-250% FPL
73% of the actuarial value
Premium Tax Credits
:
Cost Sharing Reductions
:
*Of the second lowest cost Silver plan
http
://
www.wahealthplanfinder.org
/
A Silver Metal Level plan must be purchased to qualify for Cost Sharing ReductionsSlide20
Example
Family of 3
Annual Income = 200% of FPL
Health Insurance Premium Tax Credit? YES
Cost Sharing Reduction? YES
20Slide21
How Will people get these subsidies?The ACA requires all states to create a new marketplace website where consumers can go to search, compare and enroll in an affordable health coverage plan.
The
one in our state is the:
Open enrollment is October 1, 2013 for coverage effective January 1, 2014.
After
answering a few questions
including
income, consumers will be notified
about their health care coverage eligibility.
21Slide22
Medicaid ExpansionMedicaid and Medicaid Expansion populations
Adults
(without children) up to 138% of
FPL*Parents 40% to 138% of FPL Modified Adjusted Gross Income
(MAGI)
The ACA’s “133% of the FPL” is effectively 138% of the FPL because of a 5% across-the-board income disregard
22Slide23
2014 Large Employer Requirements
Large employers with over 50 FTE’s are required to offer a minimum level of health insurance
Larger Employers
offering non-qualifying coverage
:
May be assessed the lesser of up to $3,000 per year for each FTE receiving income-based assistance, or, up to $2,000 for every
FTE.
Large Employers
not offering minimum essential coverage
:
May be assessed $2,000 per FTE (first 30 full-time employees excluded) if at least one full-time employee receives income-based assistance to buy coverage in the Exchange.
23Slide24
What About Small Businesses?
24
Up to 50 Employees (these employers are exempt from the mandate)
Small Business
Health Insurance Tax
credits available
Washington Healthplanfinder can be used to manage employee health care benefits
Options are availableSlide25
How will people get health care coverage?Slide26
Streamlined Application
26Slide27
On-the-spot eligibility resultsSingle portal for Medicaid,
tax
subsidies and Qualified Health Plans
Use of electronic data to verify eligibilityReal-time eligibility determination
Interfaces to federal and state systems
27Slide28
SUMMARY
Historic significance of the Affordable Care Act
Reforms to Health Care already in place
Reforms effective January 1, 2014Benefits to Individuals
Benefits to Families
Benefits to Employers
28Slide29
Knowledge checkWhat is the Affordable Care Act?
Health Care Insurance Reform
Affordable Car Insurance
Gun Control
Animal Case Adaptation
29Slide30
Knowledge checkOpen Enrollment begins on…
March 23, 2010
January 2, 2014
October 1, 2013
December 7, 2013
30Slide31
Knowledge checkWhat are the two key goals of the Affordable Care Act?
Increase the cost of health care and decrease the number of Americans that are uninsured.
Slow down the rising cost of health care and expand health care coverage to uninsured Americans.
31Slide32
Knowledge checkThe soonest coverage in a Qualified Health Plan can be effective is….
November 1, 2013
December 1, 2013
January 1, 2014
April 1, 2014
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Knowledge checkWashington State is implementing Medicaid Expansion. Which of the following statements is not true?
Washington State Medicaid is going to include the state of Idaho.
Washington State Medicaid will include adults (without children) up to 138% of FPL.
Washington State Medicaid will include Parents with income up to 138% of FPL
Washington State Medicaid will use Modified Adjusted Gross Income to determine applicant’s income.
33Slide34
Knowledge CheckOne way the Affordable Care Act will expand health care coverage
is…
By requiring all citizens be given pay raises.
By requiring everyone to purchase health care coverage with no exceptions.
By requiring all employers to provide health care coverage to all of their employees as well as their dependents.
Through premium subsidies.
34Slide35
Knowledge CheckWhich of the following statements is not true regarding Health Insurance Premium Tax Credits?
These credits are designed to make premiums affordable for individuals and families with lower incomes.
Enrollment through the Healthplanfinder is
not
required to receive these credits.
Tax credits can be used to reduce monthly premiums.
Tax credits can be claimed on your annual tax return.
35Slide36
Knowledge CheckCost sharing reductions…
Are a
way to reduce consumer out of pocket health care expenses.
Lower monthly premiums.
Lower annual premiums.
Lower grocery bills.
36Slide37
Knowledge CheckThe
Individual
mandate…
Requires all citizens and legal residents to have health care coverage for their dogs and cats in
2014.
Requires incarcerated individuals to purchase healthcare coverage through the Washington Healthplanfinder.
Requires all citizens and legal residents to have health care coverage in 2013.
Requires
all citizens and legal residents to have health
care coverage
in
2014.
37Slide38
Knowledge CheckWashington Apple Health (Medicaid) is administered
by…
The Washington Health Benefit Exchange.
The Washington State Health Care Authority.
The Washington Healthplanfinder.
The assister the customer is working with.
38Slide39
Knowledge CheckA person that does not obtain health insurance coverage through a Qualified Health Plan may owe a penalty to…
The Washington Health Care Authority (HCA).
Centers for Medicare and
M
edicaid Services (CMS).
Internal Revenue Service (IRS).
The Washington Healthplanfinder
39Slide40
Questions
40Slide41
Thank you!
Congratulations! You have completed
the Affordable Care Act Course!Slide42
http://wahbexchange.org
/
Includes information about:
Exchange Board
Legislation and grants
Policy discussion
Technical Advisory Committees
and stakeholder involvement
IT systems development
HHS guidance
Listserv
registration
Healthplanfinder
Calculator:
http
://
www.wahealthplanfinder.org
/
Contact the Exchange at:
info@wahbexchange.org
42
More on the ExchangeSlide43
43Slide44
Appendix: Glossary of TermsActuarial Value:
The
percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, on average, you would be responsible for 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy.
Affordable
Care
Act:
The
comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law
.
Catastrophic
Plan:
Currently
, some insurers describe these plans as those that only cover certain types of expensive care, like hospitalizations. Other times insurers mean plans that have a high deductible, so that your plan begins to pay only after you've first paid up to a certain amount for covered services.Cost Sharing: The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance and copayments, or similar charges, but it doesn't include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. Cost sharing in Medicaid and CHIP also includes premiums.Deductible: The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.
44Slide45
Glossary of terms cont. Donut Hole, Medicare Prescription Drug:
Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a "donut hole"). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again
.
Federal Poverty Level (FPL
):
A measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits
.
Grandfathered Health Plan
:
As used in connection with the Affordable Care Act: A group health plan that was created—or an individual health insurance policy that was purchased—on or before March 23, 2010. Grandfathered plans are exempted from many changes required under the Affordable Care Act. Plans or policies may lose their “grandfathered” status if they make certain significant changes that reduce benefits or increase costs to consumers. A health plan must disclose in its plan materials whether it considers itself to be a grandfathered plan and must also advise consumers how to contact the U.S. Department of Labor or the U.S. Department of Health and Human Services with questions. (Note: If you are in a group health plan, the date you joined may not reflect the date the plan was created. New employees and new family members may be added to grandfathered group plans after March 23, 2010).
Modified Adjusted Gross Income:
MAGI is the new methodology for calculation of income for certain Medicaid programs
which closely mirrors how the IRS determines adjusted gross income and household composition for tax purposes. This simplified income calculation will be used to determine Medicaid eligibility and also by the Exchange to determine Health Insurance Premium Tax
Credits.
Open
Enrollment
Period:
The
period of time set up to allow you to choose from available plans, usually once a year
.
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Glossary of terms (cont.)Out-of-Pocket Costs:
Your
expenses for medical care that aren't reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren't covered.Premium:
The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.
Prescription
Drug
Coverage:
Health insurance or plan that helps pay for prescription drugs and medications
.
Primary Care
Physician:
A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for a patient.Provider: A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), health care professional or health care facility licensed, certified or accredited as required by state law.Qualified Health Plan: Under the Affordable Care Act, starting in 2014, an insurance plan that is certified by an Exchange, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements. A qualified health plan will have a certification by each Exchange in which it is sold.Source: Health and Human Services For more terms please visit: http
://
www.healthcare.gov/glossary/a/index.html
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