The Affordable Care Act implementation questions opportunities challenges 2 How they want to feel is confident informed secure satisfied and in control If you had to look for health insurance now what feelings do you think you would have ID: 388633
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Slide1
1
The Road to Affordable Care
The Affordable Care Act – implementation, questions, opportunities, challengesSlide2
2
How they
want
to
feel is
confident, informed, secure, satisfied, and in control
.
If you had to look for health insurance now, what feelings do you think you would have?
Public: Past Confusion and Lack of Trust
Poll: 42% of Americans unsure if Obamacare is still lawBy Sarah KliffWashington Post|April 30, 2013
Source: Enroll
America Research, November 2012Slide3
Limited Public Awareness
The majority of uninsured Americans don’t know the health reform law will help them.
75%
Three out of four of the newly eligible want in-person assistance to learn about and enroll in coverage.
3
Source: Enroll America Research, November 201278% Slide4
Affordable Care Act Positive Changes
Preventive care at no charge
Restrictions on annual spending
caps
No
lifetime dollar limits
on plansDependent children covered to age 26No pre-ex waiting periods under age 19Childhood immunizations and adult vaccinations at no charge
Effective 2010Slide5
No
annual coverage limits on health plans
No Pre-Existing Condition Waiting Periods for allFor adults as well as children
Requires “guarantee issue”
and renewability of health insurance regardless of health
status
Change to Employer’s eligibility requirements – the wait can be no more than 90 calendar days from date of hireEffective 2014Affordable Care Act Positive Changes Slide6
Messages that Resonate with the PublicSlide7
Moving from
Messages to RealitySlide8
8
or
“Welcome Door”:
What will it look like?Slide9
Source: February 2013
CBO
estimatesMillions
Enroll
at least
15 million people in new coverage options
}7 million in Exchange coverage8 million in Medicaid or CHIP
}9
The 2014 Enrollment Opportunity: USASlide10
Washington 2014 Enrollment Targets
Enroll
over
½ a million people in new coverage options
}
280,000 in Exchange coverage
350,000 in Medicaid or CHIP}
10Slide11
Federal Basic Health OptionSlide12
Vision for Exchanges
A easy shopping experience
Allow consumers to find and compare Qualified Health Plans (QHPs) on quality and cost
Give consumers clear and easy-to-navigate information about coverage options –
Apples : Apples
Help consumers choose the best providers as well as health plans, based on what matters to them
Drive delivery system and payment reformsUltimately enroll consumers in the plan that will deliver the highest quality, highest value care that best meets their needs12Slide13
FPL: Eligibility for Exchange SubsidySlide14
Premium Subsidy:
Your Premium Share is a 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 incomeSlide15
Annual Out-of-Pocket Maximums:
100
% FPL
$1,983
OOP max/individual
200% FPL
$2,975 OOP max/individual 300% FPL
$3,967 OOP max/individual
> 400% FPL $5,950 max/individual15In Addition to Premium Subsidies,Cost-Sharing Assistance is needed:
Cost Sharing Subsidies100-150% FPL
94% Actuarial Value
150-200% FPL
87% Actuarial Value
200-250% FPL
73% Actuarial
ValueSlide16
16
Consumers
are confused by cost-
sharing terms
Who knows what these terms mean:
deductible
c
oinsurance
benefit maximum
allowed amountout-of-pocket maxSelecting the right plan matters –
Platinum, Gold, Silver
, BronzeSlide17
Coverage is Here slide
17Slide18
A New Way to Enroll in Coverage
Consumers can connect to whichever program they are eligible for, no matter where they start.
18
Complete single application
Determine eligibility
Enrolled in correct program!
Medicaid
CHIP
In-Person Assistance
Exchange
Single ApplicationSlide19
Going Forward:
What will be seen, learned
and evaluated?Will consumers come to the door and get in?Will there be true access to care? Will consumers get the “right” plan?
Feedback
– learn from experiences
Don’t
delay – if we don’t get it right the first time then we are going to lose trust, and lose the ability to cover uninsured19
Covering the Uninsured