Affordable care act 101
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This document provides an overview of the Affordable Care Act (ACA) for Navigators and in-person assisters. It discusses the history and goals of health care reform in the United States. Key points of the ACA include expanding coverage to 32 million Americans, creating health insurance exchanges, offering premium subsidies, and expanding Medicaid eligibility. The presentation reviews eligibility and enrollment processes, plan options, and the individual mandate to have coverage. It aims to help assisters understand and explain the ACA to consumers.
Affordable care act 101
- 1. Washington Health Benefit Exchange AFFORDABLE CARE ACT 101 SUMMER 2013 Navigator/In-person Assister Program
- 2. Today’s Agenda ▪ History of the Affordable Care Act (ACA) ▪ Highlights of the Affordable Care Act ▪ Impact of the Affordable Care Act 2
- 3. PURPOSE AND OBJECTIVES Purpose This 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 3
- 4. 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) 4
- 5. WHY THE RUSH TO REFORM HEALTH CARE? ▪ 1912 – President Theodore “Teddy” Roosevelt - Proposal ▪ 1935 – President Franklin Roosevelt - Social Security ▪ 1942 – President Franklin Roosevelt - Established Price Controls 5
- 6. WHY THE RUSH TO REFORM HEALTH CARE? ▪ 1945 – President Harry Truman – Proposal ▪ 1965 – President Lyndon Johnson – Medicare ▪ 1974 - President Richard Nixon - Proposal 6
- 7. 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 7
- 8. AFTER 100+ YEARS, WHY NOW? 8 Consumer can't afford doctor Consumer delays care, goes to ER Consumer can't pay Providers shift cost to Insurers Insurers shift cost to consumer Consumer drops policy due to high price and is now uninsured
- 9. 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. 9
- 10. 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 disregards
- 11. 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 11
- 12. 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 12
- 13. INDIVIDUAL MANDATE ▪ Require 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! 13
- 14. THE MANDATE DOES NOT APPLY FOR SOME When 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 income 14 No penalty for being without health insurance.
- 15. THE MANDATE IS SATISFIED WHEN You were insured for the whole year through a combination of any of the following sources: ▪ Medicare ▪ TRICARE ▪ The veteran’s health program ▪ A 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
- 16. 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 16
- 17. HEALTH INSURANCE PREMIUM TAX CREDITS ▪ Designed 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 17
- 18. 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.
- 19. 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 Reductions
- 20. EXAMPLE ▪ Family of 3 ▪ Annual Income = 200% of FPL ▪ Health Insurance Premium Tax Credit? YES ▪ Cost Sharing Reduction? YES 20
- 21. 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. 21
- 22. MEDICAID EXPANSION ▪ Medicaid 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 22
- 23. 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: o 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: o 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. 23
- 24. 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 available
- 25. Website Agent Broker Navigator In-person Assister Self- Directed Partner Customer Support Center HOW WILL PEOPLE GET HEALTH CARE COVERAGE?
- 27. ON-THE-SPOT ELIGIBILITY RESULTS ▪ Single portal for Medicaid, tax subsidies and Qualified Health Plans ▪ Use of electronic data to verify eligibility ▪ Real-time eligibility determination ▪ Interfaces to federal and state systems 27
- 28. SUMMARY ▪ Historic significance of the Affordable Care Act ▪ Reforms to Health Care already in place ▪ Reforms effective January 1, 2014 ▪ Benefits to Individuals ▪ Benefits to Families ▪ Benefits to Employers 28
- 29. KNOWLEDGE CHECK What is the Affordable Care Act? A. Health Care Insurance Reform B. Affordable Car Insurance C. Gun Control D. Animal Case Adaptation 29
- 30. KNOWLEDGE CHECK Open Enrollment begins on… A. March 23, 2010 B. January 2, 2014 C. October 1, 2013 D. December 7, 2013 30
- 31. KNOWLEDGE CHECK What are the two key goals of the Affordable Care Act? A. Increase the cost of health care and decrease the number of Americans that are uninsured. B. Slow down the rising cost of health care and expand health care coverage to uninsured Americans. 31
- 32. KNOWLEDGE CHECK The soonest coverage in a Qualified Health Plan can be effective is…. A. November 1, 2013 B. December 1, 2013 C. January 1, 2014 D. April 1, 2014 32
- 33. KNOWLEDGE CHECK Washington State is implementing Medicaid Expansion. Which of the following statements is not true? A. Washington State Medicaid is going to include the state of Idaho. B. Washington State Medicaid will include adults (without children) up to 138% of FPL. C. Washington State Medicaid will include Parents with income up to 138% of FPL D. Washington State Medicaid will use Modified Adjusted Gross Income to determine applicant’s income. 33
- 34. KNOWLEDGE CHECK One way the Affordable Care Act will expand health care coverage is… A. By requiring all citizens be given pay raises. B. By requiring everyone to purchase health care coverage with no exceptions. C. By requiring all employers to provide health care coverage to all of their employees as well as their dependents. D. Through premium subsidies. 34
- 35. KNOWLEDGE CHECK Which of the following statements is not true regarding Health Insurance Premium Tax Credits? A. These credits are designed to make premiums affordable for individuals and families with lower incomes. B. Enrollment through the Healthplanfinder is not required to receive these credits. C. Tax credits can be used to reduce monthly premiums. D. Tax credits can be claimed on your annual tax return. 35
- 36. KNOWLEDGE CHECK Cost sharing reductions… A. Are a way to reduce consumer out of pocket health care expenses. B. Lower monthly premiums. C. Lower annual premiums. D. Lower grocery bills. 36
- 37. KNOWLEDGE CHECK The Individual mandate… A. Requires all citizens and legal residents to have health care coverage for their dogs and cats in 2014. B. Requires incarcerated individuals to purchase healthcare coverage through the Washington Healthplanfinder. C. Requires all citizens and legal residents to have health care coverage in 2013. D. Requires all citizens and legal residents to have health care coverage in 2014. 37
- 38. KNOWLEDGE CHECK Washington Apple Health (Medicaid) is administered by… A. The Washington Health Benefit Exchange. B. The Washington State Health Care Authority. C. The Washington Healthplanfinder. D. The assister the customer is working with. 38
- 39. KNOWLEDGE CHECK A person that does not obtain health insurance coverage through a Qualified Health Plan may owe a penalty to… A. The Washington Health Care Authority (HCA). B. Centers for Medicare and Medicaid Services (CMS). C. Internal Revenue Service (IRS). D. The Washington Healthplanfinder 39
- 40. QUESTIONS 40
- 41. THANK YOU! Congratulations! You have completed the Affordable Care Act Course!
- 42. 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: [email protected] 42 More on the Exchange
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- 44. APPENDIX: GLOSSARY OF TERMS ▪ Actuarial 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. 44
- 45. 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. 45
- 46. 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 46
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Editor's Notes
- #2: Welcome to the Washington Health Benefit Exchange Overview of the Affordable Care Act This is an exciting time here in Washington, and across the country, as we take the biggest step in health care reform since the introduction of Medicare in 1965.
- #3: This presentation will provide an overview of the Affordable Care Act, including the history, the highlights, and the impact.
- #4: Our goal is to help you understand the Affordable Care Act, at a high level, and how it applies to you and others.
- #5: What is the Affordable Care Act? Congress and the Administration passed a health care insurance reform bill that is intended to lower costs, guarantee choices, and enhance the quality of health care for all Americans. President Obama signed this historic national health care legislation into law on March 23, 2010. The Patient Protection and Affordable Care Act (P.L. 111-148) is expected to provide health care coverage to approximately 32 million Americans who currently do not have any. It aims to reform the health insurance system in a number of ways, including banning pre-existing condition exemptions, capping out-of-pocket expenses, increasing competition and providing increased government oversight. In this webinar, we are going to explore some of the factors that led to the passage of this landmark legislation. We will discuss what is in the Affordable Care Act and exactly how it expands access to health care coverage while at the same time, slowing down the rising cost of health care in the United States. Let’s take a look at how this came about.
- #6: The passage of the Affordable Care Act was preceded by over 100 years of efforts by this nation’s leaders who were responsible for “reforming” or improving our health care system in incremental steps. Here are some of the incremental reforms that turned out to be significant and substantial milestones of change. 1912 – Teddy Roosevelt proposed establishing a national health care system when he ran unsuccessfully for president. 1935 – President Franklin Roosevelt hoped to create a national health care system during the Great Depression but had to forgo this idea in lieu of only creating Social Security. 1942 – President Franklin Roosevelt established price controls. As an alternative to wage increases, businesses began offering health care insurance to employees.
- #7: 1945 – President Harry Truman asked Congress to pass a national insurance program for people who wanted to voluntarily participate. Legislators declined. 1965 – President Lyndon Johnson pushed Congress for and got a new program for the elderly called Medicare. 1974 - President Richard Nixon wanted to enact legislation requiring all employers provide employees with health care coverage. He also wanted to provide subsidies for those who needed help paying for the coverage. He left office before he could convince Congress to pass his proposal.
- #8: 1993 – President Bill Clinton introduced his reform proposal mandating everyone have health insurance and requiring employers to provide health insurance to their employees. This 1,300-page bill failed in the US Senate. 2005 – President George W. Bush pushed Congress to pass legislation adding a prescription drug benefit to Medicare. Medicare Part D was created. 2010 – President Barack Obama successfully pushed for historic health care reform legislation thus fulfilling a key campaign promise to voters. We have 100 years of health reform history. Why now?
- #9: The number of uninsured Americans continued to increase and had reached 32 million in 2010 – a number that was unsustainable for patients, providers and payers. The economic downturn caused more people to lose their jobs and their health care coverage at the same time, pushing the number of uninsured up to nearly 50 million people by 2011. American Journal of Medicine reported in 2009 that illness and medical bills contribute to a large and increasing share of US Bankruptcies. 62% of all bankruptcies nationwide were related to medical debt. Most were well educated, owned homes and had middle-class occupations. 75% had health insurance but the limitations of their coverage (lifetime limits, benefit exclusions) caused people financial hardship. Those most in need of coverage could be dropped by a health insurance company or their rates could be increased significantly just for using the benefits available. In 1960, the annual individual health care cost was $148. By 2011, this cost had skyrocketed to $8,311. If other prices rose like this a tube of toothpaste might cost $13.50 today and an electric can opener might cost $479.52. Health care providers were treating more and more patients who had no means to pay for their care. They were pushing for reform too. Individuals with insurance were complaining about their increasing premiums and demanding reform.
- #10: Two key goals of the Affordable Care Act are to: Goal 1: Expand health care coverage to 32 million Americans who are uninsured. Goal 2: Slow down the rising cost of health care which accounted for almost 18% of the Gross Domestic Product (GDP) in 2010. The key questions about these two ambitious goals are: 1. How will more people get health care coverage? 2. How much will this cost? 3. Where will the money come from?
- #11: The Affordable Care Act will change the United States’ health care system. Some improvements have already started. For example, kids can’t be denied health care coverage if they are sick, and young adults, up to age 26, can now stay on their parents’ health insurance plans. Insurance carriers can no longer put a lifetime dollar limit on the amount of your health care costs they will cover. And now, carriers are required to spend more of the premium dollars they collect from policyholders on health care services. For seniors, the Affordable Care Act closes the Medicare prescription gap in coverage that resulted in high out of pocket expenses for prescription drugs. Beginning in January 2014, Medicaid will expand to include individuals with income up to 138% of the federal poverty level. The Affordable Care Act created Health Benefit Exchanges, the on-line marketplace for one-stop shopping for affordable health care coverage. In our state, this on-line marketplace is called the Washington Healthplanfinder.
- #12: Starting January 1, 2014, all individual and small employer health plans must include 10 essential health benefits. Plans will vary in how they define and package these 10 essential benefits. The Healthplanfinder will provide tools that consumers can use to compare the benefits and costs offered by different plans. This comparison will give consumers the information they need to select the plan that best fits their needs.
- #13: The Affordable Care Act will expand health care coverage in the following ways: Individual Mandate Small Business Tax Incentives Medicaid Expansion Premium Subsidies Large Employer Mandate Let’s take a more in-depth look into each of these categories
- #14: Basically the Individual mandate requires all citizens and legal residents to have health coverage in 2014. There are no criminal penalties for an individual or employer who does not meet the individual or employer mandate but there are fees to pay and we’ll look at those in a minute. Does this apply to everyone?
- #15: The mandate does not apply when: You are part of a religion opposed to acceptance of benefits from a health insurance policy. You are an undocumented immigrant. You are incarcerated. You are a member of an Indian tribe. The Affordable Care Act contains special eligibility and service delivery provisions for American Indians and Alaskan Natives. We are currently developing a separate webinar that specifically addresses these provisions. The mandate also does not apply if: Your family income is below the threshold for filing a tax return ($10,000 for an individual, $20,000 for a family in 2013). You have to pay more than 9.5% of your income for health insurance, after taking into account any employer contributions or tax credits. Currently the Federal Government is in the process of determining a process for filing an exemption. (Hardship or individuals who cannot afford coverage came from http://www.treasury.gov/connect/blog/Pages/Fact-Sheet-on-Proposed-Affordable-Care-Act-Regulations.aspx )
- #16: The mandate is satisfied and there is no penalty when: You were insured for the whole year through a combination of any of the following sources: Medicare TRICARE The veteran’s health program A plan offered by an employer Medicaid or the Children’s Health Insurance Program (CHIP) Health insurance purchased on your own that is at least at the Bronze level (plan metal levels will be discussed in the overview of the Exchange Webinar) A grandfathered health plan is a plan that was initiated prior to March 23, 2010. This can be a group or individual health insurance policy that premiums have been continuously paid for since or before March 23, 2010.
- #17: If you do not meet any of the reasons listed on the previous slide you must have health insurance and here are the fees that were mentioned earlier. In 2014, the fees are $95 per adult and $47.50 per child (up to $285 for a family) or 1% of income, whichever is greater. Income is defined as total income in excess of the income tax filing threshold. In other words, any income above $10,000 for an individual and $20,000 for a family in 2013. The penalty is pro-rated by the number of months without coverage, though there is no penalty for a single gap in coverage of less than 3 months in a year. The penalty cannot be greater than the national average premium for Bronze coverage in an Exchange. Penalties increase substantially in 2015 and 2016. After 2016 penalty amounts are increased annually by the cost of living.
- #18: Health Insurance Premium Tax Credits are designed to make premiums affordable for individuals and families with lower incomes They are only available to individuals and families with income up to 400% of the federal poverty level Tax credits can be used to reduce monthly premiums; or They can be claimed as a credit on your annual tax return To receive these credits, you must enroll in health care coverage through the Washington Healthplanfinder
- #19: This graph displays the federal poverty level based on individual or family income. For example, a family of 3 whose Modified Adjusted Gross Income (MAGI) is $39,060 per year would qualify for a Health Insurance Premium tax credit and cost reductions. A different family of 3 whose Modified Adjusted Gross Income is $78,120 would still qualify to receive a tax credit. The good news is that individuals and families who earn higher wages can also be eligible for premium tax credits that will make health care coverage more affordable. Next we’ll look at how these Health Insurance Premium tax credits are calculated.
- #20: Individuals or families who do not meet income eligibility for Medicaid (138% or below of federal poverty level) may be eligible for monthly reduced premiums or a lump sum tax credit on their annual return. Cost sharing reductions are another way to reduce consumer out of pocket health care expenses. Based on an individual’s income, the cost sharing reduction limits the amount the individual will pay for out of pocket expenses such as co-pays, deductibles, prescriptions, and so forth. In order to quality for cost sharing reductions a Silver plan must be purchased. Cost sharing reductions do not apply to premiums. If you would like to see estimated expected spending for families and individuals eligible to purchase health insurance coverage in the Healthplanfinder please go to the calculator at: http://www.wahealthplanfinder.org/
- #21: Back to our family of 3 with earnings equal to 200% of the federal poverty level which is $39,060/ year based on their Modified Adjusted Gross Income. The family’s premium would not be more than 6.3% of the family’s income. 6.3% of $39060 is $2461 annually or $205 monthly. Cost sharing reductions would be available to limit the family’s out of pocket expenses such as deductibles, co-pays and co-insurance that would otherwise be charged to them by the health plan.
- #22: The Affordable Care Act requires all states to create a new marketplace website where consumers can go to search, compare and enroll in an affordable health care plan. Organizations responsible for implementing these marketplaces are called Exchanges. The marketplace in Washington State is called the Washington Healthplanfinder. A consumer can enroll through the Healthplanfinder beginning October 1, 2013 for health care coverage beginning January 1, 2014. By answering a few questions in the Healthplanfinder, consumers can determine if they qualify for Medicaid, health care coverage with premium subsidies or health care coverage without premium subsidies. This can be done anonymously or by creating an account and completing an on-line application.
- #23: Another way people will get health care coverage in Washington is through Medicaid Expansion. States have the option to expand Medicaid to 138% of the federal poverty level. Washington’s new adult group will include any adult from the age of 19 up to 65, not on Medicare and previously not eligible for Medicaid, with incomes up to 138% of the federal poverty level. The Health Care Authority is the state agency responsible for administering Medicaid programs. A webinar that goes into more detail regarding Medicaid changes in Washington is coming soon…Stay tuned for more information.
- #24: Employers with over 50 full time equivalent employees who fail to provide health care coverage to their employees by January 1, 2014, will be charged a penalty. Employers with 200 or more employees that offer coverage must automatically enroll new full-time employees in health care coverage, with the opportunity to opt out. In the first year of the Exchange, only small employers (1-50 employees) will have the option of purchasing health care insurance for their employees through the Healthplanfinder. Benefits and tax incentives for small businesses who participate in the Exchange will be covered in a future webinar. In 2016, this option will be extended to employers up to 100 employees, and in 2017 the Exchange will have the option to offer coverage to employers greater than 100.
- #25: Small business will have more options available through the Washington Healthplanfinder. In 2014, small businesses with up to 50 employees have no mandate to provide health care coverage; however, if they choose to provide insurance, they may be eligible to receive a small business tax credit. There will be options for employers to manage their employee health care benefits through the Healthplanfinder. Employers can select one plan and make that plan available to their employees or they can choose a designated plan level and allow employees to select from among several plans in that level. In 2016, the Healthplanfinder is extended to employers up to 100 employees, and in 2017 the Exchange has the option to offer plans to employers with more than 100 employees.
- #26: There are numerous ways that people can access the Washington Healthplanfinder to shop for health care coverage. Many individuals who are used to using the internet to purchase products and who are generally familiar with health insurance will access the Healthplanfinder through the public website. If someone is using the website and would like assistance over the telephone, they can call the Customer Support Center. Customer Support Center representatives will be trained in all aspects of application and enrollment, and will be available from 7:30 a.m. to 8:00 p.m. Monday through Friday (except legal holidays) For people who need or want to talk to someone in person, Navigators or Assisters will be available in community organizations throughout the state. They will be trained and certified to provide information, explain options under the different plans, and costs. Navigators and Assisters must be unbiased in performing their work, and may not recommend for or against any specific plan. They can assist individuals to compare their coverage options and select one that best meets their health care needs. Once an individual has selected a plan, the Assister can help them through the enrollment process. Brokers must be registered with the Exchange to help consumers and small businesses enroll in health care coverage through the Exchange. They can also provide advice and make recommendations about enrollment options and Health Insurance Premium tax credits.
- #27: The Healthplanfinder will be the single point of entry for individuals, families and small businesses to apply for Medicaid, Qualified Health Plans and health insurance premium tax credits. health care coverage. All Applications will be submitted through the Washington Healthplanfinder, whether you’re applying for Medicaid, an individual insurance policy or a small business insurance policy. This is the Washington Healthplanfinder homepage. This is the single point of entry for individuals and families to apply for Medicaid, Qualified Health Plans and health insurance premium tax credits. It is also the portal for small businesses to apply for health care coverage for their employees and be eligible for a tax credit.
- #28: The Healthplanfinder provides a streamlined way to apply for health care coverage. Once you complete the on-line application, the Healthplanfinder will process and verify the information against other federal and state systems on the spot. The system will display the coverage options available to you. If you are eligible for Medicaid, you can complete your enrollment in the Healthplanfinder to start coverage. The Medicaid program is administered by the Washington State Health Care Authority. If you are not eligible for Medicaid, the system will display the following: The Qualified Health Plans that you may select from and their costs. Health insurance premium tax credits you qualify to receive Cost sharing reductions
- #29: We’ve shared the long history of efforts to improve the country’s health care system and the huge step forward the Affordable Care Act signifies. The reform was passed in 2010 and many individuals and families are already benefiting from the many improvements. Some people are receiving care that was previously unavailable or unaffordable, such as children who were previously denied coverage due to pre-existing conditions. Many more improvements will become effective January 1, 2014 that will expand access to health care to millions of people. The Exchange will be conducting widespread outreach and marketing to inform Washington residents about the new coverage options beginning in early Spring and throughout the summer, leading up to open enrollment beginning October 1. For more information about the Health Benefit Exchange or the Washington Healthplanfinder, visit our website.
- #30: What is the Affordable Care Act? Congress and the Administration passed a health care insurance reform bill that is intended to lower costs, guarantee choices, and enhance the quality of health care for all Americans. President Obama signed this historic national health care legislation into law on March 23, 2010.
- #32: Two key goals of the Affordable Care Act are to: Goal 1: Expand health care coverage to 32 million Americans who are uninsured. Goal 2: Slow down the rising cost of health care which accounted for almost 18% of the Gross Domestic Product (GDP) in 2010.
- #34: States have the option to expand Medicaid to 138% of the federal poverty level. Washington’s new adult group will include any adult from the age of 19 up to 65, not on Medicare and previously not eligible for Medicaid, with incomes up to 138% of the federal poverty level. The Health Care Authority is the state agency responsible for administering Medicaid programs.
- #35: The Affordable Care Act will expand health care coverage in the following ways: Small Business Tax Incentives Medicaid Expansion Premium Subsidies Large Employer Mandate Individual Mandate
- #36: Health Insurance Premium Tax Credits are designed to make premiums affordable for individuals and families with lower incomes They are only available to individuals and families with income up to 400% of the federal poverty level Tax credits can be used to reduce monthly premiums; or They can be claimed as a credit on your annual tax return To receive these credits, you must enroll in health care coverage through the Washington Healthplanfinder
- #37: Cost sharing reductions are a way to reduce consumer out of pocket health care expenses such as deductibles, co-pays and co-insurance. Premiums are not affected by cost sharing reductions.
- #38: The Individual mandate requires all citizens and legal residents to have health coverage in 2014. Incarcerated individuals are not eligible to purchase healthcare coverage through the Washington Healthplanfinder. The mandate does not apply when: You are part of a religion opposed to acceptance of benefits from a health insurance policy. You are an undocumented immigrant. You are incarcerated. You are a member of an Indian tribe.
- #39: Washington Apple Health (Medicaid) is administered by The Washington State Health Care Authority.
- #42: Note to Trainer: Congratulate students on completing the course. Thank students for their attendance and participation throughout the day.
- #43: Following this webinar, you will receive a short survey requesting input from you about information that you would like to see included in our webinar series. This webinar will be posted on the website for your future reference. Thank you for joining us today. We look forward to bringing you additional topics in our Countdown to Coverage Series.