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What is the ACA (“Obamacare”) ? The Patient Protection and Affordable Care Act (ACA) ACA will reform our complex health care system If you are not insured,

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Presentation on theme: "What is the ACA (“Obamacare”) ? The Patient Protection and Affordable Care Act (ACA) ACA will reform our complex health care system If you are not insured,"— Presentation transcript:

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2 What is the ACA (“Obamacare”) ? The Patient Protection and Affordable Care Act (ACA) ACA will reform our complex health care system If you are not insured, or want to purchase insurance, a new Florida-based system will help you get coverage ACA makes healthcare care more accessible and affordable Preventive care Family planning Related services No discrimination due to pre-existing conditions or gender Other benefits 2

3 How the ACA Works Uninsured consumers can enroll in a Qualified Health Plan (QHP) through the “Marketplace” The Marketplace helps consumers choose the plan that best suits their needs by allowing them to compare available plan options including monthly premiums, co-pays, deductibles, service networks, etc. There is a single, streamlined application for health plan, Medicaid and CHIP options. ACA requires most people to have coverage by January 2014 Penalty in 2014 is $95 per individual; $285 per family; or 1 percent of family income, whichever is higher. A number of exemptions are also available. 3

4 How the Marketplace Works https://www.healthcare.gov/marketplace/individual 4

5 Application Process Submit application to the Marketplace Enroll in Medicaid or CHIP Eligibility determined and verified Enroll in Qualified Health Plan Supported by Data Services Hub Online By Phone In Person 5 Eligibility determined for Qualified Health Plan, Medicaid or CHIP

6 Ways to Apply Online: By Phone (24/7, 150 languages): In Person: Certified Application Counselors & Navigators Visit your nearest federally qualified health center or go to or call to be connected. 6

7 Eligibility Eligibility: Live in the service area US citizen or lawfully residing non-citizen for the period of enrollment Not incarcerated 7

8 Affordable Coverage A refundable or Advanced Premium Tax Credit (APTC): Can only be used to buy insurance from the Marketplace Paid directly to insurer on your behalf Can reduce your monthly premium, depending on income level Eligibility for the APTC is based on: Family size and household income Household income between 100%-400% Federal Poverty Level If consumer is ineligible for other coverage such as government or employer insurance 8

9 Federal Poverty Level Table Household Size 100% 133% 150%200% 300%400% 1$11,490$15,282$17,235$22,980$34,470$45, ,510 20,62823,265 31,02046,53062, ,530 25,97529,295 39,06058,59078, ,550 31,32235,325 47,10070,65094, ,570 36,66841,355 55,14082,710110, ,590 42,01547,385 63,18094,770126, ,610 47,36153,415 71,220106,830142, ,630 52,70859,445 79,260118,890158,520 For each additional person, add $4,020 $5,347$6,030 $8,040$12,060$16, Households earning less than 100% FPL will not be eligible for APTC. 2. Households earning more than 400% FPL will not be eligible for APTC. 3. Medicaid was not expanded in Florida.

10 Types of Plans Types of health plans Platinum 90% of covered costs paid by plan Maximum services Lower deductible, higher premiums Gold 80% of covered costs paid by plan Silver 70% of covered costs paid by plan Bronze 60% of covered costs paid by plan Minimum services Higher deductible, lower premiums Catastrophic coverage is also available for adults under age 30 and/or those who obtain a hardship waiver. 10

11 Essential Health Benefits Each plan must include, at a minimum, 10 essential health benefits (below) More expensive plans offer additional benefits Ambulatory Patient ServicesPrescription Drugs Emergency ServicesRehabilitative Services and Devices HospitalizationLaboratory Services Maternity and Newborn CarePreventive & Wellness Services and Chronic Disease Management Mental Health and Substance Use Disorder Services (to include behavioral health care) Pediatric services, including oral & vision care (pediatric oral services may be provided by stand-alone plan) 11

12 Enrollment Open enrollment through the Marketplace is October 1, 2013 through March 31, Health coverage is effective January 1, 2014 if purchased by December 15,

13 For more information …. In Person: [insert CAC name & contact info] By Phone: Marketplace Call Center at 1 (800) On-line: 13


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