Presentation on theme: "Affordable Care Act & You: What every consumer should know"— Presentation transcript:
1 Affordable Care Act & You: What every consumer should know
2 What is the ACA (“Obamacare”)? The Patient Protection and Affordable Care Act (ACA)ACA reforms our complex health care system85% of working Americans receive healthcare as a benefit of their full-time employment.Consumers can now purchase insurance from the federal Marketplace.ACA makes healthcare care more accessible and affordablePreventive careFamily planningRelated healthcare servicesNo discrimination due to pre-existing conditions or gender
3 How the ACA WorksConsumers can enroll in a Qualified Health Plan (QHP) through the MarketplaceThey can compare available plan options including monthly premiums, co-pays, deductibles, service networks, etc.There is a single, streamlined application for private health plans, Medicaid and/or CHIP options.ACA requires you to have coverage.The 2014 Individual Responsibility Fee Penalty can be $95 per individual; $285 per family; or 1% family income.A number of exemptions are available.
4 How the Marketplace Works https://www.healthcare.gov/marketplace/individual
5 Application Process Enroll in Qualified Health Plan Submit application to the MarketplaceEligibility determined and verifiedEligibility determined for Qualified Health Plan, Medicaid or CHIPEnroll in Medicaid or CHIPOnlineBy PhoneIn PersonSupported by Data Services Hub
6 Ways to Apply Online: In Person: By Phone (24/7, 150 languages): By Phone (24/7, 150 languages):In Person:Certified Application Counselors & NavigatorsVisit your nearest federally qualified health center orgo to
7 Eligibility Eligibility: Live in the service area US citizen or lawfully present non-citizen for the period of enrollmentNot incarcerated
8 Affordable CoverageA refundable or Advanced Premium Tax Credit (APTC):Can only be used to buy insurance from the MarketplaceYou can take it now and have it reduce your monthly premium.Or, you can take it later and have it reduce your income tax liability.Eligibility for the APTC is based on:Tax filing status and family sizeHousehold income of 100%-400% Federal Poverty LevelConsumer is ineligible for government or employer insuranceAdditional Cost-Sharing Reductions are also availableHousehold income of 100%-250% of Federal Poverty Level
9 Lawfully Present Non-Citizens Lawfully present non-citizens are not eligible for federal benefits until they have been residents for 5+ years.However, if they are ineligible for Medicaid because of their immigration status, they can receive APTC even if their income is below 100% Federal Poverty Level.
10 Federal Poverty Level Table For households with more than 8 individuals, add $4060 for each.Households earning less than 100% FPL will not be eligible for APTC.Households earning more than 400% FPL will not be eligible for APTC.Medicaid was not expanded in Florida.
11 Types of Plans Types of health plans Platinum90% of covered costs paid by planMaximum servicesLower deductible, higher premiumsGold80% of covered costs paid by planSilver70% of covered costs paid by planBronze60% of covered costs paid by planMinimum servicesHigher deductible, lower premiumsCatastrophic coverage is also available for adults underage 30 and/or those who obtain a hardship waiver.
12 Essential Health Benefits Each plan must include, at a minimum, 10 essential health benefits (below)More expensive plans offer additional benefitsAmbulatory Patient ServicesPrescription DrugsEmergency ServicesRehabilitative Services and DevicesHospitalizationLaboratory ServicesMaternity and Newborn CarePreventive & Wellness Services and Chronic Disease ManagementMental 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)
13 EnrollmentOpen Enrollment is November 15, through February 15, 2015.Health coverage is effective January 1, 2015 if purchased by December 15, 2014.
14 For more information …. In Person: [Insert Contact Info Here]By Phone:Marketplace Call Center at 1 (800)On-line: