Presentation on theme: "AFFORDABLE CARE ACT (ACA)=OBAMACARE Universal Health Coverage toward creating a healthy community, stronger families and secure retirement Minja Hong Project."— Presentation transcript:
AFFORDABLE CARE ACT (ACA)=OBAMACARE Universal Health Coverage toward creating a healthy community, stronger families and secure retirement Minja Hong Project Coordinator KCS Public Health and Research Center 뉴욕한인 봉사센타 공공 보건 센타 2 West 32nd Street 6th Fl. New York, NY 10001 Tel. (212) 463-9685 In association with : Holy Name Medical Center 718 Teaneck Road Teaneck, NJ 07666 Korean American Senior Citizen’s Association of NJ 뉴저지 한인 상록회 1061 Slocum Ave. #A Ridgefield, NJ 07657
OBAMACARE = AFFORDABLE CARE ACT Terms you should know: Co-pay: A fixed amount (for example, $15) you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service. Co-insurance: Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount. 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 $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services. Maximum out of Pocket: The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges, or health care your health insurance or plan doesn’t cover. Some health insurance or plans don’t count your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit. In Medicaid and CHIP, the limit includes premiums. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Continued… Household Size: Household size is the number of people who are included in the annual tax return as either a spouse or a dependent. Advanced Premium Tax Credit (APTC): Advance payments of the tax credit can be used right away to lower your monthly premium costs. If you qualify, you may choose how much advance credit payments to apply to your premiums each month, up to a maximum amount. If the amount of advance credit payments you get for the year is less than the tax credit you're due, you'll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return. Also called premium tax credit. Metal Tiers: All insurance companies who have been approved to participate in the New York State of Health Insurance Marketplace will be offering these 4 levels of metal tiers: Bronze, Silver, Gold, Platinum. These tiers DO NO indicate the quality of care you will be receiving. However, they will determine how much you pay as a premium vs. how much you pay in out of pocket costs, such as co-pay. There is also a significant difference in the Deductible in each metal tier. Cost Sharing Reduction (CSR): A discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments. You can get this reduction if you get health insurance through the Marketplace, your income is below a certain level, and you choose a health plan from the Silver plan category. If you're a member of a federally recognized tribe, you may qualify for additional cost-sharing benefits.
Continued… 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. (The amounts below are based on 2013 numbers and are likely to be slightly higher in 2014.) $11,490 to $45,960 for individuals $15,510 to $62,040 for a family of 2 $19,530 to $78,120 for a family of 3 $23,550 to $94,200 for a family of 4 $27,570 to $110,280 for a family of 5 $31,590 to $126,360 for a family of 6 $35,610 to $142,440 for a family of 7 $39,630 to $158,520 for a family of 8 Qualified Health Plans (QHPs): Under the Affordable Care Act, starting in 2014, an insurance plan that is certified by the Health Insurance Marketplace, 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 Marketplace in which it is sold. NJ Medicaid Expansion
PENALTIES Keep in mind, that while the penalty seems low in the first year, within just 2 years it multiplies by 100x per person.
State Based Marketplace vs. Federal Marketplace Residents of New York State must log in through the site on the right www.nystateofhealth.ny.gov Residents of Connecticut must log in through the site on the right https://www.accesshealthct.c om/ Residents of New Jersey and States where the Federal Government is running the marketplace must log in through the site on the right www.healthcare.gov
NAVIGATING THE MARKETPLACE Click to create an account and start your application process online. This username and passworkd works like an email account and will give you access to your insurance portfolio including premiums, subsidies and benefits information. #1 #2 Click to find out more information about premiums and plans in your area.
Determining Household Size Can purchase on the Marketplace but may not be eligible for Tax Credit subsidies.
KAISER FAMILY FOUNDATION SUBSIDY CALCULATOR Sample Estimate Calculation
KOREAN COMMUNITY SERVICES AND THE ACA Korean Community Services is currently working with our lead agency Community Services Society in partnership with the New York State of Health Insurance Marketplace to bring the Asian American and Pacific Islander(AAPI) community in NYC Navigator Services. With two locations in Flushing, Queens and Midtown, Manhattan, KCS has navigators prepared to assist both English and Korean speakers with In-person assistance in obtaining affordable health insurance. We are happy to announce that KCS Public Health and Research (KCS PHRC) has begun working with Asian Pacific Islander American Health Forum (APIAHF) and out partner organizations, Holy Name Medical Center and the Senior Citizen Association of NJ, to bring Navigator services, on the Federal Marketplace, to residents of New Jersey beginning early December 2013. We hope conduct a series of information sessions and workshops geared toward increasing consumer knowledge of insurance needs and assisting clients make the choices that meet those needs.
INFORMATION YOU WILL NEED FOR APPOINTMENTS: This includes alien and naturalization numbers if you are a NATURALIZED US CITIZEN These numbers are on your naturalization certificate. Search for “Employer Coverage Tool” on healthcare.gov to get a better idea of what to ask your employer about health coverage options
EMPLOYER COVERAGE TOOL SAMPLE FORM Use this tool to gather answers about any employer health coverage that you’re eligible for (even it if it is from another person’s job, like a parent or spouse) You’ll need this information even if you don’t accept the employer’s insurance you’re eligible for.
INFORMATION TO KEEP IN MIND Important to think about since you will need to check each plans formulary to see if your medication is covered.