THE PATIENT PROTECTION & AFFORDABLE CARE ACT Navigating the Health Insurance Marketplace

Helping You Navigate The Health Insurance Marketplace 2 Building bridges between healthcare delivery systems, patients and communities. Wyoming Institute of Population Health

Helping You Navigate The Health Insurance Marketplace Today’s Presentation Outcome You will be confident of Who to contact at Enroll Wyoming How to get your staffed trained on the Marketplace How to get resources into your communities 3 Overview of Enroll Wyoming’s Vision Overview of the Health Insurance Marketplace Role of the Navigators and Certified Application Counselors How to get help in your facility and community

NO HEALTH INSURANCE? Don’t Let Medical Costs Beat You Up

AFFORDABLE CARE ACT PROVISIONS

Uberoi, Finegold, Gee. Department of Health and Human Services. Health Insurance Coverage and the Affordable Care Act, March 3, 2016

HOW DID THIS IMPACT WYOMING? WY: 83,000 uninsured Laramie County: 7,000 Potentially 51% eligible for tax credits and cost-sharing subsidy to buy on the Marketplace Helping You Navigate The Health Insurance Marketplace 8

Wyoming Open Enrollment Success!

Cheyenne Regional Hospital Uncompensated and Indigent Care Data Using the Cost to Charge Ratio on the Medicare Cost Report Schedule S-10

ENROLL WYOMING ROI FOR ALLIES – IMPROVE COMMUNITY HEALTH Impacts everyone in your community Find the consumers who are mid to late-adopters Educate your community to be better consumers Find the 10,000 kids who are uninsured Protect your bottom line Historically high premium costs in Wyoming Convert charity and bad-debt to commercial pay to soften the demand destruction impact Alignment and Compliance with PPACA Align your workflows to screen for all benefits Reserve charity care for those in the gap Helping You Navigate The Health Insurance Marketplace 13

INSTITUTE RESPONSIBILITIES TO ALLIES Navigators – Recruit and Train 12 Grant Funded Navigators & Institute Staff 34 Additional Embedded Navigators with Allies Statewide Service Area 600+ Access Events in OE3 Targets all Allies at least one time before December 15th Educational Material Development Brochures, Posters, Mailings and Cards Helping You Navigate The Health Insurance Marketplace 14

ALLY RESPONSIBILITIES Designate in-kind staff to receive Navigator Training Examples include Patient Financial Services, Customer Service, Financial Counselors and Case/Social Workers NOTE: Attestation for Avoiding Conflict of Interest Designate a facility liaison to work with the Institute Set Access Event site Invite Target Population Identify target population who may benefit Send Invitations Suggestions: self-pay, un/underinsured patients Optional: For those who fall under 100% FPL, may opt to provided information about facility charity policy Helping You Navigate The Health Insurance Marketplace 15

ACCESS EVENTS Staff Focused Education Consumer Focused Access Events Marketplace – Online, Phone, Paper or In Person Eligibility – Who is and is not on the Marketplace Explaining the Vocabulary – QHP, Essential Health Benefits, Deductible, Co-Insurance Tax Credits Cost Sharing Reductions How to work Healthcare.gov Important Enrollment Dates Call Role of the Navigator is to educate, not make recommendations Helping You Navigate The Health Insurance Marketplace 16

Helping You Navigate The Health Insurance Marketplace Navigators Can Help You Educate about the Marketplace Provide fair & impartial information Assist consumers with applying & enrolling Protect privacy & security of Personal Identifiable Information (PII)

ACA REQUIREMENTS FOR 2014 Starting in 2014, everyone must: make a shared responsibility payment Qualify for an exemption have Minimum Essential Coverage (MEC) OR Helping You Navigate The Health Insurance Marketplace

Who Doesn’t Have to Worry? Those who ALREADY have Minimum Essential Coverage Medicare Medicaid CHIP (Wyoming Kid Care) Tri-Care and Veteran’s Benefits Employer Sponsored Coverage including COBRA and Retiree Grandfathered Coverage Health Insurance Marketplace Coverage 23

Exemptions To Shared Responsibility Payment 25 Incarcerated individuals Not lawfully present in the U. S. Experience a short coverage gap * less than 3 months Live abroad for more than 330 days a year Income below tax filing threshold Automatic Exemptions Cannot afford coverage * cost of the lowest bronze plan is over 8% of the tax filing income Tribal members Religious exemption Victims of domestic violence Must Apply for Exemption

Helping You Navigate The Health Insurance Marketplace What Is The Shared Responsibility Payment? Tax penalty for not having health insurance How much is the tax penalty? 2014: $95 per adult or 1% of household income, whichever is higher 2015: $325 per adult or 2% of household income, whichever is higher 2016: $695 per adult or 2.5% of household income, whichever is higher *Penalty for a child is half that of an adult 26

Helping You Navigate The Health Insurance Marketplace THE HEALTH INSURANCE MARKETPLACE Federal Website to buy Health Insurance: Compare Apples-to-Apples Get help paying for coverage

Lower Premium Higher Premium PLAN CATEGORIES

Essential Health Benefits 11 Outpatient carePrescription drugs Emergency servicesRehabilitative & Habilitative services & devices Hospitalization Laboratory services Maternity & newborn care Preventive & wellness services chronic disease management Mental health & substance use Pediatric services, including disorder services, including oral & vision care behavioral health treatment

Helping You Navigate The Health Insurance Marketplace ELIGIBILITY The Marketplace also functions as an eligibility system to qualify for premium tax credits & cost-sharing reductions

Helping You Navigate The Health Insurance Marketplace Premium Tax Credit 16 Do I qualify for a premium tax credit? ❑ Can’t get affordable Health Insurance through your job ❑ Don’t have Health Insurance ❑ Not enrolled in Medicare ❑ Yearly tax filing income between 100% and 400% of the Federal Poverty Level ❑ Enroll in the Wyoming Health Insurance Marketplace Family Size 100%138%250%400% 1$11,770$16,242$29,425$47,080 2$15,930$21,983$39,825$63,720 3$20,090$27,724$50,225$80,360 4$24,250$33,46560,625$97,000 5$28,410$39,205$71,025$113,640 6$32,570$44,946$81,425$130,280 7$36,730$50,687$91,825$146,920 8$40,890$56,428$102,225$160,360

Helping You Navigate The Health Insurance Marketplace Do You Qualify for Cost Sharing? 21 Do I qualify for lower out-of-pocket costs? ❑ You receive a premium tax credit ❑ You choose to buy a silver-level health plan through the Wyoming Marketplace ❑ You have a household income at or below 250% of the Federal Poverty Level Household Size100%150%200%250% 1$11,770$17,655$23,540$29, ,93023,89531,86039, ,09030,13540,18050, ,25036,37548,50060, ,41042,61556,82071, ,57048,85565,14081, ,73055,09573,46091, ,89061,33581,780102,225

Re-Enrollment 26 Receive the right cost-savings May not be automatically re-enrolled New plans are available Helping You Navigate The Health Insurance Marketplace

SEE MARKETPLACE PLANS BEFORE APPLYING Individual Age 40 Living in Campbell County WY Annual Income $20,000 Eligible for APTC $341/month cost-sharing reductions

WHAT'S NEXT? If you enrolled in a Plan Expect a welcome packet & premium bill within 2 weeks You must pay your first premium to have coverage Make sure you're covered By calling your health insurance company

Helping You Navigate The Health Insurance Marketplace Enrollment Period Open Enrollment #4: Nov. 01, 2016 to Jan. 31, 2017 Open Enrollment #5: Nov. 01, 2017 to TBD Open Enrollment #6: Nov. 01, 2018 to Dec 15, 2018 Special Enrollment: Can enroll within 60 days after a triggering event Losing minimum essential coverage; Gaining/becoming a dependent through marriage, birth or adoption; An individual becomes newly eligible or ineligible for subsidies or a change in cost-sharing reductions; When new coverage becomes available as a result of a permanent move Effective Date For Coverage Purchased: January 1, 2016 Between 11/01/ /15/2015 February 1, 2016 Between 12/16/ /15/2016 March 1, 2016 Between 1/16/ /31/

If you enrolled in a Plan Expect a welcome packet & premium bill within 2 weeks You must pay your first premium to have coverage Make sure you're covered By calling your health insurance company

The project described was supported by Funding Opportunity Number CA-NAV from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

Helping You Navigate The Health Insurance Marketplace WHERE DO CONSUMERS GO? Enroll Wyoming Access Events Enrollwyo.org Healthcare.gov

THE PATIENT PROTECTION & AFFORDABLE CARE ACT Navigating the Health Insurance Marketplace