GET ANSWERS. GET COVERED. Affordable Care Act and the Health Insurance Marketplace

GET ANSWERS. GET COVERED. Agenda Affordable Care Act - Review Individual Mandate Health Insurance Marketplace Qualified Health Plans Essential Health Benefits Government Subsidies Exemptions Key Dates for Enrollment Application Process Enrollment Assistance

GET ANSWERS. GET COVERED. Affordable Care Act The Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA) is a United States federal statute signed into law by President Barack Obama on March 23, The ACA aims to increase the access, quality & affordability of health insurance through a series of reforms.

GET ANSWERS. GET COVERED. Review – 2013 Open Enrollment Period 12,890 Alaskans signed up for coverage through the Federally Facilitated Marketplace by March 31 st, % qualified for financial assistance (‘Tax Credit’). Nationwide more than 8 million individuals signed up for coverage.

GET ANSWERS. GET COVERED. Individual Mandate Beginning in 2014, the Affordable Care Act includes a mandate for individuals to have health coverage or pay a penalty. This penalty is assessed when you file your federal income taxes. You’re covered if you have: Veterans benefits, TRICARE, Medicaid, Medicare, private insurance or an employer/group plan that meets minimum essential coverage. The penalty for 2014 is $95 per adult and $47.50 per child or 1% of income, whichever is greater. The penalty for 2015 is $325 per adult and $ per child or 2% of income, whichever is greater.

GET ANSWERS. GET COVERED. The Health Insurance Marketplace Alaska is participating in the Federally Facilitated Marketplace (FFM). This is a new way to buy health insurance and see whether you qualify for financial assistance to help pay for health coverage. Key Features of the Marketplace: Makes it easy to apply for coverage and shop for a plan that best meets your needs. All plans are presented in a similar, easy to read format. One application will determine eligibility for –federal subsidies on monthly payments (premiums), –actual out-of-pocket costs, and –government programs, such as Medicaid and DenaliKid Care.

GET ANSWERS. GET COVERED. Qualified Health Plans In Alaska, two insurance companies are offering several plans in the marketplace: Premera Blue Cross Blue Shield & Moda Health Plans on the marketplace are categorized levels:

GET ANSWERS. GET COVERED. Essential Health Benefits Ambulatory patient services (i.e. doctor visits and clinics) Emergency services Hospitalization Maternity and newborn care Mental health and substance abuse treatment services Prescription drugs Rehabilitative & Habilitative services and devices (therapies) Lab services Preventative and wellness services and chronic disease management (Diabetes, HIV/AIDS, Etc.) Pediatric services, including dental & vision

GET ANSWERS. GET COVERED. Government Subsidies or Premium Tax Credits If annual household income is between % of these income brackets, individuals qualify for Premium Tax Credits. If income <250%: Cost Sharing Reductions (help with co-pays) House hold size 100%133%150%200%300%400% 1$14,580$19,391$21,870$29,160$43,740$58,320 2$19,660$26,148$29,490$39,320$58,980$78,640 3$24,740$32,904$37,110$49,480$74,220$98,960 4$29,820$39,661$44,730$59,640$89,460$119,280 5$34,900$46,417$52,350$69,800$104,700$139,600

GET ANSWERS. GET COVERED. Medicaid Expansion – Coverage Gap Income Level increases – 101%-138% of the Federal Poverty Level Allows coverage for men and women under 65 years of age. Household size 100%138% 1$14,580$20, $19,660$27, $24,740$34, $29, 820$41, $34,980$48,272.40

GET ANSWERS. GET COVERED. Exemptions Are available through the Marketplace or the Internal Revenue Service (IRS) for: –Alaska Natives/ Indian status –Members of non-federally recognized tribes –Hardships (unexpected events, lack of affordable plans, no Medicaid expansion) –Health care sharing ministry –Incarcerated –Religious concerns –Not legally present –< 3 months gap in coverage

GET ANSWERS. GET COVERED. Key Dates for Enrollment Open Enrollment period: November 15 th – February 15 th Coverage begins January 1 st if enrolled by December 15 th and first payment is made by scheduled date. After that: if enrolled by 15 th, coverage begins 1 st of next month if enrolled after 15 th, coverage begins 1 st of second next month Open Enrollment ends: February 15 th 2015

GET ANSWERS. GET COVERED.

GET ANSWERS. GET COVERED. Application Process Create an account Apply Pick a Plan Enroll

GET ANSWERS. GET COVERED. Connect for Answers. To learn more and/or to enroll yourself: Visit HealthCare.gov Call To get enrollment assistance: Call Or –2-1-1 will connect you to enrollment resources in your community, including in-person assisters. –Link to exemption forms

Thank you.

GET ANSWERS. GET COVERED. CMS Funding and Disclaimer This project is 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.