Affordable Care Act Introduction to Reform and Major Players in NY Rebecca Antar Novick Supervising Attorney, Health Law Unit The Legal Aid Society

Getting Started: Testing Your Knowledge Kaiser Family Foundation Health Reform Quiz:

New York’s Health Exchange: History and Timeline : Senate Republicans blocked efforts to pass legislation authorizing the creation of health exchange April 12, 2012: Governor Cuomo issued executive order establishing state exchange September 6, 2012: Regional Advisory Committees Established December 14, 2012: NY received conditional approval to operate state-based Exchange

Timeline Continued January 21, 2013: Invitation to health and dental plans to participate in Exchange February 4, 2013: Grant from HHS for implementation of Exchange July 10, 2013: Announcement of In Person Assistor / Navigator grants August 20, 2013: Announcement of approved health and dental plans and new name of Exchange

The Players Department of Health The Exchange: New York State of Health Regional Advisory Committees Qualified Health Plans Facilitated Enrollers In Person Assistors/Navigators Certified Application Counselors Brokers

The Players: State Staff and Advisory Entities Department of Health The Exchange Regional Advisory Committees

The Players: Plans Qualified Health Plans

The Players: Enrollers Facilitated Enrollers In Person Assistors / Navigators Certified Application Counselors Brokers

Affordable Care Act Subsidies Arielle McTootle Paralegal Case Handler, Health Law Unit The Legal Aid Society

New York State of Health: New York’s Health Insurance Marketplace Marketplace will offer health coverage through public programs (e.g. Medicaid, Medicare, Child Health Plus) and Qualified Health Plans (QHPs) and catastrophic plans

Qualifying Health Plans (QHP) QHPs offered are categorized by level of coverage into “metal tiers”: –Metal tiers differ based on actuarial value –Bronze: 60%; silver: 70%; gold: 80%; platinum: 90% Catastrophic plans offered for young adults under 30 who cannot afford coverage

Subsidies under the ACA ACA requires that Marketplace provide financial assistance in the form of subsidies (advanced premium tax credits and cost-sharing reductions) for individuals and families with incomes up to 400% FPL Advanced Premium Tax Credits (APTC): A portion of monthly premiums paid directly to insurer to decrease consumer contribution –Only individuals and families who are not eligible for public insurance programs or coverage through employer

Advanced Premium Tax Credits (APTC) Amount of tax credit is determined on a sliding scale based on an individual or family’s income and cost of premiums in benchmark plan Designed to ensure that people do not pay more than a certain percentage of their income for coverage Income Level (%FPL)Premium limit (% income) Up to 133%2% %3-4% %4-6.3% % % % % %9.5%

APTC Calculator APTC calculator can be found on New York State of Health website – provides premium cost for each participating QHP 2014 Income (%FPL) Estimated Monthly Tax Credit Estimated Monthly Premium Contribution % Income Single$20,000 (174% FPL)$280$794.74% Family of 4 $50,000 (212% FPL)$450$ %

Cost-Sharing Reductions ACA also provides additional cost-sharing reductions (CSR) for individuals and families earning less than 250% FPL enrolled in silver plan* –Those eligible will be automatically enrolled in silver plan with higher actuarial values depending on income level –Cost-sharing obligation and other out-of-pocket expenses will be capped based on income Out-of-pocket expenses for all will be capped starting in 2015 Income LevelActuarial ValueOut-of-pocket Limit Up to 150% FPL94%$2, – 200% FPL87%$2, – 250% FPL73%$5,200