The Artists Health Insurance Resource Center A program of The Actors Fund Center for Emerging Visual Artists Thursday February 28 th Philadelphia PA

 Children under age 19 with pre-existing conditions can’t be denied coverage.  Young adults up to age 26 can stay on or enroll in their parents’ coverage.  Insurers can’t retroactively cancel the policies of people who get sick.  Insurers can’t impose lifetime dollar limits on medical benefits.  All new plans must cover certain preventive services, such as mammograms and tetanus shots, for free.

 Uninsured people with pre-existing conditions may be eligible for coverage through PCIP. Pre-Existing Condition Insurance Plan PA PCIP - $283/month $1000 deductible, 20% co-pay Note: Enrollment ends March 2nd! Help for the uninsured with pre-existing medical conditions thru a temporary high-risk pool until January, 2014

 Medicare recipients in the coverage gap or “donut hole” will receive 50% off drugs  Annual wellness visits and certain preventive services will be free for Medicare recipients.  Increased funding to Community Health Centers  “Medical Homes”

 Insurers can’t refuse coverage to anyone.  Most people will be mandated to have coverage or pay a penalty.  New insurance marketplaces, called Exchanges, will offer insurance to those who don’t get it elsewhere.  Subsidies will be available to people who buy insurance through an exchange with income less than 400% of the Federal Poverty Level. ($44,680).

All new plans will offer at a minimum an essential benefits package which limits out- of-pocket medical expenses. Including:  Ambulatory care  Emergency care and hospitalization  Maternity and newborn care  Mental health and substance abuse  Prescription drugs  Preventive and wellness services

The four levels provided in the ACA are:  Bronze: 60%  Silver: 70%  Gold: 80%  Platinum: 90% In other words, for a bronze plan, the health plan would cover 60% of the cost for an average population and enrollees (on average) would cover 40%. For a platinum plan, an average individual would pay 10% out of pocket for their covered benefits and the plan would pay 90%.

Plans can also offer a lesser level of coverage to individuals under the age of 30. These “catastrophic plans” must still cover essential benefits but will have very high deductibles ($5,950 for an individual in 2010, to be updated annually by premium inflation).

Plans must limit enrollees’ out-of-pocket expenses (including the deductible) to $5,950 for an individual or $11,900 for a family (2010 figures, to be updated based on premium inflation).

 Yes!  Penalty: increases from $95 or 1% of income in 2014 to $695 or 2.5% of income in  Exceptions include: Native Americans, those w/religious objections, people who are not legal residents, those who don’t meet tax filing threshold ($9,350 single), people who’ve been uninsured for less than 3 months.  You will likely have to file proof of coverage with your taxes.

 If your annual income is less than $44,680 (single), you will receive a subsidy to buy insurance through an Exchange.  Subsidies will cap the amount you spend on premiums in relation to your total income.  Subsidies will also cap your annual out-of- pocket medical costs.

Example: a person who makes $21,000/yr will have their premiums capped at 6.3% of their income, and their annual out-of- pocket medical costs will be limited to $1,983/yr (excluding premiums).

>Are age 19 up to 65 who are not eligible for a current Medicaid program >Have income under 138% FPL >Meet citizenship requirements >Are not incarcerated >Are not entitled to Medicare 138% FPL = $15,414

 If you have a new policy that began on or after 9/23/2010, you can get certain preventive services for free:  Blood pressure, diabetes & cholesterol tests  Breast, colon & cervical cancer screenings  Vaccines, immunizations & flu shots  HIV & STD testing  Screenings for healthy pregnancies  Well-child visits

 Available beginning 2010 tax year  Employers with fewer than 25 FTE’s employees with average wages of less than $50,000 that purchase health insurance for employees are eligible for the tax credit  To be eligible, employer must offer a group health plan & contribute at least 50% of premium cost  : credit max is 35% of employer contribution (25% for tax exempt/non-profits); will increase to 50% (35% for non-profits) in 2014

 Small business will file Form 8941 when they file income tax returns  Tax exempt organizations will claim the tax credit on a revised Form 990-T FAQ:

 Artists Health Insurance Resource Center:  Office of Consumer Information and Insurance Oversight:  Federal health care reform website:  Kaiser Family Foundation:

Questions about the Affordable Care Act and current health insurance options in New Jersey:  x265 