New Health Insurance Marketplace: Opportunities for Public Health Open Enrollment Began October 1, 2013 Coverage Starts January 1, 2014

Health Insurance Marketplace—HealthCare.govHealthCare.gov  The Health Insurance Marketplace is a new and easier way to find affordable health insurance.  Many people can get a break on costs at the Marketplace. New tax credits can reduce insurance premiums right away.  Every health plan offers comprehensive coverage from doctors to medications to hospital visits to free preventive care.  Through the same streamlined application process, many can find out if they are eligible for Medicaid or CHIP.

 People can get care they need to stay healthy.  Many preventive care services are free for new health plans.  People with health coverage get more preventive care and report better physical and mental health. Baicker K, Taubman SL, Allen HL, et al. The Oregon experiment -- Effects of Medicaid on clinical outcomes. N Engl J Med 2013;368: Baicker K, Finkelstein A. The effects of Medicaid coverage -- learning from the Oregon experiment. N Engl J Med 2011;365: Covering more people with health insurance improves population health.

Essential Health Benefits  Ambulatory patient services  Emergency services  Hospitalization  Maternity and newborn care  Mental Health and substance abuse disorder services, including behavioral health treatment  Prescription drugs  Rehabilitative and habilitative services/devices  Laboratory services  Preventive and wellness services and chronic disease management  Pediatric services, including oral and vision care

Mental Health and Substance Use Disorder Coverage  The Affordable Care Act requires that health insurance plans on the Health Insurance Marketplace cover mental health and substance abuse disorder services.  Because of the law, health plans must now cover preventive services like depression screening for adults and behavioral assessments for children at no cost.  And starting in 2014, most plans won’t be able to deny you coverage or charge you more due to pre-existing health conditions, including mental illnesses.

Preventative and Wellness Services Most insurance plans, including all plans on the Marketplace, provide many free preventive services. Examples include:  Blood pressure, diabetes, and cholesterol tests  Cancer screenings, including mammograms and colonoscopies  Counseling to help quit smoking, lose weight, eat healthfully, identify depression, reduce alcohol use, and avoid sexually transmitted infections  Screenings for sexually transmitted infections  Regular well-woman, well-baby, and well-child visits  Routine vaccinations against flu, pneumonia, measles, polio, meningitis, and many other diseases  Care to ensure healthy pregnancies healthcare.gov/what-are-my-preventive-care-benefits

Financial Assistance  Premium tax credits  Will reduce the premium amount the consumer owes each month  Available to eligible consumers with household incomes between 100% and 400% of the federal poverty level ($45,960 for an individual and $94,00 for a family of 4)  Based on household income and family size for the taxable year  Paid each month to the insurer or consumer can wait until they file taxes to receive the premium tax credit

Financial Assistance  Cost Sharing Reductions  Reduce out-of-pocket costs (deductibles, coinsurance, copayments)  Generally available to those with income at 250% of the federal poverty level or below ($27,925 for and individual and $57625 for a family of 4 in 2012)  Based on household income and family size for the taxable year

Marketplace Enrollment  Open October 1, 2013 to March 31, 2014  Open October 15 to December 7 each year beginning in 2014  Special Enrollment Periods available in certain circumstances during the year (childbirth, employment changes, etc.)  Medicaid and CHIP enrollment open year-round Apply by December 15, 2014 for coverage starting on January 1, 2014.

Basic Information to Enroll  To enroll in the Marketplace, individuals should be prepared to provide basic information, such as:  Names of family members who need insurance coverage  Birthdates  Social security numbers  Income information

PA Marketplace  Pennsylvania will be a Federally Facilitated Marketplace  1.3 million uninsured in PA  600,000 Pennsylvanians eligible to enroll through the marketplace  If Medicaid is expanded in PA, an additional 650,000 Pennsylvanians will be eligible for health insurance  15 insurance companies participating  56 plans available

Marketplace Navigators  Health Insurance Marketplace Navigators can help you  Understand how the Marketplace works  Complete eligibility and enrollment forms  In PA, The Advocacy Alliance, Mental Health America Westmoreland County, Mental Health Association in PA, and PA Mental Health Consumers’ Association offer  Trained navigators with a special focus on helping people who use or need behavioral health services  Language interpreter services  Navigator help to anyone who contacts us

Get Help  If you have behavioral health needs and want help understanding and using the Marketplace, contact one of our Health Insurance Marketplace Navigators  (toll free)     Visit HealthCare.govHealthCare.gov  Learn about available health coverage choices  Find community-based Navigators that will provide unbiased advice about coverage choices  Sign up for coverage online or on the phone

Additional Navigators in Pennsylvania  Find Local Help m=83&filter=off&lang_filter=0&navc_filter=1&shop_filter=0&chip_filter= 0  Mental Health America / Mental Health Association of Southeastern PA  or  PA Association of Community Health Centers  Resources for Human Development (RHD) 

Resources For more information  HealthCare.gov; CuidadoDeSalud.gov HealthCare.govCuidadoDeSalud.gov  Sign up to get updates at healthcare.gov/subscribe, twitter.com/HealthCareGov, and facebook.com/Healthcare.govhealthcare.gov/subscribe twitter.com/HealthCareGovfacebook.com/Healthcare.gov  24/7 Call Center: ( TTY/TDD) 

Information About the Health Insurance Marketplace  Marketplace Application Checklist: articles/marketplace-application-checklist.pdf articles/marketplace-application-checklist.pdf  Tips for Helping Consumers Navigate the Marketplace: articles/tips-for-assisters-to-help-consumers-navigate-the- marketplace.pdf articles/tips-for-assisters-to-help-consumers-navigate-the- marketplace.pdf   Things for Consumers to Think About When Choosing A Plan: articles/things-to-think-about-when-choosing-a-plan.pdf articles/things-to-think-about-when-choosing-a-plan.pdf

Resources Information About the Health Care Law and Health Insurance Marketplace   How the health care law is making a difference for the people of Pennsylvania:  Articles about the Health Insurance Marketplace; Using the Marketplace; Getting Lower Costs on Coverage; Young Adults; Rights, Protections, and the Law; Prevention; and more:  Videos about the Health Insurance Marketplace:

 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. 

 Thank you  Navigator Toll Free Number   Presenter Contact Information