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What does it mean for our families and communities?

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Presentation on theme: "What does it mean for our families and communities?"— Presentation transcript:

1 What does it mean for our families and communities?

2  Review of Affordable Care Act (ACA)  Private insurance reforms and the Marketplace  ACA and immigrants/refugees

3  Everyone needs to have insurance by March 31, 2014 with some exceptions  If you have insurance through your employer that is affordable, you don’t have to do anything  If you have private insurance that complies with the base requirements, you don’t have to do anything  If you are on public insurance (Medicare, Medicaid), you don’t have to do anything and your coverage will be getting better

4  October 1, 2013 ◦ “Get Covered Illinois” opens to buy health care insurance  December 15, 2013 ◦ Last day to sign up for insurance to have a January 1, 2014 effective date  January 1, 2014 ◦ New health insurance coverage purchased on “Get Covered Illinois” begins  March 31, 2014 ◦ Last day to sign up for health care insurance for 2014

5 Changes today:  Costs  Preexisting condition  Lifetime limit  Underinsured  Women Currently and after 2014:  Insurance companies will cover some of the costs  Preexisting conditions  Preventive care services  Women  Medicare patients  Children under the age of 26  Small businesses  Lifetime limits  High-risk pool  Medicaid  Tax credits

6  Dependent Coverage up to age 26  Consumer protections/transparency  No pre-existing condition exclusion for children  No lifetime limits  Health plans cannot drop people when they get sick  Insurers are required to spend 80-85% of premium dollars on patient care (and refund consumers when they spend less!)  Preventative Services – no co-pay for many services in private insurance & Medicare  Small business tax credits  Increased primary care rates for Medicaid providers in 2013-2014  Closing of Medicare Part D “donut hole” (entirely by 2020)

7  State or federal “Health Insurance Marketplace” – new marketplaces with Essential Health Benefits package (Enrollment begins Oct. 1, 2013)  Large Medicaid Expansion to Adults up to 138% FPL  No pre-existing condition exclusion  Consumer protections – no annual limits, no rating by health status or gender only by age, location & smoker/non-smoker  Shared Responsibility Provisions  Individual Mandate  Employer Mandate (for orgs with 50+ FTEs) – postponed until 2015

8  All non-grandfathered health plans in individual & small group market must cover these essential benefits at a minimum  Illinois has chosen BCBS Blue Advantage as the Benchmark Plan supplemented by AllKids for dental and Federal VIP for vision for children. Illinois is currently developing their Medicaid Expansion Benchmark – most likely similar to FamilyCare.  Ambulatory patient services;  Emergency services;  Hospitalization;  Maternity and newborn care;  Mental health and substance use disorder services;  Prescription drugs;  Rehabilitative and habilitative services and devices;  Laboratory services;  Preventive and wellness services including chronic disease management;  Pediatric services including oral and vision care.

9  User friendly format to understand terms, compare benefits & services across plans  Enables you to: ◦ Enroll in Medicaid and possibly other public benefits ◦ Find out if you’re eligible for financial assistance that make coverage more affordable  Health plans required to have enough doctors, perform well on quality measures  Will keep health insurance low


11  Blue Cross & Blue Shield of Illinois  Humana, Inc.  Aetna Inc.  Land of Lincoln Health Inc. Co-Op  Coventry Health Care Inc.  Carle Foundation  These 6 Insurance companies will be selling over 150 plans in the Marketplace. www.icirr.org11

12 Requires most individuals (including children) to carry “minimum essential” health coverage Many exemptions: Religious reasons Undocumented non citizen Household income is below the minimum threshold for filing a tax return (Go to Return%3F for tax assistant) Return%3F Unaffordable coverage (insurance premiums exceed 8% of family income) Payment, exemption or penalty is through the federal income tax return:

13 Current Program New Category Why it is good for Illinois?

14  On top of the traditional Federal program, Illinois has three programs for families and children

15  In 2014: ◦ U.S. Citizens, Lawfully Residing Immigrants and LPRs with five years in U.S., ages 19-64 with incomes up to 133% FPL ($14,856 individual) ◦ Enrollment is via Get Covered Illinois or through ABE (Application for Benefits Eligibility – ◦ Also able to apply for SNAP and cash benefits at same time

16  What?  A new Medicaid program  Who?  Lives in Cook County.  Be 19-64 years old  Have income at or below 133% of the FPL ($14,856 individual;$20,123 couple-annually)  Not be eligible for “State Plan” Medicaid (Parent, Pregnant, Blind or receiving disability income)  Not be eligible for Medicare  Be a legal immigrant for 5 years or more OR be a US citizen  Have a SS# or have applied for one

17 Naturalized Citizens Legally present immigrants Undocumented


19      programs_AffordableCareActTipSheets.html    

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