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Understanding The Affordable Care Act (ACA) Time to learn your…

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1 Understanding The Affordable Care Act (ACA) Time to learn your…

2 The Benefit Bank of South Carolina OUR MISSION Provide training and access to innovative tools and resources that give people the opportunity to improve their financial, health and household stability.

3 We Connect People to What They Need Medicaid/CHIPLISSNAPTANFState taxesFederal taxesFAFSASelf-serveLifelineVoter registration 1.800.726.8774

4 Quick, easy, confidential & safe Electronic submission of applications Quick Check: eligibility calculator Quickly screen clients to see their potential eligibly for all programs TBB-SC offers, eligibility for tax credits or cost sharing. After one interview, several applications for several agencies are completed and eFiled with appropriate agency. Medicaid will transfer ineligible applicants to The Marketplace for processing. System has ‘two key lock’ entry. Information is saved for future use. TBB-SC Application Process

5 Affordable Care Act Healthcare Act Healthcare Reform Obamacare Patient Protection/ ACA Health Reform Law Marketplace Coverage Healthcare law Federal Healthcare Law

6 Basic ACA Provisions The Health Insurance Marketplace Minimum Essential Coverage for Individuals Coverage for Young Adults Preventive Health Services Coverage for Pre-Existing Conditions

7 The Marketplace –

8 TBB-SC Sites Navigators Certified Application Counselors Agents and Brokers Enrollment Assistance

9 October 1, 2013: Marketplace open enrollment starts January 1, 2014: Health coverage can start March 31, 2014: Open enrollment ends To enroll in the Marketplace you must: live in the service area be a US Citizen or lawfully present not be incarcerated Open Enrollment

10 Minimum Essential Coverage Any Marketplace plan or individual insurance plan you already have Any employer plan Medicaid or Medicare TRICARE Peace Corps Volunteer plan Certain other plans

11 2014 $95 per adult and $47.50 per child or 1% of annual income, whichever is greater 2015 $325 per adult or $162.50 per child or 2% of annual income, whichever is greater 2016 $695 per adult or $347.50 per child or 2.5% of annual income, whichever is greater The Penalty

12 Exemptions Granted by the Marketplace Hardship, including lack of coverage based on projected income Membership in a health care sharing ministry Incarceration Member of a Federally Recognized Tribal Member Membership in a recognized sect that objects to health coverage When the penalty does NOT apply.

13 Exemptions Granted by IRS on a Federal Income Tax Return Lack of coverage based on actual income Income below the federal income tax filing threshold Unlawful presence in the US Lack of insurance coverage for less than 3 consecutive months between months of coverage Hardships Incarceration Membership in a health care sharing ministry Membership in a federally recognized tribe When the penalty does NOT apply.

14 An insurance plan that is certified by the Health Insurance Marketplace Follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts) Meets other requirements of qualified coverage. Qualified Health Plan

15 High deductibles and lower premiums 3 primary care visits and preventive services at no extra cost Protection from high out-of-pocket costs Catastrophic Plans

16 Small businesses with 50 or fewer employees. Employers must offer coverage to all full time employees. This gives them buying power for affordable coverage. Small Business Health Options Program (SHOP)

17 Platinum Covers 90% cost of care Gold Covers 80% cost of care Silver Covers 70% cost of care Bronze Covers 60% cost of care All plans have a premium The higher the premium the lower the out of pocket costs. Qualified Health Plan Levels of Coverage

18 Sometimes called Subsidy or Advance Premium Tax Credit or Premium Tax Credit. Based on family income and size and not eligible for Medicaid Family of 4 with annual income between 100%FPL ($23,550) and 400%FPL $94,200) Individual with annual income between 100%FPL ($11,490) and 400%FPL $45,960) Lower Monthly Premiums

19 Lower out-of-pocket costs: Deductible Coinsurance Copay Family of 4 with annual income at or below 250%FPL ($58,875) Individual with annual income at or below 250%FPL ($28,725) Costs Savings

20 A streamlined and simplified application process  Automated data-matching and real-time eligibility determinations  Streamlined verification process Creation of a new income eligibility rules for certain groups effective January 1, 2014. Streamlined renewal process after January 1, 2014. Changes to SC Medicaid

21 New income methodology Mirrors Federal tax filing income rules Applied to certain Medicaid groups Modified Adjusted Gross Income (MAGI)

22 1.First do a Quick Check 2.Submit applications 3.If not eligible for Medicaid or ACA cost savings, refer to a local FQHC or free clinic. 4.If not eligible for Medicaid but eligible for ACA cost savings  Refer to if comfortable with a  Go to to identify local 800-318-2596  Refer to ACA Call Center 800-318-2596 Assisting the Uninsured

23 Counselor Training (Benefits & Taxes) Medicaid Computer Security Computer 101 Financial Wellness Affordable Care Act (ACA) Charity Tracker Mental Health First Aid 1.800.726.8774 TBB-SC Provides Training

24 Questions? 107 Saluda Pointe Drive Lexington, SC 29072 800.726.8774 803.454.3860 (f)

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