Presentation on theme: "What is the Affordable Care Act? The Patient Protection and Affordable Care Act (PPACA),commonly called the Affordable Care Act (ACA) or Obamacare,is."— Presentation transcript:
What is the Affordable Care Act? The Patient Protection and Affordable Care Act (PPACA),commonly called the Affordable Care Act (ACA) or Obamacare,is a United States federal statute signed into law by President Barack Obama on March 23, 2010. The ACA aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of healthcare for individuals and the government.
The Affordable Care Act increases access to health coverage for consumers through: Access to certain free preventative services Health coverage for pre-existing conditions Access to health coverage through the Marketplace Health coverage for young adults up to age 26 on their parents’ health plan
The Affordable Care Act protects consumers by changing requirements for health insurance companies. Health insurance companies must: Help consumers understand their coverage Summary of Benefits Glossary of Terms Refrain from canceling health coverage after they’ve already agreed to cover consumers (continued)
Health insurance companies must: (continued) Offer certified health plans –Qualified Health Plans (QHPs) Offer a guaranteed set of benefits –Essential Health Benefits (EHBs) Prohibit lifetime limits on coverage Adhere to deductible and out-of-pocket limits
Medicaid Expansion Medicaid provides health coverage for some low- income people, families and children, pregnant women, the elderly, and people with disabilities. Medicaid programs must follow federal guidelines, but they vary somewhat from state to state. The Affordable Care Act gives states the option to expand Medicaid, the health coverage program for some groups of low- income consumers. Georgia has not chosen to expand its Medicaid program at this time. T
Medicaid Expansion Consumers between the ages of 19 and 65 who have incomes up to 138% of the federal poverty level (FPL) may now qualify for Medicaid. Even though Georgia did not participate consumers may still be eligible for subsidies to help lower their costs through the marketplace.
What is the Health Insurance Marketplace? The Health Insurance Marketplace or “Exchange” is an online system that provides consumers with an easy way to shop for health coverage shows if applicants are eligible for programs to help lower their cost using a single, streamlined application allows for apples to apples comparison for qualified health plans (QHPs)
Enrollment and Coverage Dates Open enrollment for health coverage through the Marketplace begins October 1, 2013 and ends March 31, 2014. Coverage will begin on January 1, 2014, for consumers who enroll before December 15, 2013, and make their first premium payment.
Types of Marketplaces Georgia is a federally-facilitated marketplace (FFM). The federal government is operating a marketplace in Georgia.
Individual Marketplace Individuals and families SHOP Marketplace Small business owners and their employees There are two ways to access the Marketplace:
Coverage Options Health plans in the Marketplace are separated into four health plan categories: Bronze Silver Gold Platinum Health plan categories are based on the plans actuarial value (AV). AV is the percentage of total average cost for covered benefits that a plan will cover.
Coverage Options (continued) Bronze – 60% actuarial value (AV) – the Qualified Health Plan (QHP) issuer pays, on average, 60% of the cost of Essential Health Benefits (EHB) coverage. Silver – 70% actuarial value (AV) – the QHP issuer pays, on average, 70% of cost of EHB coverage. ** Health plan categories do not reflect the quality or amount of care the plans provide. 60% 70% 80% 90% Lower monthly premium Higher monthly premium Higher out of pocket Lower out of pocket
Coverage Options (continued) Gold – 80% actuarial value (AV) – the QHP issuer pays, approx., 80% of the cost of EHB coverage Platinum – 90% actuarial value (AV) - the QHP issuer pays, on average, 90% of the EHB coverage ** Health plan categories do not reflect the quality or amount of care the plans provide. 60% 70% 80% 90% Lower monthly premium Higher monthly premium Higher out of pocket Lower out of pocket
When consumers get health coverage through the Marketplace, depending on income and family size, they may be able to save money. Types of cost savings include: Advanced Premium Tax Credits Cost-Sharing Reduction Medicaid PeachCare for Kids
Advanced Premium Tax Credits Some consumers may be able to lower the cost of their monthly premiums through advanced premium tax credits. To qualify, consumers must apply and enroll in coverage through the Marketplace. If they meet income requirements, consumers will immediately see the amount of savings for which their eligible reflected in the premium cost shown for available QHPs. Consumers must reconcile tax credit payments on their federal income tax returns.
Who is Eligible for Premium Tax Credits The amount the consumers’ eligible to save through premium tax credit depends on the consumer’s income and family size. The lower consumer’s income, the higher his or her savings will be. Premium tax credits are available to consumers who make between 100% -400% FPL, which is: $11,490 to $45,960 for individuals $15,510 to $62,040 for a family of two $23,550 to $94,200 for a family four
Cost-Sharing Reductions Cost-sharing reductions lower how much consumers pay for deductibles, copayments, and coinsurance. To be eligible for cost-sharing reductions, a consumer must: Apply and enroll in health coverage through the Marketplace Have a household income less than or equal to 250% FPL Receive the premium tax credit Enroll in at least a silver level plan through the Marketplace – a plan that pays 70% of the average overall cost of providing essential health benefits to members
For 2014, the SHOP Marketplace is open to employers with 50 or fewer full-time-equivalent employees (FTEs). For employers, the advantages of using SHOP include: Controlling the coverage they want to offer and how much they pay toward employee premiums. Comparing health plans online on an apples-to-apples basis. Possibly Qualifying for a small business health care tax credit worth up to 50% of premium costs. Beginning 2014 the tax credit is available only for plans purchased through SHOP.
SHOP Eligibility A small business owner has to attest that the business: is located in a SHOP Marketplace’s service area (generally a state) offers health coverage to all full-time employees (FTEs), or those working an average of 30 or more hours per week has at least one eligible employee on their payroll has 50 or fewer FTE employees on their payroll in 2014 has at least 70% full-time employees enrolling in the SHOP Marketplace plan (may vary by state)