Affordable Care Act Community Forum September 2013

Affordable Care Act Community ForumSeptember 2013

David Evans Chief Executive Officer

Welcome

Affordable Care Act (ACA) Marketplace 101

Agenda

www.CentralHealth.net 4

• Introduction to the ACA and the Health Insurance Marketplace

• Eligibility• Application Process• Coverage• Affordability• Responsibility for Coverage• Key Points to Remember• Local Resources

What is the ACA?


The Patient Protection and Affordable Care Act,

More commonly known as:

The Affordable Care Act (ACA) is the national health reform law passed by Congress and signed by

the President in March 2010.

What is the goal of the ACA?


Increase the rate of healthcare coverage for Americans while addressing overall healthcare costs.•Establishing consumer rights and protections•Increasing insurance options•Providing assistance for healthcare costs

What is the Health InsuranceMarketplace?


Also known as the “Exchange”, the Health Insurance Marketplace is a new way to purchase health insurance.

The “Marketplace” will provide a way for consumers to:

• Look for and compare health plan options• Complete one application for multiple plans• Determine eligibility for tax credits & cost sharing

subsidies• Enroll in health insurance plan

Who Manages the Marketplace?


Each State can choose to:• Create and manage their own marketplace• Partner with the federal government to manage

their marketplace jointly• Have the federal government manage the

marketplace for their State

Who is Eligible to Participate?


• Individuals and Small Businesses with up to 100 employees can purchase health insurance through the Marketplace.

Eligibility requirements:• Must live in the U.S.; within service area• Must be a U.S. citizen or national, or• Be lawfully present in U.S.• Cannot be currently incarcerated

Application Process


One streamlined process to determine potential eligibility for: • Medicaid • Children's Health Insurance Program (CHIP)• Private health insurance offered by Qualified Health Plans

(possible tax credits and cost sharing subsidies)

Can apply:• On-line• Phone• Mail• In person -receive personal assistance

Qualified Health Plans


• Private insurance companies certified by the Marketplace in each respective State, who:• Have adequate provider networks• Provide Essential Health Benefits • Offer at least one plan at the “Silver” level and

one plan at the “Gold” level • Agree to charge the same premium rates

whether offered through the Marketplace or outside of the Marketplace

Coverage: Essential Health Benefits


Qualified Health Plans participating in the Marketplace will be required to offer benefits that meet a minimum set of standards called Essential Health Benefits.

•Ambulatory services•Emergency services •Hospitalization•Maternity and newborn care•Mental health and substance use disorder services, including behavioral health treatment•Prescription drugs•Rehabilitative and habilitative services and devices•Laboratory services•Preventive and wellness services and chronic disease management•Pediatric services, including oral and vision care

Coverage: Plan Levels


Levels of Coverage Plan Pays on Average

Consumer Pays on Average*

(In addition to the monthly premium)

Bronze 60% 40%

Silver 70% 30%

Gold 80% 20%

Platinum 90% 10%

*Based on average cost of an individual under the plan – may not be the same for every enrolled person.

Coverage: Catastrophic Plans


Who is Eligible?• Young adults under age 30• Those who cannot afford coverage and obtain a

hardship waiver from the Marketplace

What is Catastrophic Coverage?• Plans with high deductibles and low premiums• Includes coverage of 3 primary care visits and

preventive services at no cost• Protects consumers from high out-of-pocket costs

Coverage: Enrollment


• Initial Enrollment Period (1st year only): October 1, 2013 – March 31, 2014

• Beginning October 2014 - Annual Enrollment Period October 15th – December 7th

If you enroll: Your coverage will begin:

October 1 – December 15 January 1, 2014

December 16 – January 15 February 1, 2014

January 16 – February 15 March 1, 2014

February 16 – March 15 April 1, 2014

March 16 – March 31 May 1, 2014

Examples of Qualifying Events

Birth/Death Loss of Minimum Essential Coverage

Adoption Gain of a dependent or becoming a dependent through marriage

Legal separation or divorce Error in enrollment

Becoming a U.S. citizen, national, or lawfully present individual

Financial change impacting eligibility for tax credit

Move out of service area Exceptional circumstances such as a natural disaster

Coverage: Qualifying Events


• Certain qualifying events will allow individuals to enroll during the year

Affordability: Advanced Premium Tax Credits


• Advanced Premium Tax Credit is a new kind of tax credit that can be used to lower monthly health plan premiums

• Through the Marketplace individuals can apply for advance payment of this tax credit

• Advance payments will be sent directly to the insurance company and applied towards monthly premiums



• Monthly amounts owed by individuals can be reduced

Example:• Monthly premium: $300• Advance payment: $240 a month• Monthly amount owed by individual: $60


• The Marketplace will estimate the amount of advance payments based on projected income

• Report income changes immediately to avoid overpayments

• Advance payments will be reconciled at tax time against the actual Premium Tax Credit amount individuals are eligible for based upon actual income



• Option to pay total monthly premiums and claim tax credit on income tax return

Example:• Monthly premium: $300• Projected advance payment: $240 month• Individual can choose to pay: $300

monthly and receive $2,880 refund ($240 x 12); instead of advance payments




Who is Eligible?•Individuals/Families with household incomes between 100-400% of Federal Poverty Level (FPL) who do not have access to public health benefits or affordable employer coverage. •Affordable employer coverage exists as long as the lowest cost "individual" plan offered by an employer does not exceed 9.5 % of the employee's household income

Affordability: Cost-Sharing Subsidies


Cost Sharing Subsidies•A provision of the ACA requires that individuals with lower income levels have their cost sharing amounts reduced •Health plans will be responsible to pay a greater share of the covered benefits for qualifying individuals

Who is Eligible?• Individuals/Families with household incomes

between 100 - 250% of FPL • Who enroll in a Silver-Level plan

Affordability: Cost-Sharing Subsidies

• Qualifying subsidies will be automatically reflected in individual cost sharing amounts

Example:(Silver Plan)

• Co-pays for households at 250% FPL may be $10 for Dr. Visit, $7 for prescriptions

• Co-pays for households at 100% FPL may be $5 for Dr. Visit, $3 for prescriptions


Responsibility for Coverage


• A provision of the ACA requires that all individuals have health insurance beginning in 2014.

• Exceptions may be given for: • Financial hardships • Religious objections• Qualifying Indian tribes • Those for whom the lowest cost health plan exceeds 8% of their

household income • Those whose income is below the tax filing threshold

• Those who do not qualify for an exception and do not have qualifying coverage will be required to pay an annual financial penalty.

Responsibility for Coverage: Penalties


Penalty amounts will be phased in and will gradually increase from 2014 to 2016

Key Points to Remember


There will be multiple options for health care coverage –•Public Programs – Medicare, Medicaid, CHIP•Health insurance plans offered thru Employers•Health insurance plans offered outside of the Marketplace•Health insurance plans offered by Qualified Health Plans through the Marketplace•Tax Credits and Cost-Sharing Subsidies available through the Marketplace

2013 Federal Poverty Guidelines


Persons in family/household

100% 250% 400%

1 $11,490 $28,725 $45,960

2 $15,510 $38,775 $62,040

3 $19,530 $48,825 $78,120

4 $23,550 $58,875 $94,200

5 $27,570 $68,925 $110,280

6 $31,590 $78,975 $126,360

7 $35,610 $89,025 $142,440

8 $39,630 $99,075 $158,520

For family units of more than 8 members, add $4,020 for each additional member Sources: medicaid.gov and FamiliesUSA


Application Assistance Available to General Public Travis County

Organization Address City Zip Code1 CommUnityCare – North Central 1210 W. Braker Lane Austin 78758

2 CommUnityCare – Pflugerville 15822 Foothill Farms Loop Pflugerville 78660

3 CommUnityCare – Rundberg 825 E. Rundberg, Suite B1 Austin 78753

4 CommUnityCare – UT Family Wellness 2901 N. IH-35, Suite 101 Austin 78722

5 CommUnityCare – Hancock 1000 E. 41st Street, Suite 925 Austin 78751

6 CommUnityCare – Manor 600 W. Carrie-Manor Street Manor 78653

7 CommUnityCare – East Austin 211 Comal Street Austin 78702

8 CommUnityCare – Rosewood-Zaragosa 2802 Webberville Road Austin 78702

9 CommUnityCare – South Austin 2529 S. 1st Street Austin 78704

10 CommUnityCare – UT Children’s Wellness 5301 Ross Road, Suite H Del Valle 78617

11 CommUnityCare – Oak Hill 8656-A Hwy 71 West, Suite C Austin 78735

12 CommUnityCare – William Cannon 6801 S. IH-35, Suite 1-E Austin 78744

13 LoneStar Circle of Care – Seton Northwest 11111 Research Blvd., Suite 230 Austin 78759

14 LoneStar Circle of Care – Ben White 1221 W. Ben White Blvd. Suite B200 Austin 78704

15 Foundation Communities – North Highland Mall – 6001 Airport Blvd Austin 78752

16 Foundation Communities – Southwest 2600 W. Stassney Lane Austin 78745

CommUnityCare – 512.978.9015 ▪ LoneStar Circle of Care – 1.877.800.5722 ▪ Foundation Communities – 2-1-1


Application Assistance to Existing Client Base

Central Health Eligibility Services Seton Community Clinics Austin Travis County Integral Care

(ATCIC) People’s Community Clinic


Education and Referrals for Existing Client Base

Child Inc./HeadStart Program Easter Seals Project Access WIC Program SIMS & HAAM Foundations


Additional Services

Central Health has committed to fund additional outreach & education efforts

These efforts will: Compliment services provided by Enroll America Coordinated culturally competent, community

based approach Data driven activities, directed at targeted

populations and underserved areas of county Allow for assistance in non-traditional settings

such as schools, community events or even personal residents


Additional Services

Central resource for local information & referrals

United Way for Greater Austin Manages the local 2-1-1 Center 10 County Central Texas region Central Health Healthcare

Navigation Center


United Way 2-1-1 Center


Summary

www.CentralHealth.netwww.CentralHealth.net

Questions?Questions?Questions?Questions?

Enrollment and Outreach for Integral Care

ACA and Integral Care• Champion for Coverage and Certified

Application Counselor Organization– Training staff and volunteers to assist with enrollment

• Consumer Benefits Office will enroll eligible people using Integral Care services

• Additional Open Enrollment for the public– 1631 East 2nd Street

– 1702 South Lamar, Large Training Rm

– 5225 North Lamar Professional Building

– Dove Springs

Enrollment Information for People Currently Using Services• Approximately 1,200 People are Eligible

• Provide Technical Assistance

• Begin October 1st – March 31st

• Currently Recruiting Volunteers for Enrollment Assistance for the Public (Limited Space)

• Offering Extended Hours

Additional Outreach Efforts • Working with partner organizations for referrals

to enrollment sites

• Traditional marketing and social media activities

• Online information and resources

• Participation in fairs and community events:– Binational Health Week fair

– Community Connections Health Fairs

Mental Health & Substance Use Parity• Parity means insurance companies can not

discriminate against mental health and substance use treatment in coverage decisions

• ACA designates mental health coverage as an essential health benefit

• All plans offered in the Marketplace must offer coverage and you cannot be denied due to a preexisting condition

Prevention, Wellness & Chronic Disease Management• Essential Health Benefit

• Profound disparity in life expectancy for persons with serious mental illness:– Persons with a serious mental illness are more than

twice as likely to smoke cigarettes

– People with major depressive disorder are at higher risk for cardiovascular disease and stroke

• Includes smoking cessation and other programs to help people get and stay healthy

Questions?

Q & A Session

David Evans Chief Executive Officer

Closing Remarks

Documents

Affordable Care Act Community Forum September 2013