Understanding the Health Insurance Marketplace Find health care
options that meet your needs and fit your budget Find health care
options that meet your needs and fit your budget. July 2014 Slide 2
1.Health Insurance Marketplace (Marketplace) 2.Eligibility and
enrollment 3.Ways to lower costs Monthly premiums Out-of-pocket
costs 4.Medicaid and the Childrens Health Insurance Program (CHIP)
5.Assistance with applying and enrolling 6.Key points Session
Topics July 2014Understanding the Marketplace2 Slide 3 Part of the
Affordable Care Act Where qualified individuals and families
directly compare private health insurance options Known as
qualified health plans (QHPs) Can directly compare on the basis of
price, benefits, quality, and other factors Small Business Health
Options Program (SHOP) Marketplace for small employers Provides
coverage for their employees The Health Insurance Marketplace July
2014Understanding the Marketplace3 Slide 4 Consumers saved nearly
$1.2 billion on their premiums Nearly 7 in 10 are paying $100 a
month or less for coverage The average monthly premium dropped from
$346 before tax credits to $82 after tax credits across all plans
An average of $69 per month after tax credits for Silver plans (the
most popular plan type) with a choice of 5 health insurers and 47
plans 266 insurers in the Marketplace by state, offering over
19,000 Marketplace plans across all rating areas Report on
Affordability, Competition and Choice July 2014Understanding the
Marketplace4 Slide 5 It uses one process to determine eligibility
for Qualified health plans through the Marketplace Premium tax
credits to lower monthly premiums Reduced cost sharing Medicaid
Childrens Health Insurance Program (CHIP) It offers choice of plans
and levels of coverage Insurance companies compete for business How
the Marketplace Works July 2014Understanding the Marketplace5 Slide
6 A qualified health plan Is offered through the Marketplace by an
issuer that is licensed by the state and in good standing Covers
essential health benefits Is offered by an issuer that offers at
least one plan at the Silver and one at the Gold plan category of
cost sharing Charges same premium whether offered through the
Marketplace or outside the Marketplace Qualified Health Plans July
2014Understanding the Marketplace6 Slide 7 Qualified Health Plans
Cover Essential Health Benefits July 2014Understanding the
Marketplace 7 9.Preventive and wellness services and chronic
disease management 10.Pediatric services, including oral (dental)
and vision care (pediatric oral (dental) services may be provided
by stand-alone plan) 1.Ambulatory patient services 2.Emergency
services 3.Hospitalization 4.Maternity and newborn care 5.Mental
health and substance use disorder services, including behavioral
health treatment 6.Prescription drugs 7.Rehabilitative and
habilitative services and devices 8.Laboratory services Essential
health benefits include at least these 10 categories Slide 8 Health
Plan Categories July 2014Understanding the Marketplace8 Highest
Premiums Lowest Out-of-Pocket Costs Lowest Premiums Highest
Out-of-Pocket Costs Percent of Total Cost of Care Covered
60%70%80%90% Slide 9 9 What is catastrophic coverage? Plans with
high deductibles and lower premiums You pay all medical costs up to
a certain amount Includes 3 primary care visits per year and
preventive services with no out-of-pocket costs Protects you from
high out-of-pocket costs Who is eligible? Young adults under 30
Those who qualify for a hardship exemption Those whose plan was
cancelled and believe Marketplace plans are unaffordable
Catastrophic Health Plans July 2014Understanding the Marketplace
Slide 10 1. Have minimum essential coverage Theyre already covered
and dont need to do anything. 2. Have an exemption from the shared
responsibility payment (fee) They dont have to get coverage and
wont have to pay a fee for not having coverage. 3.Pay a fee (shared
responsibility payment) They should consider getting coverage. If
they dont, theyll pay a fee. 10 OR Starting in 2014, Everyone Must:
July 2014Understanding the Marketplace Slide 11 11 About 85% of
Americans already have minimum essential coverage. If you have
coverage from any of the following, youre covered and dont have to
do anything related to the Marketplace Employer-sponsored coverage,
including COBRA and retiree Medicare Part A (including Medicare
Advantage Plans) Medicaid Childrens Health Insurance Program (CHIP)
Marketplace coverage Individual coverage (outside the Marketplace)
TRICARE or certain types of VA coverage 1. Minimum Essential
Coverage July 2014Understanding the Marketplace Slide 12 12 You may
qualify for an exemption if Youre uninsured for less than 3 months
of the year The lowest-priced coverage available to you would cost
more than 8% of your household income You dont have to file a tax
return Youre a member of a federally recognized tribe or an Alaska
Native Claims Settlement Act (ANCSA) shareholder, or an individual
eligible for services through an Indian health care provider Youre
a member of a recognized health care sharing ministry Youre a
member of a recognized religious sect with religious objections to
health insurance Youre incarcerated (unless pending disposition of
charges) Youre not lawfully present in the U.S. 2. Exemption from
the fee July 2014 Understanding the Marketplace Slide 13 13 You may
qualify if you have a circumstance that affects your ability to
purchase health coverage You were homeless You were evicted in the
past 6 months or were facing eviction or foreclosure You received a
shut-off notice from a utility company You recently experienced
domestic violence You recently experienced the death of a close
family member You experienced a fire, flood, or other natural or
human- caused disaster that caused substantial damage to your
property You filed for bankruptcy in the last 6 months Hardship
Exemptions July 2014Understanding the Marketplace Slide 14 14 You
had medical expenses you couldnt pay in the last 24 months which
resulted in substantial debt You experienced unexpected increases
in necessary expenses due to caring for an ill, disabled, or aging
family member You expect to claim a child as a tax dependent whos
been denied coverage in Medicaid and CHIP, and another person is
required by court order to give medical support to the child As a
result of an eligibility appeals decision, youre eligible for
enrollment in a qualified health plan (QHP) through the
Marketplace, lower costs on your monthly premiums, or cost- sharing
reductions for a time period when you werent enrolled in a QHP
through the Marketplace Hardship Exemptions Continued July
2014Understanding the Marketplace Slide 15 15 You were determined
ineligible for Medicaid because your state didnt expand eligibility
for Medicaid Your individual insurance plan was cancelled and you
believe other Marketplace plans are unaffordable You experienced
another hardship in getting health insurance Hardship Exemptions
Cont. July 2014Understanding the Marketplace Slide 16 16 Less than
2% of Americans are expected to have to pay the fee. You may pay a
fee when you file your 2014 Federal tax return in 2015 (and
thereafter) If you dont have minimum essential coverage, and You
dont qualify for an exemption Paying the fee doesnt provide health
coverage 3. You May Pay a Fee July 2014Understanding the
Marketplace Slide 17 Fee Calculation 17 July 2014 Understanding the
Marketplace *After 2016 - Plus an increase based on cost of living.
Penalty for noncompliance cant exceed the national average premium
for a bronze level Marketplace QHP (for the relevant family size).
The total family penalty is capped at 300% of the annual flat
dollar amount. In 2014, you pay the greater amount of 1% of your
annual household income or $95 per adult, and $47.50 per child
under 18 In 2015, you pay the greater amount of 2% of your annual
household income or $325 per adult, and $162.50 per child under 18
In 2016*, you pay the greater amount of 2.5% of your annual
household income or $695 per adult, and $347.50 per child under 18
Slide 18 In the following examples, we assume that the payment
amounts dont exceed the national average premium for Bronze
coverage for the individuals involved. These examples are used only
to represent the mechanics of calculating the payment and arent
estimates of current or future health insurance premium costs. For
information on the cost of bronze level plans, visit
HealthCare.gov.HealthCare.gov Fee Examples July 2014Understanding
the Marketplace18 Slide 19 Jims 2014 filing threshold is $10,150 To
determine his payment using the income formula, subtract $10,150
(filing threshold) from $40,000 (2014 household income). The result
is $29,850. One percent of $29,850 equals $298.50. Because $298.50
is greater than his $95 flat dollar amount (and is less than the
national average premium for bronze level coverage for 2014), Jims
shared responsibility payment for 2014 is $298.50, or $24.87 for
each month he is uninsured (1/12 of $298.50 equals $24.87). Fee
Example Jim Single Individual, $40K Income, No Dependents, No
Minimum Essential Coverage in 2014 July 2014Understanding the
Marketplace19 Slide 20 Eduardo and Julias 2014 filing threshold is
$20,300. To determine their payment using the income formula,
subtract $20,300 (filing threshold) from $70,000 (2014 household
income). The result is $49,700. One percent of $49,700 equals $497.
Eduardo and Julias flat dollar amount is $285, or $95 per adult and
$47.50 per child. The total of $285 is the flat dollar amount in
2014. Because $497 is greater than $285 (and is less than the
national average premium for bronze level coverage for 2014),
Eduardo and Julias shared responsibility payment is $497 for 2014,
or $41.41 per month for each month the family is uninsured (1/12 of
$497 equals $41.41). Fee Example Eduardo and Julia Married Couple
with Two Children Under 18, $70K Income, No Minimum Essential
Coverage in 2014 July 2014Understanding the Marketplace20 Slide 21
Part of the Health Insurance Marketplace Offers employers a choice
of health insurance plans and dental plans and tools for making
informed choices Offers qualified small employers access to the
enhanced Small Business Health Care Tax Creditnow worth up to 50%
of employers premium contributions Works with new insurance reforms
to spur competition based on price and quality What is the SHOP
Marketplace? (Small Business Health Options Program) July
2014Understanding the Marketplace21 Note: If you have fewer than 50
full-time-equivalent employees, youre not required to offer health
insurance, and theres no penalty if you choose not to. Slide 22
Small employers who Have 50 or fewer employees in 2014 Have at
least one common law employee Offer coverage to all of their
full-time employees In the Federally-facilitated SHOP this means
employees working on average 30 or more hours per week Can be
for-profit or tax-exempt Meet minimum participation rates In many
states using the Federally-facilitated SHOP Marketplace, at least
70% of full-time employees must accept your offer of insurance
Visit the SHOP FTE Calculator HealthCare.gov/fte-calculator Who Can
Purchase Federally-facilitated SHOP Coverage? 22 Slide 23 In 2014
The Federally-facilitated SHOP Marketplace offers employer choice
(employer chooses one plan to offer), but no employee choice
(employer chooses multiple plans for its employees to choose from)
option States running own SHOP can offer employee choice option --
many do In 2015 The SHOP in all states may offer small employers an
employee choice option How SHOP Works: Moving Toward Employee
Choice 23 Slide 24 Giving employers a choice of health plans
Providing access to tax credits for qualified small employers
Offering tools to help them make informed choices More features and
options coming for 2015 SHOP Helps Small Businesses 24 Slide 25 To
be eligible for Marketplace coverage, you must Live in its state,
or service area, and Be a U.S. citizen or national, or Be a
non-citizen who is lawfully present in the U.S. for the entire
period for which enrollment is sought Not be incarcerated except
when pending disposition of charges Anyone can apply for
Medicaid/CHIP at any time, even if incarcerated Eligibility and
Enrollment in the Individual Market July 2014Understanding the
Marketplace25 Slide 26 2015 Open Enrollment Period: November 15
February 15 Special enrollment periods are available in certain
circumstances during the year December 31, 2014: Coverage ends for
some Marketplace plans bought in 2014 (others may continue to
provide coverage) When You Can Enroll in the Individual Market July
2014Understanding the Marketplace26 If You Enroll Between theYour
Coverage Begins the 1st and 15th days of the monthFirst day of the
next month, but no earlier than January 1, 2015 16th and last day
of the monthFirst day of the second following month Slide 27
Special Enrollment Periods Qualifying Life Events July
2014Understanding the Marketplace27 Qualifying Life Events Marriage
or divorce Having a baby, adopting a child, or placing a child for
adoption or foster care Moving your residence, gaining citizenship,
leaving incarceration Losing other health coverage Change in income
or household status that affects eligibility for premium tax
credits or cost-sharing reductions for people enrolled in the
Marketplace Indian status as member of a federally recognized tribe
Slide 28 Special Enrollment Periods Complex Situations July
2014Understanding the Marketplace28 Complex Situations Related To
Applying Exceptional Circumstance Misinformation or
misrepresentation Unresolved casework Medicaid/Marketplace
transfers Errors (Enrollment errors, system errors related to
immigration status, display errors on HealthCare.gov, error
messages, or other system errors) Slide 29 Special Enrollment
Period Screener July 2014Understanding the Marketplace29 Slide 30
All 2014 Marketplace health plans will come up for renewal in 2015
Your insurance company will send you information this Fall about
updated premiums and benefits Review your plans 2015 changes to see
if it still meets your needs If you want to keep your current
plan-and your income or household size havent changed-the
Marketplace will auto- enroll you in the same plan for 2015 if its
available Renewal and Auto-Enrollment July 2014Understanding the
Marketplace30 Slide 31 Report changes to income or household size
to the Marketplace If you want to change plans, you can 1.Choose a
Marketplace health plan your company offers in your service area if
you want to stay with your current insurance company 2.Choose a new
health plan from another insurance company through the Marketplace
3.Buy a new private health plan outside of the Marketplace No
Marketplace premium tax credits/cost-sharing reductions Renewal and
Auto-Enrollment Continued 1 July 2014Understanding the
Marketplace31 Slide 32 If your current Marketplace plan isnt
offered in 2015, youll Be automatically enrolled in a similar plan
Unless you choose another plan and enroll Qualify for a Special
Enrollment Period that lets you enroll in an individual plan
outside the Open Enrollment Period Renewal and Auto-Enrollment
Continued 2 July 2014Understanding the Marketplace32 Slide 33 33
How the Marketplace Works July 2014Understanding the Marketplace
May apply or change plan during Special Enrollment Period due to
certain life changing events. Slide 34 July 2014Understanding the
Marketplace34 Enroll Medicaid/CHIP Enroll Medicaid/CHIP Premium tax
credit Cost-sharing reduction Enroll in Marketplace qualified
health plan Enroll in Marketplace qualified health plan Eligible
for qualified health plan, Medicaid, or CHIP Eligible for qualified
health plan, Medicaid, or CHIP Supported by Data Services Hub
Online By phone By mail In person Application and Eligibility Pay
first monthly premium NO YES Slide 35 Available electronically and
on paper in English and Spanish Federally-facilitated Marketplace
Application form Dynamic online version asks only relevant
questions based on your responses Streamlined paper version
State-based Marketplaces may have own version Help is available to
complete application The Coverage Application July
2014Understanding the Marketplace35 Slide 36 Apply and Shop for
Coverage July 2014Understanding the Marketplace36 You can also call
the Marketplace Call Center, which services Federally- facilitated
and State Partnership Marketplaces 1-800-318-2596 (TTY
1-855-889-4325) Slide 37 Get Help Paying for Coverage July
2014Understanding the Marketplace37 Slide 38 Eligibility Results
July 2014Understanding the Marketplace38 Slide 39 Enrolling in
Coverage July 2014Understanding the Marketplace39 Slide 40 You must
pay the first months premium by the insurers deadline Issuers must
accept at least these payment methods Paper check Cashiers check
Money order Electronic fund transfer (EFT) Pre-paid debit card Some
issuers may also accept online, credit card, or debit card payments
(check with the plan) Premium Payment July 2014Understanding the
Marketplace40 Slide 41 When your information doesnt match up with
existing records or you didnt provide enough information to match
existing records Most of the time its because you have more
up-to-date information than the data sources the Marketplace is
checking You have 90 days to submit additional documentation The
Marketplace will mail and/or email you a notice with a request for
additional information You have an extra 30 days from receipt of
the notice Data Matching Issues/Inconsistencies July
2014Understanding the Marketplace41 Slide 42 The Marketplace will
send a reminder if you havent responded Submit documents (your tax
credit or coverage could depend on it) The notice describes what
information the Marketplace needs from you, or find out by logging
in to your Marketplace account If you mail in documents, include
the barcode from the notice Resolving an Inconsistency July
2014Understanding the Marketplace42 Slide 43 You get to keep the
Marketplace coverage you currently have while the documents are
being reviewed If the Marketplace hasnt sent you a notice telling
you the result or status of your issue, were still processing your
information If the deadline listed on your notice for submitting
documents is very soon or has already passed, you should still
submit documents Resolving an Inconsistency July 2014Understanding
the Marketplace43 Slide 44 Decisions you can appeal Whether youre
eligible to buy a Marketplace plan Or buy a Marketplace
Catastrophic Plan Whether you can enroll outside of the regular
Open Enrollment Period Whether youre eligible for lower costs The
level of premium tax credits/cost-sharing reductions for which
youre eligible Whether youre eligible for Medicaid or CHIP Whether
youre eligible for an exemption Marketplace Appeals July
2014Understanding the Marketplace44 Slide 45 Two ways to appeal are
explained in your eligibility determination notice 1.Writing a
letter to the Marketplace 2.Completing and mailing an appeal
request form Available at
HealthCare.gov/can-i-appeal-a-marketplace-
decisionHealthCare.gov/can-i-appeal-a-marketplace- decision
Expedited appeals available in certain circumstances How to Appeal
July 2014Understanding the Marketplace45 Slide 46 Financial help is
available for eligible families and individuals, including Tax
credits that may be used to lower monthly premiums Refundable
premium tax credits Advance payment of premium tax credits Reduced
cost sharing to lower out-of-pocket spending for health care costs
Marketplace Affordability July 2014Understanding the Marketplace46
Slide 47 Eligibility is based on Household income and family size
Household income between 100% to 400% FPL o $23,850 $95,400 for a
family of four in 2014 for 2015 coverage Obtaining health insurance
through the Marketplace Must be ineligible for government-sponsored
coverage, affordable employer-sponsored insurance, or certain other
minimum essential coverage Lower Premium Costs July
2014Understanding the Marketplace47 Slide 48 Amount of the premium
tax credit depends on Actual household income as a percentage of
the federal poverty level (FPL) and family size Sliding scale that
increases your contribution toward the premium as income as
percentage of FPL increases The premium for the second lowest cost
Silver- level qualified health plan (QHP) adjusted for age May
apply premium tax credit to QHP in any health plan category (i.e.,
Bronze, Silver, Gold, or Platinum) How Much Is the Premium Tax
Credit? July 2014Understanding the Marketplace48 Slide 49 Choose to
Get It Now: Advance Payments of the Premium Tax Credit All or some
of the premium tax credit is paid directly to your plan on a
monthly basis You pay the difference between the monthly premium
and advance payment You reconcile when you file your tax return for
the coverage year* Choose to Get It Later Dont request any advance
payments You pay the entire monthly plan premium Claim the full
amount on the tax return you file for the coverage year Ways to Use
a Premium Tax Credit July 2014Understanding the Marketplace49 *You
should report all changes in the information you provided on your
application to avoid owing money after reconciliation on your tax
return. Slide 50 Lower costs on deductibles, copayments, and
coinsurance To be eligible, you must Have income at or below 250%
FPL $59,625 annually for a family of 4 in 2014 Receive the premium
tax credit Enroll in a Marketplace Silver-level plan Members of
federally recognized Indian tribes or ANSCA shareholders qualify
for cost-sharing reductions: When they enroll in any level metal
plan. If income is at or below 300% FPL, can enroll in a zero cost
sharing plan variation. If income is more than 300% FPL, can enroll
in a limited cost sharing plan variation. Cost-Sharing Reductions
July 2014Understanding the Marketplace50 Slide 51 The health care
law extends eligibility for coverage under Medicaid The law
simplifies eligibility for Medicaid and the Childrens Health
Insurance Program (CHIP) It coordinates coverage under Medicaid and
CHIP with new qualified health plan coverage available through the
Marketplace No wrong door if you apply through the Marketplace
Single application for affordability programs Medicaid and CHIP
July 2014Understanding the Marketplace51 Slide 52 Eligibility
process has been simplified Relies primarily on electronic data
Reduces need for paper documentation Apply on-line, by phone, by
mail, or in person State option for 12-month eligibility period for
Adults Parents Children Simplified process for renewing coverage
Simplifying Medicaid and CHIP July 2014Understanding the
Marketplace52 Slide 53 July 2014Understanding the Marketplace53
Medicaid Expansion in 2014 26 States + D.C. Medicaid Expansion in
2014 26 States + D.C. DC DE Expanding Medicaid in 2014 Not yet
expanding Medicaid Slide 54 If youre eligible for Medicaid, you
arent eligible for premium tax credits or Marketplace cost-sharing
reductions If you live in a state that is NOT expanding Medicaid If
your income is more than 100% FPL, you may be eligible for a
premium tax credit (about $23,850 for a family of 4 in in 2014) If
your income is less than 100% FPL, you arent eligible for a premium
tax credit May be eligible for Medicaid under states existing rules
Can get hardship exemption and wont have to pay a fee for not
obtaining health coverage Medicaid and the Marketplace July
2014Understanding the Marketplace54 Slide 55 Help is available in
the Marketplace Marketplace Call Center SHOP Call Center for
employers Navigators Non-Navigator assistance personnel Certified
application counselors Issuer application assisters Enrollment
assistance contractors Agents and brokers Champions for Coverage
Enrollment Assistance July 2014Understanding the Marketplace55
Slide 56 Services consumers in Federally-facilitated and State
Partnership Marketplaces 1-800-318-2596 (TTY 1-855-889-4325)
Customer service representatives available 24/7 Help with
eligibility, enrollment, and referrals Assistance in English and
Spanish Language line for 240+ additional languages State-based
Marketplaces have own call centers Marketplace Call Center July
2014Understanding the Marketplace56 Slide 57 For questions about
SHOP for small employers with 50 or fewer employees 1-800-706-7893
(TTY 711) Customer service representatives available Monday Friday
from 9 a.m. to 7 p.m. EST Starting November 15, 2014, small
business employees with SHOP questions can also call the SHOP Call
Center SHOP Call Center July 2014Understanding the Marketplace57
Slide 58 Grant program administered by each Marketplace Anticipate
grants to be awarded September 8, 2014 Each Navigator must Maintain
expertise in eligibility, enrollment, and program specifications
and conduct public education activities Distribute fair, accurate,
and impartial information about enrollment in qualified health
plans (QHPs) and other health programs such as Medicaid and CHIP
Facilitate selection of a QHP and refer consumers to certain other
programs Provide information that is culturally and linguistically
appropriate and accessible for people with disabilities and/or
limited English proficiency Navigator Program July
2014Understanding the Marketplace58 Slide 59 Navigators must be
trained and certified Initial web-based training Required on-going
training Annual recertification Must not accept direct or indirect
compensation from issuers related to enrollment in qualified health
plans (QHPs) or non-QHPs Must meet reporting requirements Navigator
Program Continued for Federally-facilitated and State Partnership
Marketplaces July 2014Understanding the Marketplace59 Slide 60
Every Marketplace must have certified application counselors who
perform many of the same functions as Navigators and non-Navigator
assistance personnel Educating consumers Helping consumers complete
applications for coverage CMS designates organizations to certify
application counselors for Federally-facilitated and State
Partnership Marketplaces State-based Marketplaces may designate
organizations or certify individuals directly Certified Application
Counselors (CAC) July 2014Understanding the Marketplace60 Slide 61
Community health centers, such as federally qualified health
centers (FQHCs) Hospitals Indian health care providers (health
programs operated by the Indian Health Services, tribe, tribal
organizations and Urban Indian organizations) Mental or behavioral
health providers Ryan White HIV/AIDS providers Agencies that have
experience providing social services Other local governmental
agencies that have relevant processes and protections in place such
as other health care providers, health departments, and libraries
Examples of Possible Qualified CAC Organizations in the
Federally-facilitated Marketplace July 2014Understanding the
Marketplace61 Slide 62 State licensed agents and brokers may
Provide information on qualified health plans Help people
review/compare coverage options Agents and brokers must be
registered and pass training to enroll qualified individuals in the
Marketplace State Based Marketplaces may have additional standards
Agents or brokers may be Navigators if all Navigator standards are
met Cant receive direct or indirect compensation from an issuer
related to enrollment in Qualified Health Plans (QHPs) and non-QHPs
Agents and Brokers July 2014Understanding the Marketplace62 Slide
63 Champions for Coverage help educate consumers about the
Marketplace and refer them to resources where they can get
assistance Many ways your organization can get involved Email your
network about the Marketplace Post a HealthCare.gov widget on your
website Hang posters or give out fact sheets and brochures Host a
conference call or webinar about the Marketplace Visit
Marketplace.cms.gov for more information and to apply Champions for
Coverage July 2014Understanding the Marketplace63 Slide 64 Coverage
to Care Initiative July 2014Marketplace 10164 Written materials and
videos available in English and Spanish Marketplace.cms.gov/c2c
Slide 65 Visit marketplace.cms.gov/getofficial
resources/publications-and-articles Tips Sheets on Using Your
Health Coverage July 2014Understanding the Marketplace65 TopicsCMS
Product No. Seeing your doctor11767 Using provider networks11766
Getting prescription medications11769 Getting emergency care11770
Appealing your insurers decision not to pay11771 Early renewal11764
Slide 66 Get the latest resources to help people apply, enroll, and
get coverage Marketplace.cms.gov July 2014Understanding the
Marketplace66 Redesigned Home Page Coming Soon Slide 67 Medicare
isnt part of the Marketplace if you have Medicare You dont need to
do anything related to the Marketplace Your benefits dont change
because of the Marketplace The Marketplace doesnt offer Medigap or
Part D plans Its generally against the law for someone who knows
you have Medicare to sell you a Marketplace plan If you become
eligible for Medicare after you join a Marketplace qualified health
plan You can cancel the QHP once your Medicare coverage starts, or
You can keep the QHP after your Medicare coverage starts Once Part
A coverage starts, you lose any premium tax credits/reduced cost
sharing you get through the Marketplace Marketplace and People with
Medicare July 2014Understanding the Marketplace67 Slide 68
Exception Marketplace coverage instead of Medicare If youre
eligible for Medicare but havent enrolled because youd have to pay
a premium, or because youre not collecting Social Security
benefits, you may be eligible to get a Marketplace plan If youre
paying a premium for Part A, you can drop Part A and Part B and may
be eligible to get a Marketplace plan Important considerations A
late enrollment penalty may apply if you decide to enroll in
Medicare later, after your initial enrollment period ends Generally
you can enroll only during the Medicare general enrollment period
(January 1 to March 31) Employer coverage through SHOP is treated
like any other employer coverage Marketplace and People with
Medicare (Continued) July 2014Understanding the Marketplace68 Slide
69 Key Dates July 2014Understanding the Marketplace69 March 31,
2014 Open Enrollment ended for 2014 coverage November 15, 2014
February 15, 2015 2015 Open Enrollment January 1, 2015 Earliest
2015 coverage can begin for Marketplace plans bought during Open
Enrollment, or for a plan you reenroll in December 15, 2014
Deadline for current enrollees to change coverage for new coverage
to begin January 1, 2015 Slide 70 The Marketplace is a way to find
and buy health insurance Qualified individuals and families can
shop for health insurance that fits their budget Small employers
can shop for health insurance for their employees States have
flexibility to establish their own Marketplace Individuals and
families may be eligible for lower costs on their monthly premiums
and out-of-pocket costs There is assistance available to help you
get the best coverage for your needs Key Points to Remember July
2014Understanding the Marketplace70 Slide 71 Employer-based
coverage continues Insurance continues to be sold outside of the
Marketplace Purchase from Marketplace not required The Marketplace
is the only place to get the Premium tax credits Cost-sharing
reductions After youre enrolled, contact your insurer first with
questions Key Points to Remember July 2014Understanding the
Marketplace71 Slide 72 1. Sign up for updates at
HealthCare.gov/subscribe or CuidadodeSalud.gov/es/subscribe 2.
Twitter.com/HealthCareGov Follow @HealthCareGov 3.
Facebook.com/HealthCareGov 4. Youtube.com/HealthCareGov 5. The
Health Insurance Blog: HealthCare.gov/blogHealthCare.gov/blog 6.
Federal training for agents and brokers, Navigators, in- person
assisters, and certified application counselors
Marketplace.medicarelearningnetworklms.com
Marketplace.medicarelearningnetworklms.com Ways to Connect with the
Marketplace July 2014Understanding the Marketplace72
