Health Insurance Marketplace

Jessica Killeen & Carlon OcelHealth Insurance Navigators for ENROLL

Virginia!

1) What is a Navigator?2) Overview of Individual Market

and Small Business Health Options Program (SHOP)

3) Process to Apply for Health Insurance

4) Contact Information

TOPICS TO COVER TODAY

WHAT IS A NAVIGATOR?

Nationally, 75% of the newly eligible said that they wanted in-person assistance to learn about and enroll in coverage. (Enroll America Research, 2012).

The profile of Marketplace enrollees is unique.Nationally:• 65% previously uninsured • 77% have high school diploma or less• Lower income than insured today

81% will receive subsidies Median income is 235% FPL ($54k for a family of 4)

• More racial and ethnic diversity• 23% do not speak English at home

THE NEED FOR NAVIGATORS

Kaiser Family Foundation, A Profile of Health Insurance Exchange Enrollees , March 2011

Navigators mustBe certified

Must take initial web-based trainingMust take required on-going trainingBe recertified annuallyNot accept direct or indirect compensation from issuers related to enrollment in QHPs or non-QHPs

Mid-August – Notification of grant approvalStarting in September, find Navigators and other

assisters through the Call Center or on HealthCare.gov

NAVIGATOR PROGRAMFOR FEDERALLY FACILITATED AND STATE-PARTNERSHIP

MARKETPLACES

• Conduct outreach and public education on Marketplace coverage options and financial assistance

• Distribute fair and impartial information on enrollment, plan options, and subsidies. This includes options from the Marketplace as well as public programs, such as Medicaid and CHIP

• Facilitate enrollment in Marketplace health plans

• Provide referrals for any grievance, complaint, or question about their health plan, post-enrollment.

• Provide information that is culturally and linguistically appropriate, and accessible to those with disabilities

• Guidance expected to clarify that a Navigator entity must support all functions, but not every individual Navigator must perform each function; i.e. how the entity divides the work is up to them.

WHAT WILL NAVIGATORS DO?

NAVIGATOR DUTIES: MAKE THINGS EASIER

E Expertise (Medicaid, CHIP, QHPs)

A Accessibility (cultural, linguistic, people w/disabilities)

S Selecting a plan (facilitating)

I Impartiality

E Education

R Referrals

OVERVIEW OF INDIVIDUAL AND SHOP

MARKETPLACES

New Marketplace Run by Federal Government

Open Enrollment 10/01/2013 – 03/31/2014 Coverage can begin January 1, 2014

To compare/purchase private health insurance from Qualified Health Plans (QHPs)

Income between 100%-400% federal poverty line

No “affordable ” job-based coverage Not affordable if employee-only plan costs ↑9.5% family income; covers ↓60% costs

Also available to small employers Fewer than 50 “full time equivalent” employees “SHOP Exchange”

NEW INSURANCE MARKETPLACE

Marketplace eligibility requires you toLive in its service area, andBe a U.S. citizen or national, orBe a non-citizen who is lawfully present in the U.S. for the entire period for which enrollment is sought

Not be incarceratedCan apply for Marketplace if pending disposition of charge

Can apply for Medicaid/CHIP at any time

ELIGIBILITY AND ENROLLMENT

Marketplace Initial Open Enrollment Period starts October 1, 2013 and ends March 31, 2014

Annual Open Enrollment Periods after that start on October 15 and end on December 7

Special Enrollment Periods available in certain circumstances during the year

WHEN YOU CAN ENROLL IN THE INDIVIDUAL MARKET

Types of Standard Plans:4 Tiers of Coverage

Bronze – low overall coverage, lower premiums

Silver Gold Platinum – best coverage, highest costs

Catastrophic coverage for people under age 30 Very high deductible

INSURANCE MARKETPLACEHOW WILL IT WORK?

SHOP = Small Business Health Options ProgramA new, streamlined way for small employers to offer health insurance to their employees beginning in 2014 Access to SHOP begins October 1, 2013

Part of the new Heath Insurance Marketplace established by the Affordable car Act (ACA)

Offers access to health insurance plans that must include certain “essential health benefits”

Works with new insurance reforms and tax credits to lower barriers to offering health insurance that employers face

WHAT IS THE SHOP MARKETPLACE?

Who’s eligible?Small businesses with fewer than 50 full-time equivalent employees in 2014

Most states will keep upper limit of 50 FTEs in 2015When can businesses enroll?

Starting October 1, 2013, for coverage beginning January 1, 2014

Thereafter, throughout the year How can businesses enroll?

Directly through the SHOP-Online or toll-free call center

Through a broker registered with SHOP

ENROLLING IN SHOP:WHO, WHEN & HOW?

• The SHOP is a Marketplace for small businesses and their employees (fewer than 100 FTE employees)–States may limit participation to those with 50 or fewer employees for the first 2 years–Employer will access the SHOP where its principal business office is located–Employer must offer coverage to all full-time employees–Sole proprietors may buy through the Marketplace rather than the SHOP

SMALL BUSINESS HEALTH OPTIONS PROGRAM (SHOP) - EMPLOYEES

Eligible employers canDefine how much they’ll contribute toward their employee’s coverage

Have access to small business tax credit

Benefit from new protections that help them get real value for consumer’s premium dollars

SMALL BUSINESS HEALTH OPTIONS PROGRAM (SHOP) - EMPLOYERS

PROCESS TO APPLY FOR COVERAGE

APPLICATION AND ELIGIBILITY

CONTACT US!

Your local Navigators: (703)-647-4748

Federal Call Centers:

Marketplace Call Center(For employees and those assisting them)1-800-318-25961-877-871-6594 - TTY

SHOP Call Center (For small employers and those assisting them): 1-800-706-78931-800-706-7915 – TTY

www.cciio.cms.govFamilies USA – www.familiesusa.orgVirginia Consumer Voices for Healthcare – www.vaconsumervoices.orgVirginia Organizing – www.virginia-organizing.org

FOR MORE INFORMATION