Disclaimers and Copyright

This presentation is copyrighted by Brent Heurter and Healthy Halo Insurance Services, Inc. which is solely responsible for its content. Affordable California, Brent Heurter and Healthy Halo Insurance Services are not affiliated with Covered California, and Covered California bears no responsibility for the content of this presentation. The email addresses and telephone number that appears throughout this presentation belong to Brent Heurter and Healthy Halo Insurance Services, Inc. and cannot be used to contact Covered California.

Copyright 2013-2014, Healthy Halo Insurance Services, Inc. All rights reserved. No duplication, in whole or in part, permitted without expressed written consent. Health insurance provided by Healthy Halo Insurance Services, Inc., CA License #: OF76504

Brent Heurter, Director of Education Affordable California™

Elea Sherrod, Enrollment DirectorAffordable California™

Agenda

•Health Insurance Law

• Why Get Health Insurance?

• Affordable Care Act Improvements

• Expanded Medi-Cal

Agenda•Standardized Benefits

• Enhanced Benefits

• Premium Subsidies

• Health Plans

• How to Enroll

Introduction

• The Affordable Care Act and Obamacare are the same

• Starting in 2014, most people are required to have health insurance under Federal law

Introduction

• Financial assistance is available for those who qualify

• Medi-Cal is being expanded to cover more people and is based only on income

Reasons people do not have health insurance:•Pre-existing conditions

•Not offered by their employer

•Unaffordable

Why get health insurance?

•Because life is unpredictable

•Because medical care is expensive

•Because health insurance protects you financially

Why get health insurance?

•Because health insurance covers more than just injury or illness

•Because health insurance is now affordable

•Because it’s the law!

Average costs without insurance

• Average cost of broken arm is $14,911

• Average cost of pregnancy is $18,320

• Average cost of hospital stay is $33,079

Am I required to buy health insurance?

•Income is below the tax filing threshold

• Undocumented immigrant

• Insurance would cost more than 8% of your income

• Member of an Indian tribe

Do any of the following apply to you:

If Yes then:

There is no penalty for being without health insurance

Do you currently have health care coverage – or expect to have it by January 1, 2014: • Employer-sponsored healthcare

• Coverage purchased in the individual market

• Medicare

• Medi-Cal

• TRICARE or Veteran’s Health Program

If No then:

The requirement to have health insurance is

satisfied and no penalty is assessed

If Yes then

There is a penalty for being without health insurance:

If No then

You must enroll no later than

March 31, 2014 to avoid a tax penalty

Essential Health Benefits

1) Outpatient care

2) Emergency care

3) Hospitalization4) Maternity & newborn

care5) Mental health,

substance abuse & therapy

6) Prescription drugs

7) Rehabilitative & habilitative Services

8) Children’s dental & vision

9) Preventative & wellness services

10) Lab Services

What is Covered California?

What Covered California does

Access to guaranteed issue

affordable, quality health

care coverage

What is Medi-Cal?

• California’s version of Medicaid

• Government-run healthcare program for low-income individuals and families that qualify

• Not private insurance

Am I eligible for Medi-Cal?

$15,856 or less

$21,403 or less

$26,961 or less

$32,499 or less

$38,046 or less

$43,594 or less

Are my children eligible for Medi-Cal? (under age 18)

$30,563 or less

$41,256 or less

$51,949 or less

$62,643 or less

$73,336 or less

$84,029 or less

What if I have access to affordable coverage?• Ask your employer to not offer spousal

and dependent coverage

• Ask your employer to make your job classification not eligible for benefits

• Consider working part-time

$$1.00in annual income

can determine eligibility

Med-Cal vs. Subsidized Private Health Plan

What if I don’t want Medi-Cal?

• Adults can purchase a private health plan, but will not be eligible for subsidies

• Private health plans for children may be purchased and the parents will still be eligible for the maximum subsidy

• Health plans for children start at $96

Southern CA Health Plan Plans

Northern CA Health Plans

Metal Tiers:Bronze60, Silver70, Gold80, Platinum90

Key Terms to Know

• Medical Deductible: how much you pay for medical services before the health plan pays (example, $2,000)

• Brand Name Drug Deductible: how much you pay for brand-name prescriptions before the health plan pays (example, $250)

• Co-Payment: fixed amount you pay for a service (example, $45)

• Co-insurance: a % of the plan’s negotiated rate that you pay for a service (example, 20%)

• Maximum Out of Pocket: the most you pay in a year before the health insurance pays 100% of costs. Think of it as your safety net.

Types of Health Plans

Plan Feature: HMO EPO PPODesignate a primary care physician?

Yes No No

Need a referral to see a specialist?

Yes No No

Out of network benefit? No No Yes

Level of flexibility? Minimal Moderate High

Standard Coverage by Benefits Level

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Enhanced Silver Benefits based on Income

1 person = $15,857 to

$28,725

2 people = $21,404 to

$38,775

3 people = $26,953 to

$48,825

4 people = $32,500 to

$58,875

5 people = $38,047 to

$68,925

6 people = $43,595 to

$78,975

With Enhanced Silver your out of pocket costs are lower

Healthcare That’s Affordable

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Premiums as a maximum % of income

42

What is a Premium Subsidy?

•Reduces your monthly premium•Amount is based on your household’s projected income for 2014•Paid by the federal government directly to the insurance company you select

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Who is eligible for premium subsidies?

44

Who is not eligible for premium subsidies?

45

Maximum Monthly Premium

• Based on second most affordable Silver plan

• Maximum amount you will pay

• Based on percentage of income

• Your premiums cannot increase

• Buy less expensive Bronze plan or pay more for Gold or Platinum

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What is considered annual income?

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Income Includes:

•Wages, salaries, tips

•Business or self-employment income

•Rental income

• Interest received or accrued

•Capital gains

•Alimony

50

Deductions

• Self-employed expenses

• Student loan interest

• IRA and Health Savings Account deductions

• Moving expenses

• Penalty on early withdrawal of savings

• Alimony

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Modified Adjusted Gross Income

(MAGI)• Line 4 of Form 1040 EZ

• Line 21 of Form 1040A

• Line 37 of Form 1040

• Add in non-taxable Social Security Benefits

• Add in non-exempt interest

• Include any income earned by children if you claim them as dependents

• Spouses are required to file their income taxes jointly

What if I have access to affordable coverage?• Ask your employer to not offer spousal

and dependent coverage

• Ask your employer to make your job classification not eligible for benefits

• Consider working part-time

$$1.00

Can make a big difference

Project your income wisely…

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What if I don’t qualify for a subsidy?

Single $45,961 or more

Family of Three $62,041 or more

Family of Four $78,121 or more

Family of Five $94,201 or more

Family of Six $126,361 or more You can buy the same plans, have the same benefits and have more choices from the private market

What am I eligible for?

Medi-Cal Premium Assistance & Cost

Sharing Assistance

Premium Assistance

Affordable Health

Insurance

up to $15,856 $15,857 - $28,725 $15,857 - $45,960 $45,961 or more

up to $21,403 $21,404 to $38,775

$21,403 - $62,040 $62,041 or more

up to $26,951 $26,952 to $48,825

$26,952 to $78,120

$78,121 or more

up to $32,499 $32,500 to $58,875

$32,500 to $94,200

$94,201 or more

up to $38,046 $38,047 to $68,925

$38,047 to $110,280

$110,281 or more

up to $43,594 $43,595 to $78,975

$43,595 to $126,360

$126,361 or more

Eligibility for Medi-Cal & Premium Subsides

Not Eligible for SubsidiesEligible for Subsidies

Eligible for Enhanced Benefits & Subsidies

Eligible for Medi-Cal

Eligibility for Medi-Cal & Premium Subsides

Not Eligible for SubsidiesEligible for Subsidies

Eligible for Enhanced Benefits & Subsidies

Eligible for Medi-Cal

Eligibility for Medi-Cal & Premium Subsides

Not Eligible for SubsidiesEligible for Subsidies

Eligible for Enhanced Benefits & Subsidies

Eligible for Medi-Cal

Eligibility for Medi-Cal & Premium Subsides

Not Eligible for SubsidiesEligible for Subsidies

Eligible for Enhanced Benefits & Subsidies

Eligible for Medi-Cal

How to enroll in a Covered California health plan

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Open Enrollment

• You can only enroll during annual open enrollment

• Next open enrollment period starts November 15, 2014 for coverage effective January 1, 2015

• Exceptions are if you have a qualifying life event: loss of employer-sponsored coverage, death of a spouse, birth of a child

• You must enroll by March 31, 2014 to avoid a tax penalty for 2014

Streamlinedenrollmentform

• California driver’s license or passport

• Recent paycheck stub or tax return

• If applicable: Naturalization Certificate or Certificate of Citizenship

Required Documents

How to Choose a Plan

• How many doctor visits, prescriptions and hospital stays do I expect my family to use in the next year?

• What level of coverage do I want? Bronze, Silver, Gold or Platinum?

• Do I qualify for an Enhanced Silver Plan?

• What type of network do I want? HMO, EPO or PPO?

Enrollment Worksheet

64

We make it easy

• We’ll determine your eligibility for subsidies

• We’ll find the plans that have your doctors

• We’ll show you plan choices and options

• We’ll help you select the plan best suited for you

• We’ll help you apply for government assistance

• We’ll handle the enrollment process

• We’ll help you with the appeals process if you get turned down

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Our commitment to you

• We’ll help you figure out if you’re eligible for money from the government or your employer, and we’ll help you get that money

• We’ll help you choose the right health plan

• We’ll make sure you get the best deal possible

• We’ll help you with the paperwork to enroll or enroll for you

• If you run into any roadblocks, get confused, have an issue with your plan or a change in circumstance, we’ll always here to help.

If You Enroll by: Your Health plan must receive first month’s premium

by:

For coverage effective:

January 15, 2014 January 28, 2014 February 1, 2014

February 15, 2014

February 25, 2014 March 1, 2014

March 15, 2014 March 26, 2014 April 1, 2014

March 31, 2014 April 25, 2014 May 1, 2013

Next Steps

• Complete enrollment form

• FAX with documentation to 1-800-297-6319 (no emails, please) docs

• Call us at 1-800-788-2197 if you need help

• Pay the first month’s premium before the due date

Streamlinedenrollmentform 1-800-788-2197

help@AffordableCA.com

Contact us