The Health Insurance Marketplace:

Basic Information for

Fairfax County Employees

Updated November 2014

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The Affordable Care Act (ACA) became law on March 23, 2010.

Affordable Care Act

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You can no longer be denied coverage for pre-existing conditions.

Prices for the same plan can vary only for age, family size, tobacco use, and geography.

There are limits to how much you can be forced to pay out-of-pocket each year, and annual and lifetime limits on benefits are being eliminated.

All plans must include “essential health benefits.”

What is new in health insurance?

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Starting in 2014, most people will be required to have health insurance or pay a penalty if they don't.

Several groups are exempt from the requirement including: ◦ People with very low income;◦ People who qualify for religious exemptions; ◦ Members of Indian tribes; ◦ Undocumented immigrants; and ◦ People who are incarcerated.

In 2015, the penalty is $325 per person or 2% of income, whichever is higher. Beginning in 2016, the penalty is the greater of $695 per year or 2.5% of income.

The “Individual Mandate”

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The law allows states to expand the eligibility for Medicaid to 138% of the Federal Poverty Level ($16,105 per year for an individual).

Virginia has not yet decided to implement the expansion.

Medicaid Expansion

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Insurance companies submit plans to become “Qualified Health Plans” (QHP).

Plans get listed online. ◦ Plain language◦ Compare plans

The Marketplace

www.healthcare.gov(Spanish: www.cuidadodesalud.gov)

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All plans cover the essential health benefits.

Plans are offered at 4 “Metal Levels.”Based on actuarial value◦ Bronze: 60%◦ Silver: 70%◦ Gold: 80%◦ Platinum: 90%

The Marketplace

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Many low to middle income residents will receive help paying their health insurance premiums.

If you answer NO to ALL of these questions, you may qualify.1. Does your employer offer affordable health insurance? No.2. Do you receive Medicare? No.3. Do you or your family make more than the yearly income below?

No.

Lowering Costs

Federal Poverty Level (2013)

Examples 100% 250% 400%

Individuals $11,670/yr. $29,175/yr. $46,680/yr.

Family of 2 $15,730/yr. $39,325/yr. $62,920/yr.

Family of 4 $23,850/yr. $59,625/yr. $95,400/yr.

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The tax credits are available to consumers with household incomes between 100% and 400% of the Federal Poverty Level, a factor of household income and family size.

Those who qualify for financial help will receive “premium tax credits:”1. Reduced monthly premiums; or 2. Annual tax refund.

People between 100% and 250% of FPL may also qualify for lower co-pays and deductibles.

Lowering Costs(continued)

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The SHOP Marketplace will provide affordable and quality health plans to small business owners.

Businesses with 25 or fewer employees and average salaries below $50,000 may qualify for additional tax credits if they purchase plans through the SHOP Marketplace.

SHOP can also be accessed through www.healthcare.gov.

Small Business Options

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4 Steps of Enrollment

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People can purchase insurance through the Marketplace between November 15, 2014 and February 15, 2015.

Open Enrollment

Enroll Coverage Begins

On or before December 15, 2014 January 1, 2015

Between the 1st and 15th day of January – February

First day of the following month

Between the 16th and the last day of December and January

First day of the second month

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Help will be available from the Marketplace.◦ Toll-free call center

24/7 (closed for five holidays per year) 150 languages

◦ Web chat 24/7 English and Spanish

In-person help is also available.◦ Enroll Virginia navigators◦ Certified application counselors◦ Insurance agents and brokers

Enrollment Help

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Please direct clients with additional questions to:

◦Marketplace www.healthcare.gov (Spanish: www.cuidadodesalud.gov) 1-800-318-2596

◦Enroll Virginia (in-person assistance) www.enroll-virginia.com 703-647-4748 or 1-888-392-5132

Where to Get Enrollment Help

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For outreach assistance, please contact

◦Enroll Virginia www.enroll-virginia.com 703-647-4748 or 1-888-392-5132

◦Northern Virginia Family Service www.nvfs.org health-help@nvfs.org 571-748-2582

Community Outreach

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If you suspect fraud, report it! • Someone you don’t know contacts you about getting health insurance and asks you to pay or provide private information• Someone contacts you and claims to be from the government• You give your out bank account information or Social Security number

Call the Health Insurance Marketplace consumer call center:

1-800-318-2596 (TTY 1-855-889-4325)

Report Anything Suspicious

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Marketplace: www.healthcare.gov

Marketplace Info: marketplace.cms.gov

ACA Info: www.hhs.gov/healthcare

ACA Info: kff.org/health-reform

Fairfax County Health Care Reform Implementation Task Force: www.fairfaxcounty.gov/healthreform

Additional Information