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TheAffordable Care ActWhat It Means For You and Your Family
What We’ll Cover:What Is the Affordable Care ActHow Will the Affordable Care Act Impact HealthCoverage Choices and Optio...
What is it?Affordable Care Act:The comprehensive health care reform law enacted inMarch 2010. The law was enacted in two p...
Who is Affected?• American citizens• American nationals• Aliens legally present
What’s Coming?Coming in 2014Individuals musthave basic coveragealso known asMinimum EssentialCoverage;Or be eligible for a...
What is Minimal EssentialCoverage?Minimum Essential Coverage:The type of coverage an individual needs to have, tomeet the ...
Individual Shared Responsibility• Everyone shares responsibility under the AffordableCare Act• Each individual must ensure...
What Qualifies as MinimalEssential Coverage?• Employer sponsored coverage including COBRA, andretiree coverage plans• Cove...
What’s Not Required forMinimum Essential Coverage?• Vision Only Plans• Dental Only Plans• WorkersCompensationPlans• Specia...
What Is a Qualifying Exemption?• Religious Conscience• Health Care SharingMinistry• Indian Tribes• No Filing Requirements•...
How to Qualify For An Exemption• Certificate through Health Insurance Marketplace ifseeking exemption based on religion or...
Health InsuranceMarketplace
What Do You Need To Do?If you have coverage and are happy with yourcoverage you don’t need to take any action.
What Do You Need To Do?• If you do not havecoverage• If you want toexplore youroptions• If you plan onterminating yourcurr...
What Do You Need To Do?Open enrollment beginsOctober 1, 2013Coverage begin on Jan 1, 2014
How Much Will This Cost?• Manypeople/families willbe able to qualifyfor free or low costinsurance• Others may beeligible f...
Free and Low Cost Options• Private InsuranceOptions• Medicaid• Children’s HealthInsuranceProgram (CHIP)• CommunityHealth C...
Free and Low Cost Options• Private insurance options• Insurance finder tool to help you identify options thatare affordabl...
Tax Credits• Tax credit foreligible individualscan be appliedright away tolower monthlypremiums• Application for taxcredit...
Medicaid ExpansionBeginning in 2014most adults underage 65 with incomeless than$15,000/year willqualify for Medicaid ineve...
Medical Loss Ratio RebatesInsurance companies must spend at least80% of premium dollars on medical care, orthey must provi...
Other Changes• Flexible Spending Accounts (FSA) contributionslimited by the government to a $2,500 max• High income earner...
More About WLSFor more information about WLS please visit ourwebsite: www.workplace-learning-solutions.comFollow us on Twi...
Recommended Resources http://www.healthcare.gov/index.html http://www.medicaid.gov/
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Affordable Care Act For Individuals and Families

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  • The Affordable Care Act was passed by Congress and then signed into law by President Obama on March 23, 2010 as the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act was enactedto increase the number of Americans covered by health insurance and decrease the overall cost of health care. On June 28, 2012 the Supreme Court rendered a final decision to uphold the health care law.
  • Note that every American Citizen, American National and Legally Present Alien, regardless of age, must have coverage.The only exception will be individuals who are exempt. We will discuss exemptions a bit later in the presentation.Possible Question: What is the difference between a citizen and a national?Answer:A citizen. One who, under the Constitution and laws of the United States, or of a particular state, is a member of the political community, owing allegiance and being entitled to the enjoyment of full civil rights. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the state wherein they reside. The term“national” means a person owing permanent allegiance to a state.The term “national of the United States” means (A) a citizen of the United States, or a person who, though not a citizen of the United States, owes permanent allegiance to the United States.A legally present alien is one who has been granted permission by the United States to reside. This includes individuals with temporary and permanent residency.
  • One key provision of the Affordable Care Act is the individual mandate, which requires most Americans to maintain “minimum essential” health insurance coverage. If you fail to maintain “minimum essential coverage” you must show that you are eligible for an exemption. Individuals who are not exempt, and who do not receive health insurance through their employer or government program, must purchase insurance from a private company. Beginning in 2014, those who do not comply with the mandate must make a “shared responsibility payment” to the Federal Government. Some call this “shared responsibility payment” a penalty, others call it a tax. Whatever you choose to call it, this payment will be calculated as part of your annual income tax filings and your payment will be made to the Internal Revenue Service (IRS) with your taxes.You will not have to pay if:The insurance plan is unaffordableYou went without insurance for less than 3 months during the yearYou qualify for an exemption due to hardship, religious beliefs and several other categories.We will discuss these instances a bit later in the presentation.
  • Minimum essential coverage includes any health plan that provides minimum healthcare coverage. Most existing plans will meet the minimum requirements. So if you are currently on a healthcare plan from your employer, or Medicaid/Medicare you will be fine.If you have to purchase a plan then you should select one from the healthcare marketplaces that will open up soon to ensure that your plan meets the minimum. Think of minimum essential coverage as the type of insurance that allows for preventive care doctor’s visits, emergency room care, hospital stay and basic care, pre-natal care etc.
  • Under the Affordable Care Act Everyone including the Federal Govt, State Govt, insurers employers and individuals are jointly responsible to reform and improve the availability, quality and affordability of health insurance coverage in the U.S.This provision applies to all individuals including children.This means that starting in 2014, every member of a household must either be covered with minimum essential coverage, or qualify for an exemption. Each individual, including children, who does not have this minimum essential coverage will be assessed a penalty on the federal income tax return.If you are responsible for claiming a child or other individual as a dependent on your income taxes, you will also be responsible for making the payment on the penalty if the child or dependent does not have coverage or a qualifying exemption.
  • As a rule, if you have any of these types of plans you most likely meet the requirement for minimal essential coverage:An employer sponsored plan (including COBRA)Coverage you purchased privately in the individual insurance marketplaceMedicare Part AMedicaidPeachcare for KidsChildren’s Health Insurance Program (CHIP)Some veteran’s health plansTRICAREIf you become eligible to apply for Medicare this year, enrolling in Medicare will ensure you meet the requirements for minimum essential coverage.
  • The mandate does not require you to have these types of plans:Vision only plansDental only plansWorkers compSpecial coverage for special conditionsThis does not mean you can’t get this type of coverage if you want it. It simply means that if you don’t have these special plans, but you do have a basic coverage plan that you are in compliance with the requirements.If your employer already offers these types of coverage, or if you purchase these additional plans then you have met the requirements and then some.
  • Certain groups of individuals who can show a qualifying exemption may not have to purchase health insurance or pay a penalty.These areas listed represent the types of exemptions that are allowed.Religious Conscience: You are a member of a religious sect that is recognized as conscientiously opposed to accepting any insurance benefits.Health Care Sharing Ministry: You are a member of a recognized health care sharing ministry.Indian Tribes: You are a member of a federally recognized Indian Tribe.No Filing Requirements: Your household income is below the minimum threshold for filing a tax return.Short Coverage Gap: You went without coverage for less than 3 consecutive months during the year.Hardship: A Health Insurance Marketplace or Affordable Insurance Exchange has certified that you have suffered hardship that makes you unable to obtain coverage.Unaffordable Coverage Options: You can’t afford coverage because the minimum amount you must pay is more than 8% of your income.Incarceration: You are in jail, prison or some similar penal or correctional facility after the disposition of charges against you.Not Lawfully Present: You are neither a U.S. Citizen, a U.S. National nor an alien legally present in the U.S.
  • If you think you qualify for an exemption, you need to know how to demonstrate your eligibility. Some exemptions will happen automatically, but others you will need to take some type of action to ensure you are properly documented:If you are seeking exemption based on religion or hardship, you will need to obtain a certificate through the Health Insurance Marketplace. We’ll discuss the Health Insurance Marketplace on the next slide.If you are seeking exemption due to legal status, low income, affordability or coverage gaps you may simply elect this status on income tax return. The tax programs and forms will be updated to allow for this new election for tax years 2014 and beyond.If you are seeking exemption based on health care sharing ministry, incarcerationor member of an Indian tribe you can choose either method. You may seek a certificate from the marketplace, or you can simply elect it on your tax return.If you are not required to file income taxes you are automatically exempt and do not need to be certified by the exchange.
  • About the Health Insurance MarketplaceThe Marketplace is designed to help individuals and familiesfind health insurance that fits their budgets, with less hassle.Every health insurance plan in the new Marketplace will offer comprehensive coverage, from doctors to medications to hospital visits. You can compare all your insurance options based on price, benefits, quality, and other features that may be important to you, in plain language that makes sense.Every state will have a Health Insurance Marketplace, but each state can choose how it will operate. States can create and run their own Marketplace, or have a Marketplace supported by the Department of Health and Human Services (HHS). States may also choose to partner with HHS to run some functions of their Marketplace.You can check the status of your state’s marketplace on the Healthcare.gov website. The link will be available at the end of the presentation.
  • What actions or steps do you now need to take?If you and your household currently have coverage and you are happy with your coverage, then you don’t need to do anything.However, if you are not satisfied with your current coverage for reasons such as costs, high deductibles, limitations on coverage etc…, and want to see what else is available, you are free to check out the Health Insurance Marketplace.The marketplace gives you the freedom to choose so that if you were to find a plan that offers more and/or costs less you could purchase such a plan. Also, you may be paying for a plan right now but your income may allow you to qualify for a subsidy or even free insurance.In some instances employers offer coverage for the employees only. You could explore the marketplace to see the availability of plans that offer family coverage, spouses, domestic partners etc…Ultimately, it will not hurt to explore the marketplace and learn about your options.
  • If you do not have coverage, or are anticipating terminating your current coverage, or you want to explore your options, you will need to explore the Health Insurance Marketplace/Affordable Insurance Exchanges. when they open for Open Enrollment in October of 2013.There you will be able to:Learn more about affordable coverage optionsGet information about financial assistanceExplore your eligibility for Medicaid or other free insurance programs for adults and childrenApply for certificates of exemption … and more
  • Open enrollment begins on October 1, 2013.Watch for more information in October 2013Starting in October, you’ll be able to get information about all the plans available in your area. You’ll be able to enroll yourself, directly through the website, or call a toll-free phone hotline.If you’re having difficulty finding a plan that meets your needs and budget, there’ll be people available to give you personalized help with your choices. These helpers aren’t associated with any particular plan, and they aren’t on any type of commission, so the help they give you will be completely unbiased.Coverage from the Marketplace starts in January 2014.There are 4 levels of benefits packages that differ by the percentage costs of the health plans.Self-employed persons and individuals may qualify for tax credits and subsidies on a sliding scale based on income.
  • Insurance plans run by private companiesWhen you shop at the Marketplace, everything you need is laid out for you. All your costs are stated up front, so you’ll get a clear picture of what you’re paying and what you’re getting before you make a choice.More people than ever will qualify for free or low cost health insurance that fits their budget in 2014. You may be eligible for a free or low-cost plan, or a new kind of tax credit that lowers your monthly premiums right away.Different financial assistance programs will be directly linked into the Health Insurance Marketplace when enrollment starts in October 2013. In the meantime, you or your child or teen may qualify NOW for no-cost or low-cost health insurance through Medicaid and the Children’s Health Insurance Program (CHIP).Under the health care law, there will also be new protections for you and your family. Health insurance companies can't refuse to cover you or charge you more just because you have a chronic or pre-existing condition, and they can’t charge more for women than for men.
  • If you currently do not have health insurance, you don’t have to wait for the Affordable Care Act to kick in. There are options available to you right now. You can start out at the Healthcare.gov website and use the insurance and coverage finder tool to investigate available options.Private Insurance OptionsLearn how to find and compare private insurance plans based on price, out-of-pocket costs, and other features. Our insurance and coverage finder tool allows you to shop for private health insurance policies.While coverage can be expensive, this tool will help you find policies in your area that offer the lowest premiums, the lowest out-of-pocket costs, and other features that matter when finding the most affordable option.The tool also helps you find coverage if you have a pre-existing health condition or qualify for other public options. MedicaidYou can also get coverage for yourself and/or your children under Medicaid.Currently, coverage eligibility varies by state and typically includesLow income individualsFamilies with childrenThe elderlyPeople with disabilitiesBeginning in 2014 most adults under age 65 with income less than $15,000/year will qualify for Medicaid in every state.Children’s Health Insurance Program (CHIP)If your income disqualifies your children for Medicaid, the Children’s Health Insurance Program (CHIP) provides low-cost health insurance coverage for children in families who earn too much income to qualify for Medicaid but can’t afford private health insurance. Generally, children up to age 19 in families with incomes up to $45,000 per year (for a family of four) are likely to be eligible for coverage. Health insurance through CHIP is designed to be affordable for families.Routine doctor visits are provided free of charge, but there may be copayments for certain other services. Many states also charge a monthly premium for coverage. The costs you’ll be responsible for under CHIP are different in each state, but cannot be more than 5% of your family’s income each month.Community Health CentersA network of community health centers such as select hospitals, health centers, or clinics across the country that provide preventive and primary care for free or on a sliding scale based on your income. Anyone may use a community health care center, whether you have health insurance or not. How much you pay will depend on your income.
  • In summary…Go over the slide
  • Many people will get a break on costsThanks to new rules and expanded programs, even working families will be able to get help through the Health Insurance Marketplace. There will be new, expanded programs available, and more people than ever before will qualify for free or low-cost health insurance programs.Most people will be able to get a break on costs through the Marketplace, even if you think your income is too high to get help. One application, one time, and you’ll see all the programs you qualify for.Tax Credits in 2014When you enroll in October 2013, you may be eligible for a new kind of tax credit you can use right away to lower what you pay for your monthly health plan premiums.Tax credits can reduce your costs right away.With most tax credits, you have to wait until you file your taxes to get the credit. But the new tax credit available through the Marketplace lets you reduce your costs right away.People who qualify can take the tax credit in the form of advance payments to lower their monthly health plan premiums starting in 2014, which can help make insurance more affordable.You’ll see the amount of tax credit you’re eligible for immediately once you submit your application.Once you enroll in a qualified health plan, you can control how much of your tax credit you want to use to help pay your monthly health plan premiums.The tax credit is sent directly to your insurance company and applied to your premium, so you pay less out of your own pocket.Eligibility depends on income & family size.The amount of tax credit you’re eligible for depends on how much income your family expects to earn. When enrollment starts in October 2013, it’s important to double-check your application to make sure everything is accurate. If the amount of income you report is inaccurate, you may not get the right amount of tax credit you’re eligible for, and it could mean you have to pay back money at the end of the year.
  • Medicaid ExpansionIn 2014, individuals under age 65 (including parents and adults without dependent children) with incomes below 133% of the FPL ($14,500 for an individual in 2011) will become eligible for Medicaid in every state. This change ends the longstanding coverage gap for low-income adults. States can choose to expand eligibility for adults prior to 2014, and several states have already done so.
  • Under the Affordable Care Act, insurance companies must spend at least 80% of premium dollars on medical care rather than on administrative costs. Those who do not meet this ratio are required to provide rebates to all policy holders.This is called "Medical Loss Ratio," or MLR, or the 80/20 rule.Consumers may see the "rebate" in a number of ways. These include:A rebate check in the mail;A lump-sum reimbursement to the same account that was used to pay the premium if it was paid by credit card or debit card;A direct reduction in their future premiums; orYour employer using one of the above rebate methods, or applying the rebate in a manner that benefits employees.People who have individual insurance policies will receive the rebate directly from the insurer. In the small group and large group markets, the rebate is usually paid to the employer, which may use one of the above rebate methods, or apply the rebate in a manner that benefits employees.
  • Other changes already implemented:Limits on FSA contributions:Beginning in 2013, the maximum amount an employee may elect to contribute to FSA (Health Care) is $2,500.Additional Medicare Withholding on Wages:Beginning this year, 2013, individuals with incomes over $200,000 (single) and $250,000 (married) saw an increase in their Medicare withholding on their paychecks from 1.45% to 2.35%.Medicare Assessment on Net Investment Income:Beginning in January of this year, there is a 38% tax being assessed on net investment income such as capital gains, dividends, rents, royalties and interest for taxpayers with a modified adjusted gross income over $200,000 (single) and $250,000 (married).The following income types are not considered investments:WagesUnemployment benefitsOperating income for your small businessSocial Security BenefitsAlimonyTax exempt interestSelf-employment income
  • Transcript of "Affordable Care Act For Individuals and Families"

    1. 1. TheAffordable Care ActWhat It Means For You and Your Family
    2. 2. What We’ll Cover:What Is the Affordable Care ActHow Will the Affordable Care Act Impact HealthCoverage Choices and OptionsYour Call To Action
    3. 3. What is it?Affordable Care Act:The comprehensive health care reform law enacted inMarch 2010. The law was enacted in two parts:The Patient Protection and Affordable Care Act wassigned into law on March 23, 2010 and was amended bythe Health Care and Education Reconciliation Act onMarch 30, 2010.The name “Affordable Care Act” is used to refer to thefinal, amended version of the law.On June 28, 2012 the Supreme Court rendered a finaldecision to uphold the health care law.http://www.healthcare.gov/glossary/a/affordable-care.html
    4. 4. Who is Affected?• American citizens• American nationals• Aliens legally present
    5. 5. What’s Coming?Coming in 2014Individuals musthave basic coveragealso known asMinimum EssentialCoverage;Or be eligible for aqualifyingexemption;Or pay a sharedresponsibility cost onannual income tax.
    6. 6. What is Minimal EssentialCoverage?Minimum Essential Coverage:The type of coverage an individual needs to have, tomeet the individual shared responsibility requirementunder the Affordable Care Act.
    7. 7. Individual Shared Responsibility• Everyone shares responsibility under the AffordableCare Act• Each individual must ensure they have minimumessential coverage• All individuals are included regardless of age –everyone must have coverage or an exemption, ormust make a payment on individual income tax
    8. 8. What Qualifies as MinimalEssential Coverage?• Employer sponsored coverage including COBRA, andretiree coverage plans• Coverage purchased in the individual insurancemarketplace• Medicare Part A• Medicaid• Peach Care for Kids• Children’s Health Insurance Program (CHIP)• Some veterans’ health coverage plans• TRICARE
    9. 9. What’s Not Required forMinimum Essential Coverage?• Vision Only Plans• Dental Only Plans• WorkersCompensationPlans• Special Coveragefor SpecificConditions
    10. 10. What Is a Qualifying Exemption?• Religious Conscience• Health Care SharingMinistry• Indian Tribes• No Filing Requirements• Short Coverage Gap• Hardship• Unaffordable CoverageOptions• Incarceration• Not Lawfully Present
    11. 11. How to Qualify For An Exemption• Certificate through Health Insurance Marketplace ifseeking exemption based on religion or hardship.• Elect status on income tax return if seeking exemptiondue to legal status, low income, affordability or coveragegaps.• Choose either method (certificate or tax return) if seekingexemption based on health care sharingministry, incarceration or member of an Indian tribe.• If you are not required to file income taxes you areautomatically exempt and do not need to be certified bythe exchange.
    12. 12. Health InsuranceMarketplace
    13. 13. What Do You Need To Do?If you have coverage and are happy with yourcoverage you don’t need to take any action.
    14. 14. What Do You Need To Do?• If you do not havecoverage• If you want toexplore youroptions• If you plan onterminating yourcurrent coverageHealthInsuranceMarketplace
    15. 15. What Do You Need To Do?Open enrollment beginsOctober 1, 2013Coverage begin on Jan 1, 2014
    16. 16. How Much Will This Cost?• Manypeople/families willbe able to qualifyfor free or low costinsurance• Others may beeligible for a taxcredit to reduce thecost of premiums
    17. 17. Free and Low Cost Options• Private InsuranceOptions• Medicaid• Children’s HealthInsuranceProgram (CHIP)• CommunityHealth Centers
    18. 18. Free and Low Cost Options• Private insurance options• Insurance finder tool to help you identify options thatare affordable www.healthcare.gov• Low premiums• Low out-of-pocket costs• Coverage for pre-existing health conditions• Network of community health centers that providepreventive and primary care for free or on a slidingscale.• American Indians and Alaska Natives may beeligible through the Indian Health Services programwww.ihs.gov
    19. 19. Tax Credits• Tax credit foreligible individualscan be appliedright away tolower monthlypremiums• Application for taxcredit can becompleted duringopen enrollment• Eligibility basedon income andfamily size
    20. 20. Medicaid ExpansionBeginning in 2014most adults underage 65 with incomeless than$15,000/year willqualify for Medicaid inevery state
    21. 21. Medical Loss Ratio RebatesInsurance companies must spend at least80% of premium dollars on medical care, orthey must provide a rebate to policy holdersat the end of the year.
    22. 22. Other Changes• Flexible Spending Accounts (FSA) contributionslimited by the government to a $2,500 max• High income earners ($200,000 single or $250,000married) saw a 0.9% increase in Medicarewithholding in 2013• Beginning in 2013 there is a 38% Medicare taxbeing assessed on certain types of investmentincome
    23. 23. More About WLSFor more information about WLS please visit ourwebsite: www.workplace-learning-solutions.comFollow us on Twitter: @WLSTrainingCoLike us on Facebook: www.facebook.com/WLSPage
    24. 24. Recommended Resources http://www.healthcare.gov/index.html http://www.medicaid.gov/
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