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This is a review of the Patient Protection and Affordable Healthcare Law. This presentation does not comment on the politics behind the legislation or the economics of the legislation.

This is a review of the Patient Protection and Affordable Healthcare Law. This presentation does not comment on the politics behind the legislation or the economics of the legislation.

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ACL Deck Presentation Transcript

  • 1. Patient Protection and Affordable Healthcare Law Update Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 2. Ground Rules • This is a conversation about the healthcare act, the online exchanges, as well as current and exchange based health insurance policies • This is not a conversation about politics Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 3. What has happened so far • Some preventative care covered at 100% – Immunizations / Flu Shots – Blood Pressure / Cholesterol Screenings – Mammograms / Colonoscopies – Type II Diabetes Screening – Obesity Screening & Counseling – Tobacco Use Screening Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 4. What has happened so far • More Preventative Care for Women – Annual well woman visits – Screening for gestational diabetes – Testing for HPV (human papillomavirus) – Counseling for sexually transmitted infections – Counseling and screening for HIV – Contraception methods and counseling – Breastfeeding support, supplies, and counseling – Screening and counseling for interpersonal violence Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 5. What has happened so far • Children up to age 26 can remain on their parent’s policies • Lifetime limits have been eliminated • Appeals to insurance company decisions are now handled by an independent party outside of the insurance company (no longer an internal appeals board). Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 6. Coming Soon – Jan 1, 2014 • Guaranteed Issue – You cannot be refused • “Pre-Existing” conditions riders can no longer be applied to policies • For the same policy an older age group cannot be charged more than three times the premium of a 21 year old • Excess premiums charged by companies have to be returned (80% of premiums collected have to go to health care benefits or improving health care, not administrative costs or profit) Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 7. Coming Soon – Jan 1, 2014 • The individual mandate – the requirement is to have health insurance. The requirement is not about purchasing on the marketplace • Qualified Health Plan • Penalties (higher of the two) – 2014 - $95 per adult and $47.50 per child (maximum of $285) or 1% of income – 2015 - $325 per adult and $162.50 per child (maximum of $975) or 2% of income – 2016 - $695 per adult and $347.5 per child (maximum of $2085) or 2.5% of income Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 8. Who is eligible? Family size Family Income 1 2 3 4 $ 11,490 $ 15,510 $ 19,530 $ 23,550 $ 45,960 $ 62,040 $ 78,120 $ 94,200 Anyone is free to purchase outside the online marketplace, but you must purchase inside the marketplace to be eligible for a subsidy. The household income must be between 100 % - 400% of the federal poverty level. Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 9. Financial Assistance Available Income Level Premium as a Percentage of Income Up to 133% of FPL 133% - 150% 150% - 200% 200% - 250% 250% - 300% 300% - 400% 2 % of income 3-4% of income 4-6.3% of income 6.3 - 8.05% of income 8.05 - 9.5% of income 9.5% of income Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 10. Financial Assistance Available Andrew F. Bennett 865.712.5711 Maximum Income Allowed 1 $28,725 2 $38,775 3 $48,825 $58,875 5 Cost Sharing is ONLY available in Silver Plans Family Size 4 Cost Sharing – Provides assistance with: • Deductibles • Co-insurance • Co-Pays $68,925 6 $78,975 7 $89,025 Your Family Health Insurance Agent
  • 11. Qualified Health Plan Ten Essential Health Benefits (EHB’s) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Ambulatory Patient Services Emergency Services Hospitalization Maternity and Newborn Care Mental Health & Substance Abuse Disorder Services Prescription Drugs Rehabilitative Services and Devices Laboratory Services Preventative & Wellness Svcs/Chronic Disease Mgmt Pediatric Services including oral & vision Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 12. Your Current Plan • Grandfathered till your renewal date in 2014 • At that point your plan will need to contain all ten essential health benefits in order to qualify as a “Qualified Health Plan.” (QHP) Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 13. Online Marketplace • State Based, State & Federal Partnerships, Federally Facilitated • TN is a Federally Facilitated Marketplace • Carriers in TN will likely be BlueCross/BlueShield, Humana, and Cigna (Chattanooga Area only), and CHA (Community Health Alliance). Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 14. Online Marketplace • Policies will be color coded based on “actuarial value.” – Catostrophic • Under 30 years old • Lower Premiums • Higher Deductibles • Everything is cost shared except for preventative medicine – Bronze 60% / 40% – Silver 70% / 30% – Gold 80% / 20% – Platinum 90% / 10% Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 15. Online Marketplace • Open Enrollment – October 1, 2013 till March 31, 2014 • Coverage effective January 1, 2014 • Coverage must be in place for at least nine (9) months in 2014 to avoid penalty • Subsidies – Income and family sized base – Premium set on parent(s), up to three children (under 21), and those children between 21 to 26 yrs of age – Subsidy set on total number of children • Subsidies will be paid directly to insurer OR can be claimed at end of year on tax return Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 16. Online Marketplace Eligibility • Household income must be between 100% and 400% of FPL (federal poverty level) • Individual’s must be either Citizens of the United States or have documentation proving they are “legally present.” (permanent resident visa, student visa, worker visa, etc). Exemptions • Religious exemptions (i.e. your religion requires you to abstain from the healthcare system) • Financial exemption – if private insurance is too expensive, if you do not qualify to purchase in the online marketplace, and you are not eligible for medicaid you will not be fined. • Native American Indian Tribes have separate programs and will be exempted. Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 17. Online Marketplace What do you need in order to register? • Social Security Number • Policy numbers if you have a current health insurance plan • Employer and income information from everyone in household (examples: W-2 forms, Tax Statements, pay stubs – anything that will help verify income level). • Employer Coverage Tool (if coverage is available to you). Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 18. Online Marketplace • What is included in income? – – – – – Wages, Salary, Tips Net income from self-employment Unemployment Compensation Social Security income (including disability) Alimony • What is NOT included in income: – – – – – Child Support Worker’s Compensation Gifts SSI (Supplemental Security Income) Veteran’s Disability Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 19. Online Marketplace If you have employer based coverage available there is more information required. Employer Coverage Tool • Google – “Employer Coverage Tool” the first result will take you right to the tool. • Employer name, phone, address, contact person (usually someone in HR). • Employer Identification Number (EIN) • Information about the plan they offer. – Could coverage apply to Spouse and/or dependents? – If employee was covered as an individual what would the premium be (factor in any discounts for smoking cessation programs)? How often would that be paid (weekly, monthly, etc.)? – Is plan changing in 2014? Date of change? What will premium be? Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 20. Online Marketplace Helpful information when selecting a policy. This information will help us choose the best policy for you and your family. • Prescription information – Prescriptions are categorized into tiers (levels) by expense. Knowing the tiers your medications are in helps us understand what prescription benefit you may need. • Frequency of office visits – If you have a conditions that requires office visits every month, quarter, etc. that will help us understand what kind of office visit co-pay will be best for you in your situation. • Knowledge of your own financial situation. This will help us understand what will fit you and your family best in regards to deductibles and out of pocket maximums. Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 21. Online Marketplace Questions? Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 22. Employer Mandate • Pushed back till 2015 • Based on the number of full time equivalent employees – 30 hours a week is one “equivalent” full time employee • 1 employee equivalent works 30 hours a week • 2 employees working 15 hours a week = 1 full time equivalents • 2014 & 15 States can decide if a “small business” has less than 50 employees or less than 100 • 2016 Federal definition 50 or fewer • Exchanges are not for large businesses Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 23. SHOP Exchange • Small Business Health Options Program – For small business where employer mandate does not apply. – Tax Credits will apply only if they enroll in 2014. Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent
  • 24. Other Resources • Healthcare.gov • KFF.org (Kaiser Family Foundation) • NAHU.org Andrew F. Bennett 865.712.5711 Your Family Health Insurance Agent