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Covered California Enrollment
 

Covered California Enrollment

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This presentation provides an overview of eligibility for government financial assistance programs through Covered California and provides instructions for enrolling in a Covered California health ...

This presentation provides an overview of eligibility for government financial assistance programs through Covered California and provides instructions for enrolling in a Covered California health plan.

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  • Bronze Plan: Most Affordable <br /> Silver Plan: Second Most Affordable <br /> Gold Plan: $0 Deductible & Lower Out of Pocket Costs <br /> Platinum Plan: $0 Deductible and Lowest Out of Pocket Costs <br />
  • 6 health carriers in the Greater Los Angeles area and 27 plans to select from. <br /> If you expect a lot of medical expenses, a plan that offers a higher level of coverage might be a better <br /> choice. Premiums are higher, but your copays and deductible will be less, so overall it will be less expensive <br />

Covered California Enrollment Covered California Enrollment Presentation Transcript

  • 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
  • Elea Sherrod, Enrollment Director Affordable California™ Brent Heurter, Director of Education Affordable 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?
  • Do any of the following apply to you: •Income is below the tax filing threshold • Undocumented immigrant • Insurance would cost more than 8% of your income • Member of an Indian tribe
  • If Yes then: There is no penalty for being without health insurance
  • If No then: 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 Yes then The requirement to have health insurance is satisfied and no penalty is assessed
  • If No then There is a penalty for being without health insurance:
  • You must enroll no later than March 31, 2014 to avoid a tax penalty
  • Essential Health Benefits 1) 2) 3) 4) 5) 6) Prescription drugs Outpatient care 7) Rehabilitative & Emergency care habilitative Services 8) Children’s dental & Hospitalization vision Maternity & newborn 9) Preventative & care wellness services Mental health, 10) Lab Services substance abuse & therapy
  • 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 lowincome 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
  • Med-Cal have access to vs. Subsidized What if I Private Health Plan affordable coverage? • Ask your employer to not offer spousal and dependent coverage $$1.00 • Ask your employer to make your job classification not eligible for benefits in annual income can • Consider working part-time determine eligibility
  • 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: Bronze , Silver , Gold , Platinum 60 70 80
  • 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 PP O Designate a primary care physician? Need a referral to see a specialist? Out of network benefit? Level of flexibility? Yes No No Yes No No No No Yes Minimal Moderate High
  • Standard Coverage by Benefits Level
  • 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 38
  • With Enhanced Silver your out of pocket costs are lower
  • Healthcare That’s Affordable
  • Premiums as a maximum % of income 41
  • 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 42
  • Who is eligible for premium subsidies? 43
  • Who is not eligible for premium subsidies? 44
  • 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 45
  • 47
  • What is considered annual income?
  • Income Includes: • Wages, salaries, tips • Business or self-employment income • Rental income • Interest received or accrued • Capital gains • Alimony 49
  • Deductions • Self-employed expenses • Student loan interest • IRA and Health Savings Account deductions • Moving expenses • Penalty on early withdrawal of savings • Alimony 50
  • 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 51
  • Project I have access to your income What if wisely… coverage? affordable • Ask your employer to not offer spousal and dependent coverage $$1.00 • Ask your employer to make your job classification not eligible for benefits • Consider working part-time Can make a big difference
  • 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 53
  • What am I eligible for? Medi-Cal Premium Assistance Premium Assistance & Cost Sharing Assistance up to $15,856 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 up to $43,594 $15,857 - $28,725 Affordable Health Insurance $43,595 to $78,975 $15,857 - $45,960 $45,961 or more $38,047 to $110,280 $110,281 or $43,595 to $126,361 or more
  • Eligibility for Medi-Cal Premium Subsides Not Eligible for Subsidies Eligible for Subsidies Eligible for Enhanced Benefits & Subsidies Eligible for Medi-Cal
  • Eligibility for Medi-Cal Premium Subsides Not Eligible for Subsidies Eligible for Subsidies Eligible for Enhanced Benefits & Subsidies Eligible for Medi-Cal
  • Eligibility for Medi-Cal Premium Subsides Not Eligible for Subsidies Eligible for Subsidies Eligible for Enhanced Benefits & Subsidies Eligible for Medi-Cal
  • Eligibility for Medi-Cal Premium Subsides Not Eligible for Subsidies Eligible for Subsidies Eligible for Enhanced Benefits & Subsidies Eligible for Medi-Cal
  • How to enroll in a Covered California health plan
  • 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 60
  • Required Documents Streamlined • California driver’s license or passport enrollment • Recent paycheck stub or tax return form • If applicable: Naturalization Certificate or Certificate of Citizenship
  • 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? PPO? HMO, EPO or
  • Enrollment Worksheet
  • 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 64
  • 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. 65
  • 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
  • Contact us Streamlined enrollment 1-800-788-2197 form help@AffordableCA.com