Oregon Affordable Care Act_McKenzie River Chamber Presentation
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Oregon Affordable Care Act_McKenzie River Chamber Presentation

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This presentation was given to the McKenzie River Chamber of Commerce to help educate and inform local business owners and individuals about Cover Oregon, Oregon's Health Care Exchange implemented in ...

This presentation was given to the McKenzie River Chamber of Commerce to help educate and inform local business owners and individuals about Cover Oregon, Oregon's Health Care Exchange implemented in accordance with the Patient Protection Affordable Care Act.

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Oregon Affordable Care Act_McKenzie River Chamber Presentation Oregon Affordable Care Act_McKenzie River Chamber Presentation Presentation Transcript

  • USA Benefits Group“The State of Health Insurance”• Patient Protection and Affordable Care Actaka: Obama CareTom Koanui541-914-8441Shonna Butler541-870-0815
  • Tom Koanui541-914-8441Shonna Butler541-870-0815Cover Oregon Health Care Insurance ExchangeThe Health Insurance Exchange is an online Market Place for people to shop andpurchase PPACA plans. PPACA plans will be available through a public exchange,private exchanges, and off-exchanges in Oregon. The State of Oregon wasgranted a $182 million grant to develop what we now know as Cover Oregon.Cover Oregon is the only public exchange in the state of Oregon and will be theonly means to acquiring a tax or cost share subsidy. Oregon is one of 3 states thathave a fully functioning public exchange in operation today and Oregon leads thenation in health care benchmarks.
  • Patient Protection Affordable Care Act• Adopted on March 23, 2010• Prior to March 23, 2010 plans are grandfathered• Most Americans are required to purchase• Exempt: certain religious groups, Native AmericanTribe, undocumented immigrants, prisoners, low income• 2 types of subsidies to help offset health care costs• Important dates to remember:- Open enrollment: Oct. 1, 2013 to Dec. 31, 2013- Extended enrollment: thru March 31, 2014- Plan effective date: Jan. 1, 2014• Creation of the health insurance exchangeTom Koanui541-914-8441Shonna Butler541-870-0815
  • Patient Protection Affordable Care ActHighlights for January 01, 2014• All individuals MUST have E.H.B. (Essential Health Benefits)• Guaranteed acceptance• No pre-existing condition exemptions• Maximum waiting periods of 90 days• NO RATING for health, gender, build & industry• 100% coverage for wellness visits• Metallic Levels: Bronze- Silver- Gold- Platinum• Insurance companies are required to spend 80 cents ofeach premium dollar on the cost of careTom Koanui541-914-8441Shonna Butler541-870-0815
  • Patient Protection Affordable Care ActEssential Health Benefits (EHB):1. Ambulatory patient services2. Emergency services3. Maternity and newborn care4. Pediatric services, including dental and vision care5. Rehabilitative/habilitative services and devices6. Mental health and substance use disorder services,including behavioral health treatment7. Preventive and wellness services and chronic disease management8. Hospitalization9. Prescription drugs10. Laboratory servicesTom Koanui541-914-8441Shonna Butler541-870-0815
  • Tom Koanui541-914-8441How will Health Reform affect me?Shonna Butler541-870-0815Individual:- Required to purchase- Penalty= 1% of taxable income or $95- May be eligible for tax subsidy- May be eligible for cost share subsidy- Estimated “taxable income” from previous year- Must purchase on exchange for subsidy- Non-medicare eligible may purchase- Need a knowledgable agentTax Subsidy:- Federal Poverty Level: $11,490-133% to 400% FPL- Single: $15,282 to $45,960- Couple: $20,928 to $62,040- Family: $31,322 to $94,200Cost Share Subsidy:-100-150% FPL= 94%- 150-200% FPL= 87%- 200-250% FPL= 73%- 250-400% FPL= 70%NOTE: Based on Silver Plan Actuarial Values
  • Tom Koanui541-914-8441How will Health Reform affect my business?Shonna Butler541-870-0815Small Business:- < 50 FTE not required to offer coverage- Penalty= 0- May be eligible for premium tax credit- May be eligible for full premium tax credit- May purchase on the exchange- Oregon zip code to purchase on exchange- Need a knowledgable agentPremium Tax Credit:- If elect to offer coverage-Pay min. 50% of FTE only- < 25 FTE- Average income of $50KFull Premium Tax Credit:- Up to 35% of FTE only premium- < 10 FTE- Average income of $35K
  • Tom Koanui541-914-8441How will Health Reform affect my business?Shonna Butler541-870-0815Large Business:- > 50 FTE required to offer coverage- Penalty= the lesser of $2,000 /FTE or $3,000 for eachemployee that receives subsidy, minus 30.- May be eligible for premium tax credit- May be eligible for full premium tax credit- Required to notify employees of PPACA and your choice- May purchase on the exchange- Oregon zip code to purchase on exchange- Realize increased cost of materials and supplies- Must consider price increases on products and services tocover additional expenses- Need a knowledgable agent
  • Tom Koanui541-914-8441PPACA Plan DesignShonna Butler541-870-0815
  • Tom Koanui541-914-8441Employer Program RequirementsShonna Butler541-870-0815
  • Oregon Exchange Plan DesignTom Koanui541-914-8441Shonna Butler541-870-0815
  • Tom Koanui541-914-8441Shonna Butler541-870-0815
  • Exchange Prescription Drug PlanTom Koanui541-914-8441Shonna Butler541-870-0815
  • Tom Koanui541-914-8441Proposed Rates and SubsidiesShonna Butler541-870-0815
  • Tom Koanui541-914-8441IndividualProposed Rates for Standardized Plans(Based on age 40 Non-Tobacco)Bronze 60% Silver 70% Gold 80%Moda (ODS): $169 $225 $276LifeWise: $195 $252 $303Pacific Source: $195 $257 $323Regence: $237 $280 NAKaiser: $229 $291 $344Trillium: $401 $486 $563Shonna Butler541-870-0815
  • Tom Koanui541-914-8441SubsidiesIndividual:Silver Plan $368Income:$20 K $283$26K $212$32K $131$38K $67$42K $36Family of 4:Silver Plan $1,102Income:$42K $916$50K $822$60K $693$70K $553$80K $469Shonna Butler541-870-0815
  • Tom Koanui541-914-8441Small BusinessProposed Rates for Standardized Plans(Based on age 40 Non-Tobacco)Bronze 60% Silver 70% Gold 80%Moda (ODS): $209 $309 $375LifeWise: $220 $292 NAPacific Source: $271 $358 $448Regence: $268 $316 NAKaiser: $222 $299 $354OR Co-Op: $284 $338 $403Shonna Butler541-870-0815
  • Tom Koanui541-914-8441Please consider scheduling a time to meetwith us to discuss PPACA privately or witha group of friends or family.Questions?If you would like to receive updates regardingPPACA, please give us your email addressShonna Butler541-870-0815