Health Care Reform
for Individuals & Families
Brian J. Schroeder - LUTCF
AdvoCare Insurance Services
“Advocates for Afford...
Why The Affordable Care Act
Health care costs continue to rise
Outcomes not getting any better
50% of small businesses no ...
Highlights of the PP/ACA
EHB – set up minimum standards
Expands Patient Rights & Appeals
Mandates to acquire coverage
Min ...
10 EHB – Essential Healthcare Benefits
Ambulatory patient services
Emergency services
Hospitalization
Maternity and Newbor...
Our Exchange Is CoveredCA
Opened Oct 1st for indiv & families
5.6 Million currently uninsured
Californians can get Coverag...
The 4 Exchange Health Plan Options
Benefits

Bronze

Silver

Gold

Platinum

Deductible

$5000*

$2000

$0

$0

Dr Copay

...
12 Health Insurance Companies
Anthem Blue Cross
Blue Shield
Health Net
Kaiser Permanente
Alameda Health Alliance
Chinese C...
Key Facts About Premium Assistance
Reduces the cost of your monthly premium.
Only applies to enhanced Silver Plans
Helps l...
A Real Life Illustration
Silver Plan premium subsidy & tax credit for middle
aged couple with 2 kids earning $48,000 per y...
The Penalties For Not Enrolling
1st year – $95/adult + $47.50/child,
or 1% of reported income, whichever is greater,
to a ...
What This Means to You
Get informed, know your options
Talk to your health insurance agent
Develop a coverage strategy tha...
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Brentwood Covered California Agent on Obamacare Healthcare Reform (800) 536-7522

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http://advocareassoc.com/ (800) 536-7522
Brian Schroeder is a certified Brentwood Covered California Agent that specializes in Obamacare Healthcare Reform here in Brentwood California.
I am an independent insurance agent that offers health insurance plans from all the major carriers in California. This presentation slide helps you better understand Obamacare and what it means to you here in California.
http://advocareassoc.com/ (800) 536-7522

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Brentwood Covered California Agent on Obamacare Healthcare Reform (800) 536-7522

  1. 1. Health Care Reform for Individuals & Families Brian J. Schroeder - LUTCF AdvoCare Insurance Services “Advocates for Affordable Health Care” Independent Agents providing: - Individual & Family Health Plans - Medicare & Part D Plans - Accident & Disability Coverage - Critical Illness Plans - Long-term Care Insurance - SG Employee Benefits
  2. 2. Why The Affordable Care Act Health care costs continue to rise Outcomes not getting any better 50% of small businesses no longer offer health care benefits To cover more of the 46 million Americans without health insurance Annual out-of-pocket costs are $160B and rising No apparent signs that insurance rates were leveling off Looming health crisis needed a solution
  3. 3. Highlights of the PP/ACA EHB – set up minimum standards Expands Patient Rights & Appeals Mandates to acquire coverage Min Loss Ratio – premium rebates $0 Co-Pays for Preventive Care ACOs – Accountable Care Orgs State Health Insurance Exchanges Taxes and Fees to help pay for it
  4. 4. 10 EHB – Essential Healthcare Benefits Ambulatory patient services Emergency services Hospitalization Maternity and Newborn care Mental health, substance abuse treatments Prescription drugs Re/Habilitation services & devices Laboratory services Preventive & Wellness services Pediatric services including dental &vision
  5. 5. Our Exchange Is CoveredCA Opened Oct 1st for indiv & families 5.6 Million currently uninsured Californians can get Coverage Most will Qualify for Premium Subsidies and Tax Credits Subsidies are based on annual household income and total family members Subsidies help pay monthly premiums and OOP expenses Standardized plans for Individuals, families, and small business
  6. 6. The 4 Exchange Health Plan Options Benefits Bronze Silver Gold Platinum Deductible $5000* $2000 $0 $0 Dr Copay $60 – 3x $45 $30 $20 Sp Copay $79* $65 $50 $20 Urgent C $120* $90 $60 $40 Lab 30%* $45 $30 $20 X-Ray 30%* $65 $50 $40 ER $300* $250 $250 $150 Imaging 30%* $250 $250 $150 Gen Rx $19* $19 $19 $5 Brand Rx $50* $50 $50 $15 OOPM 1 $6350 $6350 $6350 $4000 OOPM F $12700 $12700 $12700 $8000
  7. 7. 12 Health Insurance Companies Anthem Blue Cross Blue Shield Health Net Kaiser Permanente Alameda Health Alliance Chinese Community Health Contra Costa Health Plans Sharp Molina Healthcare L.A. Care Western Advantage Valley Health Plans
  8. 8. Key Facts About Premium Assistance Reduces the cost of your monthly premium. Only applies to enhanced Silver Plans Helps low and middle-income individuals and families who earn less than 250% FPLs <$28,275 individual, <$58,857 family of 4 Can be used when you enroll. Is only available through Covered California. Is paid directly to your health plan. Will be adjusted at the end of the benefit year based on your actual income, if your income is different than you anticipated. Can be split between premium reduction and cost share reductions Not available if you are paying less than 9.5% of your household income for employer coverage.
  9. 9. A Real Life Illustration Silver Plan premium subsidy & tax credit for middle aged couple with 2 kids earning $48,000 per year. Monthly Credit Actual Saving/year Husband 45 $1,075 $729 $346 $8,748 Wife 42 w/2 children Annual medical deductible $2,000. Largest is $5,000 Individual Out-of-Pocket max = $6,400 Family Out-of-Pocket max = $12,800 Co-pays for primary doctors, specialists, urgent care, generic Rx, lab testing, X-ray, and ER Hospital – 20% of negotiated rate $500 annual brand named Rx deductible *Add separate Dental, Accident/Injury, or Critical Illness coverage
  10. 10. The Penalties For Not Enrolling 1st year – $95/adult + $47.50/child, or 1% of reported income, whichever is greater, to a maximum of $285 per family. 2nd year – $325/adult + $162.50/child, or 2% of reported income, whichever is greater, to a maximum of $975 per family. 3rd year – $625/adult + $374.50/child, or 2-1/2% of reported income, whichever is greater, to a maximum of $2,085 per family. No good reason not to enroll.
  11. 11. What This Means to You Get informed, know your options Talk to your health insurance agent Develop a coverage strategy that fits your unique needs and budget Compare more than just price Get advice if you feel you need it. There is no reason to go it alone. Be flexible. Expect some bumps.

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