3. Enrollment timeline
Families
USA
2013
FamiliesUSA.org
October 15th, 2013-March 31st 2014
• Open enrollment
April 1st, 2014- November 14th, 2014
• Open enrollment CLOSED
• Medicaid and CHIP enrollment OPEN ALL YEAR
• Limited circumstance “special enrollment periods” for complicated
application problems
• Special enrollment periods for people with certain life changes
November 15th, 2014-February 15th 2015
• Open enrollment for 2015 coverage
• Medicaid and CHIP enrollment continues
Jan. 1, 2015 – April 15, 2015
• First reconciliation with tax filing
February 16th, 2015- October 7th, 2015
• Open enrollment closed!
5. Congratulations!
8.02 Million individuals signed up for marketplace plans
• 89% of enrollees received financial assistance
More than 14.7 million people have signed up for
Medicaid/CHIP
• > 4.8 million are in the newly eligible expansion population
Studies show that uninsured people have gotten
coverage:
• RAND: 9.5 million previously uninsured people received
FamiliesUSA.org
coverage
• Gallop: Uninsured rate dropped to 13.4%, the lowest level since
polling began in 2008
6. Marketplace Enrollment through March 31, 2014
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
FamiliesUSA.org
26,794
110,410
1,059,226
743,158
681,498
2,825,092
79,391
148,087
729,513
402,913
261,335
952,346
0
October November December January February March/April
FFM SBM
*Federally Facilitated Marketplace (FFM)/ State Based Market Place (SMB) breakdown for
March estimated.
11. Who applies for coverage AFTER March 31st
FamiliesUSA.org
Parents with uninsured children or teens
People who are very low income
People who live in states that expanded Medicaid
People who have had certain life changes may
be able to enroll and get financial assistance
You may gain important protections if you can’t get health
insurance because your state did not expand Medicaid
12. Enrollment isn’t really over
Special Circumstances:
FamiliesUSA.org
lost other coverage when you left a job, aged out, lost eligibility
for Medicaid/CHIP, your individual market plan ended
family size changed (birth, marriage, etc.)
moved to a place not served by your plan
gained citizenship/ new lawful resident
left incarceration
had a certified hardship that ended
victims of domestic abuse who can’t file joint tax returns
have until May 31
people who encountered errors/problems on the
marketplace
Apply for Medicaid and CHIP all year – enrollment never closes
American Indians/Alaska Natives – enrollment never closes
13. Can you get Medicaid or CHIP?
For adults, if your state has expanded Medicaid you might qualify
if your income is lower than:
If you don’t qualify for Medicaid because of immigration status, you
may still be able to get covered by Medicaid for emergency services
FamiliesUSA.org
People in the Household Household Income
1 $16,105
2 $21,707
3 $27.310
4 S32, 913
14. What can YOU do?
FamiliesUSA.org
Know
where
people can
get care
Spread the
word that
people
may still
apply
Learn the
facts about
the penalty
Plan for
next open
enrollment
Partner
with us
What can your organization do right now?
16. What is the Penalty?
Starting this year, you must have health insurance or an allowable reason
for not getting health insurance, or pay a penalty when you file taxes.
You may not have to pay the penalty if you:
Were uninsured for less than three months
in a row
Have income low enough that you don’t
have to file taxes (even if you file to get a
refund)
Do not have eligible immigration status to
get insurance
Can’t get health insurance because your
state has not expanded Medicaid
Your private insurance plan is cancelled and
you can’t afford other insurance
FamiliesUSA.org
17. How much is the penalty?
If you have to pay a penalty for not
having health insurance, the amount
you pay for each of the months you
don’t have insurance will be
whichever of the following amounts
is higher:
• 1% of the income your family makes
above the tax filing threshold, not
counting social security income, OR
• $95 for each adult and $47.50 for
each child, up to $285 for a family
There will be some maximum amount for the penalty, but this
maximum amount is not yet set.
FamiliesUSA.org
18. How do you apply for protection from the penalty?
You can apply for an exemption from the penalty by:
1) Calling the Marketplace at 1-800-318-2596
2) Going online to https://www.healthcare.gov/exemptions/
FamiliesUSA.org
and mailing in a paper application
3) Contacting a Marketplace in-person assister listed on
localhelp.healthcare.gov
19. Medicaid gap states: why apply?
1) People who submit a health insurance application
will not have to pay a penalty if they can’t get
health insurance even if their income increases
2) If your income increases, you may be eligible to
get financial assistance for a private health
insurance plan, even if your income was too low
when you first applied
FamiliesUSA.org
20. How do people apply?
You can apply any of the following ways:
1) Call the Marketplace at 1-800-318-2596
2) Go online to healthcare.gov
3) Contact a Marketplace in-person assister listed on
FamiliesUSA.org
localhelp.healthcare.gov
4) Go to your state Medicaid or CHIP agency
21. Reminder! After you get health insurance
Take these important steps to keep and use your health
insurance:
Pay your health insurance premium every month
Schedule an appointment with an in-network primary care
provider (preventative services are free!)
Call your health plan with questions
Respond to any notices from the marketplace
Tell the marketplace about changes to the information on
your application
FamiliesUSA.org
22. 1201 New York Avenue, NW, Suite 1100
Washington, DC 20005
main 202-628-3030 / fax 202-347-2417
Questions?
Name
Organization
Email
Website
Editor's Notes
Presentation Goals
Provide overview of the Affordable Care Act (ACA)
Explain my role
Explain why the ACA is important to you, and what you can do to help get your friends and neighbors enrolled into health insurance
Answer questions you may have
ACA background
- Law passed in 2010
Helps more people get health insurance:
o People can no longer be denied coverage for pre-existing conditions (like diabetes, pregnancy, high blood pressure or cancer)
People can no longer be charged more for their gender or have annual/lifetime caps on how much their health insurance will pay for their care
o Young adults can stay on their parents coverage until they are 26
o Drug coverage for seniors
o Created New marketplaces for people to shop and compare prices to get health insurance
Although the law passed in 2010 and these protections were put in place over the last few years, people were not able to start applying for coverage until this past October.
Example: building these marketplaces is like building a home. The permission was given in 2010, but when the law passed, they knew people needed time to build it, which is why people couldn’t start applying until October of last year.
So when can people apply?
Similar to private health insurance there is a time period every year when people can enroll. This is called open enrollment. The first open enrollment period was from October 1st, 2013 through March 31st 2014.
The next open enrollment period (which is when EVERYONE can apply) begins on November 15th.
What you’ll notice with this timeline is that right now, although open enrollment is CLOSED, some people can still apply. I’ll discuss that more in a minute.
So how successful was this last open enrollment period?
Glossary
Special enrollment periods (these are times when people can apply because something happened in their life that changes (marriage, birth, move, etc.)
Medicaid: health insurance for adults, children and families with low incomes, and certain seniors and people with disabilities
CHIP: The Children’s Health Insurance Program is a health insurance for children and teens under the age of 19.
Some of you may wondering how this relates to you because you already have health insurance. Some of you may already have health insurance and some may not. Some of you may have always had health insurance and are wondering why it’s important to YOU for others to be covered.
Good for health
Good for economy
Good for education
Why is this good for the community? - Having insurance helps people stay healthy
Healthy kids learn better and do better in school. When parents have health insurance, both them and their children are more likely to be healthier. - Not having insurance is the #1 cause of bankruptcy - Helps keep hospitals open for emergency use
When people who don’t have health insurance get sick or have an accident and use the emergency room, we all end up paying for it. By all of us having coverage, the cost of health insurance will decrease, fewer people will stay home from work sick which is good for the economy, and children will be able to learn better (as they will be less likely to get sicker and miss more school).
So now that you know what it is, when you can apply, and why it’s important- you may be wondering: how successful was it?
The congressional budget office estimated that seven million America would apply for coverage this year. Although the administration never set a goal for open enrollment, based on these numbers, enrollment was tremendously successful. It highlights that around the country, people want health insurance- they just haven’t been able to afford it in the past.
To take a deeper dive into what it looked like:
This pattern of enrollment was similar to what was predicted. We saw an uptick of people applying in December, trying to get their coverage to start January 1st. Because open enrollment closed March 31st, there was a tremendous amount of marketing going into spreading the word for people to apply, which is when we saw the surge in numbers.
What did this look like in [insert your state]? We don’t have the monthly breakdown yet, but we do know what is possible here. If we reach all of the folks in [insert your state] that can get financial help paying for coverage, this is how many could get assistance. The biggest issue is they don’t know it. That’s where you and I come in.
Insert the graphic for your state: http://familiesusa.org/product/financial-assistance-and-affordable-care-act-who-benefits
Talk about how many people have enrolled in your state and how many people are eligible, but have not yet enrolled: http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014Apr_enrollAddendum.pdf
Use the HHS state-by-state enrollment profiles to provide specifics on enrollment in your state: http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/Marketplace_StateSum.cfm
Next slide:
My role
Maintain expertise in eligibility, enrollment, and program specifications
Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange Facilitate selection of a Qualified Health Plan
Provide information and services in a fair, accurate, and impartial manner
Conduct public education activities
Provide referrals
Over the last six months I’ve been working with consumers to get covered.
Next slide
We continue to spread the word that coverage is available for some folks (kids and teens, people with life changes)
We help consumers who are currently eligible to apply
We help consumers navigate the system. For many people this is their first time having health insurance so they have a lot of questions about how to use their coverage
We partner with organizations like yours to make sure the people you reach have access to coverage.
We plan for the next open enrollment period, so with YOUR help, we make sure that all uninsured consumers are able to enroll in coverage.
Life changes all the time. People lose jobs, change jobs, get married, get divorced- when you think of your community, think of yourself as a leader- as that connector for people. What can you do to make sure that people know what it means when they hear that coverage is available. Know that I am here to help them through that.
We want to make sure we are reaching those people.
You or family members may be able to enroll in Medicaid or the Children’s Health Insurance Program.
There is no limited enrollment period for Medicaid and CHIP
You can apply and get coverage starting right away at any time of the year
Medicaid and CHIP are available at higher income levels for:
Children
Pregnant women
Young adults under 26 who were formerly in foster care
Individuals with disabilities
So just to do a slightly deeper dive: I want to make it clear that if people have a change in their life, they may be eligible for coverage. The best thing you can do is have them either go online to healthcare.gov or contact me.
Losing other health insurance, including coverage from a job or a family member’s job, Medicaid, CHIP, COBRA (insurance after job loss)
Your job makes a change to your insurance and you can no longer afford it
Get married
Birth, adoption, placement for foster care or adoption
Permanent move (including release for prison or jail)
Become a citizen, national, or lawfully present
You receive an exemption from the marketplace for not having health insurance because of a hardship and you no longer have the hardship (You applied, but didn’t qualify because your state has not expanded Medicaid and your income increases)
You didn’t get health insurance or financial assistance because of a mistake made by the marketplace
Talk about Medicaid eligibility in your state
There will always be people who are uninsured. As community leaders, know where uninsured consumers can go to get health care services (like community health centers).
As you saw, some people can apply for coverage between open enrollment periods. It’s crucial to make sure that people know this and are applying. If someone has kids or has a life change, spread the word that I’m available to help them, or they can go online and apply.
Learn the facts about the penalty
What role do you want your organization to play during the next open enrollment period? How can you better reach people in your community? What do you need to be ready to go on November 15th? Start planning now.
As navigators, we work to get people enrolled into health coverage. Partner with us to make sure the people you reach, have help applying. During this open enrollment period, make sure to send people who can apply, our way so we can help with them with the process.
Now I wanted to change directions and go through some details that are commonly asked questions- before I do- does anyone have questions on what I’ve just discussed?
Would have to pay more than 8% of your household income for insurance
Have a hardship (unexpected increase in expenses, buying health insurance would prevent you from paying for other necessities, and other extenuating circumstances)
Are in jail or prison after a conviction
Are a member of a recognized health care sharing ministry
Belong to a federally recognized American Indian or Alaska Native tribe
Are eligible for services through an American Indian health care provider
Belong to a religious sect that is opposed to insurance
For most reasons that allow you not to pay the penalty, you can indicate on your tax return that you didn’t have health insurance for that reason.
You should tell the marketplace as soon as possible if you are not getting health insurance for any of the following reasons (getting an exemption for these reasons now can provide you with important protections if your circumstances change during the year):
You would have to pay more than 8% of your household income for insurance
You are eligible for services through an American Indian health care provider
You belong to a religious sect that is opposed to insurance
You can’t get health insurance because your state has not expanded Medicaid
Have a hardship (unexpected increase in expenses, buying health insurance would prevent you from paying for other necessities, and other extenuating circumstances)
Your private insurance plan is cancelled and you can’t afford other insurance
This is confusing and I wish it weren’t. As of right now, the maximum amount for the penalty will be based on the national average cost of bronze plans.
Things to keep in mind
you have to be uninsured for three months in a row
The amount you owe is divided on a monthly basis. For example: take the amount, divide it by 12 and then multiple apply it by the number of months you were uninsured for that year.
Reminder to you and your community
Let me know if you need help doing any of this
A lot of the language is confusing, we understand that and are here to help.
Glossary
In-network: your “network” consists of doctors and other providers your health insurance company works with. Your health insurance company has arranged for certain providers to be in your network and has agreed to pay them for it. Seeing “in-network” providers costs you less money.
Premium: the money you pay to your health insurance company (usually every month)
