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Navigating Affordable Health Care


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Navigating Affordable Health Care

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Navigating Affordable Health Care

  1. 1. Navigating Affordable Health Care Personal Assistance Within Reach... Haywood County Library October 15, 2013 5:00 PM Jan Plummer Health Care Navigator Program Coordinator Mountain Projects, Inc.
  2. 2. Today's Topics Mountain Project's Role The MarketPlace Personalized assistance Privacy and Protection Eligibility and Enrollment Preparing for an Appointment Contact Information
  3. 3. Mountain Projects Community Action Agency NC Navigator Program: Our Role • MPI awarded a grant to implement a Navigator program in the seven counties in WNC • Counties: Clay, Cherokee, Haywood, Graham, Jackson, Swain, Macon • Local and personal assistance • Community education and partnership agencies • 5.5 employees- covering the 7 counties of WNC-Navigators • Volunteers trained and more needed
  4. 4. The Affordable Care Act Provisions GOAL: Affordable health care for millions TOOLS: The Marketplace/An Insurance Exchange • Shop, compare and purchase insurance based on income and household size. • Medicaid Expansion: NC did not expand • Individual Mandate beginning 2014/Exemption • Employer Shared Responsibility: Must offer a plan that meets ACA minimum essential benefits or pay a fee. (ESRP)
  5. 5. The Affordable Care Act Protections • Prohibits higher premiums due to health/gender • Extend coverage for dependents up to age 26 • Prohibits discrimination against consumers seeking coverage with pre-existing conditions • Eliminated Insurance Annual Coverage Limits
  6. 6. What is in the Marketplace? • One stop shopping to determine eligibility for Qualified Health Plans AND... New tax credits to lower premiums Reduced cost sharing Medicaid Children's Health Insurance Program (CHIP) Review choice of plans and levels of coverage Transparency, Competition, Choice
  7. 7. Navigator Assistance • • • • • • • • Unbiased, free, impartial Individuals or Small Employers Assigned to Counties Block Times at partner Agencies, i.e. DSS, Mountain Projects Community Events Can not go door to door Refer to state agencies if appropriate Appointments available
  8. 8. Jan Shuler Plummer Navigator in Training Graham/Swain Patti Deridder Volunteers certified in NC Navigator Program all Counties Clay/Cherokee Navigator in Training Macon Jane Harrison Rebecca Mathis NC Navigator Program
  9. 9. How Can a Mountain Projects Navigator Help Me? • Certified to assist through enrollment • Explain insurance terminology; choices; implications • Unbiased, impartial, and free • Privacy/Confidentiality • No rush, no pressure, no affiliation • Resource for questions • May complete on-line or paper applications
  10. 10. Marketplace Consumers Individuals Small Businesses • Need health insurance • Have health insurance they can't afford • Have dependents or a spouse that make insurance unaffordable • Employed by a small employer getting health insurance through the Marketplace • Investigate coverage for employees • Explore options via the Marketplace • Questions about exemptions and penalties • Have 50 FTE's or equivalent
  11. 11. Eligibility and Enrollment • Started October 1, 2013 • Enroll by December 15,2013 coverage begins January 1, 2014 • Ends March 31, 2014 First Month • Special Enrollment Periods Premium Due October 1 2013 January 1 2014 December 15 2013
  12. 12. How to Prepare Individuals Employer • SSN for Household/Birthdates • Pay Stubs/W2 Tax Information for 2013/estimate2014 • Employer insurance information (handout) • Additional HH income information • Names of employees with DOB • Expected enrollment • Existing health coverage? • Age of Spouse • Dependent information • Agent may help enroll/explore
  13. 13. Qualified Health Plans Minimum Essential Benefits • • • • • • • • • • Ambulatory Patient Services Emergency Services Hospitalization Maternity and Newborn Care Mental Health/Substance Abuse/Behavioral Health Treatment Prescription Drugs Rehabilitation: physical or mental Labs Wellness/Chronic Disease Management (Asthma, diabetes) Pediatric Services including dental
  14. 14. Categories of Health Plans The Four Metal Models BRONZE: Minimum Essential Benefits/Insurance pays 60% of covered expenses SILVER: Minimum Essential Benefits/Insurance pays 70% of covered expenses GOLD: Minimum Essential Benefits/Insurance pays 80% of covered expenses PLATINUM: Minimum Essential Benefits/Insurance pays 90% of covered expenses CATASTROPHIC: Meet all QHP requirements but only cover 3 primary care visits annually until deductible is met. Must be under 30 or receive a hardship exemption.
  15. 15. Options to Lower Costs Premium Tax Credits - Lower monthly premiums/HH income, size, cost of available plans Cost Sharing Reductions - Limits out-of-pocket costs (deductibles and co-pays)/HH income/size MAY REQUIRE SILVER PLAN SELECTION Competition in the Marketplace - Blue Cross and CoventryOne
  16. 16. Exemptions to Individual Responsibility Requirement Investigate first • Hardships: Homelessness, eviction, foreclosure, utility shut-off, domestic violence victim, death of close family member, recent bankruptcy, unexpected caretaker expenses, eligibility denials, coverage exceeding 8% of projected annual income, ineligible for Medicaid/no state expansion Navigators can not assist with the exemption application. (IRS) • • • • Incarceration Indian Status Religious Conscience Health Care Sharing Ministry Past months Past and Future Complete IRS Form 4029 Past months
  17. 17. Personal Assistance Mountain Projects: 828-452-1447, ext. 115/1-800-627-1548 Toll Free Number: All NC Counties: 1-855-733-3711 Health Insurance Marketplace: 1-800-318-2596