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The affordable care act power point (updated) again


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A powerpoint to describe the ACA and how to sign up

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The affordable care act power point (updated) again

  1. 1. RLee Insurance Solutions The Affordable Care Act Understanding it and enrolling in your new health care plan
  2. 2. How does the ACA improve my health care? • Provides health insurance to those that were once considered „uninsurable‟ with preexiting health conditions. • Provides for certain protections and rights to make your coverage fairer and easier to understand. • Provides for a health care Marketplace for an easier shopping experience. • Holds insurance companies accountable for rate increases. • Makes it illegal for health insurance companies to arbitrarily cancel your health insurance. • Covers young adults under 26. • Provides free preventive care. • Ends lifetime and years dollar limits. • Guarantees your right to appeal Questions? Call 1-800-318-2596, 24 hours a day, 7 days a week. (TTY: 1-855-889-4325)
  3. 3. What will my new policy cover? All private health insurance plans offered in the Marketplace will offer the same set of essential health benefits. These are services all plans must cover. The essential health benefits include at least the following items and services: • Ambulatory patient services (outpatient care you get without being admitted to a hospital) • Emergency services • Hospitalization (such as surgery) • Maternity and newborn care (care before and after your baby is born) • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) • Prescription drugs • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills) • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services
  4. 4. OK so how do I start ? First thing you need to figure out is are you applying “on exchange” or “off exchange”? • If your income is between 100% - 400% of the federal poverty level then you may qualify for a federal subsidy, premium assistance tax credit. It was put into place to help reduce the cost of premiums, this subsidy may only be applied to “on exchange” plans. Since you can only use your subsidy with plans that are “on exchange” and you must enroll through the government web site • If your income is above 100% - 400% of the federal poverty level you may apply for either “on exchange” or “off exchange” plans. If you choose to enroll in a “on exchange” plan then you must go through the web site. Plans that are “off exchange” may be purchased though various web sites. • Lastly if your income is below 100% of the poverty level you do not qualify for a subsidy and in many cases you can enroll for Medicaid through or your State web site. You may also choose to buy an “off exchange” plan since no subsidy is involved.
  5. 5. How to calculate my subsidy? • First determine how many in your family/household. • Second calculate your modified adjusted gross income(MAGI). MAGI can also be located on: line 4 on a form 1040EZ line 21 on a form 1040A line 37 on a form 1040 • Third use a subsidy calculator to enter these numbers and find your subsidy. 2013 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA Person in family/household Poverty guideline 1 $11,490 2 $15,510 3 $19,530 4 $23,550 5 $27,570 6 $31,590 7 $35,610 8 $39,630 For families/household with more than 8 persons, add $4,020 for each additional person * The figures are the 2013 HHS poverty guidelines which are scheduled to be published in the Federal Register on January 24, 2013. (Additional information will be posted after the guidelines are published.) SOURCE: Federal Register, Vol. 78, No. 16, January 24, 2013, pp. 5182-5183
  6. 6. What are Federal Cost-Sharing Subsidies? Individuals with a household income of 100-250 percent of the federal poverty line, who enroll in a plan through the exchange,, are eligible for a cost sharing subsidy. Under the 2013 federal poverty guidelines, the annual income thresholds to qualify are: $28,725 for individuals; $38,775 for couples; $48,825 for a family of three; and $58,875 for a family of four. Cost sharing subsidies are designed to minimize out-of-pocket costs by reducing the amount individuals have to pay for deductibles, co-payments and co-insurance payments. The amount of the reduction depends on the insured‟s household income. For those with incomes between 100% and 200% of poverty, a 2/3 reduction applies. For others, the reduction in the limit is either ½ or 1/3, depending on income. The precise amount by which an individual‟s out of pocket maximum is reduced by this assistance depends on what the maximum is for the plan in which they are enrolled. • To receive a Cost-Sharing subsidy you have to have a Silver Plan, as these are the only eligible plans for this subsidy.
  7. 7. But which plan? The new plans will be labeled with “metallic” names, bronze, silver, gold, and platinum. There is also one more plan labeled “catastrophic” but only certain folks may apply for them. • Each plan with have a deductible, an amount you must pay before benefits are triggered. • After you have satisfied the deductible you will have to pay a co-pay, or coinsurance, a set percentage of your bill. • The good news each plan does have a maximum amount listed that you would have to pay. Should your health expenses exceed the maximum out of packet amount your plan will generally pay all remaining medical expenses.
  8. 8. The Plans… Catastrophic Plans Bronze Plans A catastrophic plan generally requires you to pay all of your medical costs up to a certain amount, usually several thousand dollars. Costs for essential health benefits over that are generally paid by the insurance company. Generally speaking, the Bronze Plan is intended to have the lowest premium of the 4 new categories of plans but charge the highest out-of-pocket costs for healthcare services. For people without group insurance from an employer or other group, the Bronze plan is the minimum health insurance plan in which they can enroll that will satisfy the Affordable Care Act‟s mandate for people to purchase health insurance. These policies usually have lower premiums than a comprehensive plan, but cover you only if you need a lot of care. They basically protect you from worst-case scenarios. • Only people under 30 may apply for them. • You may apply for a hardship exemption if over 30 Plans often have high deductibles. • *Not a subsidy eligible plan • Co-pay is at the 60/40 level
  9. 9. The Plans… Silver Plans Gold Plans The Silver Plans have lower out-of-pocket costs than the Bronze Plans but higher out- ofpocket costs than both the Gold and Platinum Plans. All Silver Plans share the same minimum health benefits but the way they charge out-of-pocket costs can differ significantly. The Gold Plan is one of the two plan types that an insurance company must offer in order to participate in a health insurance exchange. A health insurance exchange is a state marketplace for health insurance plans meeting the ACA requirements. • Subsidies in your state are based on Silver plans in your state. • Co-pay is at the 70/30 level One of the issues that the government intends to monitor is whether Gold and Platinum plans attract more sickly enrollees and drive up premiums. • These plans have the second lowest out-ofpockets of the metallic plans. • Co-pay is at the 80/20 level
  10. 10. The Plans… Platinum Plans Since the Platinum Plan has the most generous cost-sharing for enrollees, it is expected that these plans will typically have the highest premiums when compared to the Bronze, Silver, and Gold plans. It will be important to compare premiums among different insurance companies offering Platinum Plans. Moreover, deductibles and copayments will also differ among Platinum Plans. This is perfectly acceptable as long as the Platinum Plan covers 90% of healthcare expenses for a standard population. • Co-pay is at the 90/10 level Most Expensive Platinum Most Coverage Gold Silver Bronze Least Least Catastrophic Coverage Expensive
  11. 11. You Which Exchange is for you? • First Calculate your subsidy • Second choose your exchange path • Calculate Your subsidy Third click one of the blue balls on the bottom to enroll! Of course you can visit Or call our office 765-746-6459 for help, we are here to help. On Exchange Off Exchange Anthem Humana PHP Healthcare .gov
  12. 12. Our office Location RLee Insurance Solutions Located just off IN 26 in Lafayette Indiana, we are easy to find with ample parking and our facility is handicapped accessible. Click here for easy Directions 100 Executive Dr. Suite D Lafayette, IN 47905 Phone: 765-746-6459 Web: Email: