Find Your Way Around The New Health Care Law (ACA/ObamaCare)
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Have questions about the new health care law aka the affordable care act aka Obamacare? AARP is here to help with resources and FAQ's to guide you along the way! If you're looking for Illinois specific information be sure to check out GetCoveredIllinois.Gov
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Find Your Way Around The New Health Care Law (ACA/ObamaCare)
- 1. Find Your Way Around The Health Care Law
- 2. 2 Agenda People with health insurance People who are uninsured or buy their own coverage People with Medicare
- 3. 3 People with Health Insurance
- 4. Adds More Consumer Protections • Insurance companies can’t drop coverage if you get sick (Now) • Insurance companies must justify increases to premiums and spend more on health care over administrative costs (Now) • No one can be denied coverage for a pre-existing condition (2014) 4
- 5. 5 Eliminates Lifetime And Annual Coverage Limits • Insurance companies can’t place lifetime limits on your coverage (Now) • Insurance companies can’t place annual limits on your coverage (2014)
- 6. 6 Mammograms Immunizations Screening for cancer or diabetes Requires Coverage For More Preventive Services
- 7. 7 People Who Are Uninsured Or Buy Their Own Coverage
- 8. 8 Makes It Easier to Buy Health Insurance Offers Health Insurance Plans by 2014 The Health Insurance Marketplace
- 9. 1. Doctor visits 2. Emergency Services 3. Hospital care 4. Maternity and newborn care 5. Mental health and substance use disorder services, including behavioral health treatment 6. Prescription drugs 7. Rehabilitative services and habilitative services and devices 8. Laboratory services 9. Preventive and wellness services, and chronic disease management 10.Pediatric services, including oral and vision care 9 Core Set Of Benefits
- 10. Several Levels Of Coverage 10 Based on average cost of an individual under the plan. Figures may not be the same for every enrolled person.
- 11. • Starting 2014 • For health insurance purchased through the Marketplace • Must meet income limits to be eligible 11 Provides Help Paying For Insurance
- 12. Extends Coverage To Young Adults 12 Adult children can stay on your family policy until age 26 even if they: • No longer live with you • Are married • Are no longer in school
- 13. Options For States To Expand Medicaid • Your state has the option to expand coverage to more people • Starts in 2014 • Must meet income limits to be eligible 13
- 14. 14 People Who Have Medicare
- 15. • Protects guaranteed Medicare benefits • Improves Medicare benefits • Lowers out-of-pocket costs for prescription drugs 15 For People With Medicare
- 16. 16 Lowers Out-Of-Pocket Drug Costs 2020: Coverage gap will disappear Part D cost sharing will remain 2013: 52.5% discount on brand name drugs 21% discount on generics
- 17. Medicare Drug Coverage 52.5% discount for Brand Name and 21% for Generic Initial Benefit Catastrophic Benefit You pay: Deductible and 25% of drug costs You pay: 5% of drug costs Doughnut Hole
- 19. 19 Medicare Covers More Preventive Services • Expands coverage for preventive care • No copayments or deductibles for Medicare- approved preventive care Call Medicare at 1-800-633-4227 www.medicare.gov
- 20. • Increases consumer protections • Makes it easier to find health insurance • Improves Medicare-covered benefits 20 Key Points To Remember:
- 22. The Health Care Law www.HealthLawAnswers.org www.MiLeydeSalud.org Medicare www.medicare.gov 1-800-633-4227 www.healthcare.gov 1-800-318-2596 22 For More Information
Editor's Notes
- Welcome to this presentation “Find Your Way Around The Health Care Law”If you are like many people, you may have questions about what the health care law means for you. Learning the benefits and protections within the law, you can find your way, get the facts, and make informed decisions for yourself and your family.
- Today’s session will provide an overview of the key benefits and protections within the Affordable Care Act, more commonly referred to as the health care law. We realize there is, and will continue to be, a lot to learn about the health care law. This is a starting point to get you acquainted with the law and some of the key provisions. Here is what today’s session will cover: We will go over what the law means for several groups of people: Those who have insurance Those who do not have coverage or who buy coverage on their own People with MedicareWe will also provide you with resources on where you can go for more information and assistance.
- The health care law has already helped millions of people. Let’s start by discussing how the law will provide benefits and protections for different groups of people - specifically, people with health insurance, people without health insurance and people with Medicare.The first group we’re going to discuss are people who currently have health insurance.
- The law adds more consumer protections so you can be confident your health coverage will be there for you when you need it!For instance, as long as you continue to pay your premiums, health insurance companies cannot drop your health coverage if you become sick or disabled. There are also protections in place to limit increases to insurance premiums. Insurance companies must now justify any rate increases of 10% or more and the must spend more of your premium dollars on health care as opposed to administrative costs.Starting in 2014, no one can be denied coverage because they have a pre-existing condition, like asthma, diabetes, high blood pressure or even cancer.
- The law also makes changes in the limits that an insurance company can place on your coverage. Before the law was passed, some insurers could limit how much they would pay for your care during the year and over your lifetime. So, once your insurance coverage ran out, you would either have to pay out-of-pocket for all of your medical expenses, or go without medical care.Because of the health care law, insurance companies will no longer be allowed to limit how much they will pay for covered medical benefits over your lifetime—giving you peace of mind that your benefits won’t run out when you need them the most. Insurance companies also won’t be allowed to limit how much they will pay for your medical benefits over the course of a year. The ban on lifetime limits is in effect now, and the ban on annual limits starts in 2014.
- Another change under the law is in the area of preventive health services. Most insurance plans, including Medicare, must now cover certain preventive benefits such as immunizations, and screenings for diabetes and certain cancers. This includes mammograms and colonoscopies. Again, these benefits are in effect now. So, please check with your insurance plan to see which of these services are covered at no cost to you.
- As we all know, there are many Americans who either do not have health insurance, or have to buy their own insurance. Let’s take a look at how the health care law will affect this group.
- If you are uninsured or buy your own coverage, the health care law will make it easier to find health plans in your state and choose the plan that is best for you and your family.If you are uninsured, own a small business, or are self-employed, you will be able to purchase health insurance through the Health Insurance Marketplace in your state. Think of the Marketplace as an online shopping mall for health insurance. TheMarketplace is designed to help you find health insurance in one place, where you can compare the benefits and costs of health plans side-by-side. The Initial Enrollment Period to sign up and purchase health insurance through the Marketplace will begin in October 1st this year (2013). Coverage will begin as early as January 2014. Remember, the Marketplace is for people by are uninsured or buy their own coverage. If you are already covered by your employer or have coverage through Medicareyou do not need to purchase any additional coverage in the Marketplace. If you have Medicare, Medicare supplemental plans will not be available in the Marketplace. You will continue to enroll in Medicare or Medicare Advantage the same way you always have at medicare.gov
- Every health plan offered in the Health Insurance Marketplace is required to offer a core set of 10 comprehensive benefits including doctor visits, emergency services, hospital care, prescriptions, preventive care and more.
- Health plans offered in the Marketplace will also have several levels of coverage to chose from. Each level of coverage pays a different percentage of covered costs. This chart represents the levels of coverage for health plans offered through the Marketplace and what the plan pays on average and what you would pay on average--in addition to your monthly premium, of course. For example, Silver level plans pay on average 70 percent of the costs of your covered benefits and you pay about 30 percent of the costs. As you can see, these different level of coverage, gives you a way to make apples-to-apples comparisons so you can get a clear picture of coverage and costs before you decide on a plan.
- One of the hallmarks of the law is that it provides financial help to pay for health insurance for those who cannot afford coverage. Starting 2014, depending on your income, you may be able to get financial help with the costs of your premiums and other out of pocket costs for health insurance purchased through the Marketplace. For example, a family of four earning less than $94,200 a year may be able to get financial help. Low-cost or free plans are also available, depending on your income.
- As you know, there are many young adults who are no longer covered by a family policy or don’t have insurance through their job. But, now, because of the health care law, you may be able to cover your son or daughter on your insurance policy until they reach age 26. If you currently have your children on your health insurance, you can keep them on your family policy until they reach 26—even if they no longer live with you, are married, and are no longer in school. You do not have to claim them as a dependent on your tax return. If your adult children are not included on your health insurance, and you want them to be—you will be able to add them to your policy — if your insurer provides family coverage. However, if you’re adding adult children to your policy, their coverage may not begin until the start of your new insurance plan year. It is important to note that insurance companies and employer-based plans are not required to offer family plans. So you will want to be sure to check with your insurance company or with your employer to see if your adult children can be included on your family policy. Also, if you adult children have access to coverage through a job, you will not be able to add them to your plan. To be insured, they will have to be enrolled in their employer’s health plan.
- Another way the health care law can help people who do not have health insurance is through the expansion of the Medicaid program. It is important to point out that it is up to each state to decide if they wish to allow more people to get Medicaid.Remember, Medicaid is a very different program than Medicare. Medicaid is a health insurance program for low-income people that is jointly funded by the federal government and the states. It currently provides health coverage to children, older persons, disabled persons, with low incomes. Starting in 2014, if your state decides to expand their Medicaid program, you may be able to enroll in Medicaid. You would need to meet the income limits which are currently about $15,000 a year for an individual and about $20,000 per year for a couple. Note that these figures will most likely change in 2014 as they do every year.
- Let’s turn now to people with Medicare. What benefits and protections does the health care law have in store for this group?
- The law aims to improve Medicare by requiring Medicare to spend more wisely. If you have Medicare, your guaranteed Medicare benefits are protected. This includes doctor and hospital visits, and rehabilitation services. This is true whether you have Original Medicare, which includes Part A and Part B, or a Medicare Advantage plan.You will also receive improved benefits. For example, improvements to Medicare will lower your out-of-pocket costs for prescription drugs.
- Before the health care law was passed, you would have to have paid all of your prescription drug costs while you were in the doughnut hole. If you reach the Medicare Part D doughnut hole this year (2013), you’ll get a 52.5% discount on brand-name prescription drugs and a 21% discount on generic prescription drugs while you are in the coverage gap. The gap will gradually narrow until it disappears in 2020. However, even after the gap is gone, everyone with Part D will still have the same level of cost sharing -- about 25% -- from the time you meet your deductible until the time you reach catastrophic coverage.Catastrophic coverage remains in place even after the coverage gap goes away. Catastrophic coverage starts when your total out-of-pocket drug costs have climbed to $4,750 in 2013. After that point, you only have a 5% co-payment.
- Let’s take a minute to review the Medicare Part D Doughnut Hole. I know this can be confusing, so here’s a visual presentation of the doughnut hole that may be helpful. Starting on the left side, this is your initial benefit period where you pay your Part D deductible and about 25% of your drug costs. Moving to the middle, once you reach the initial coverage limit, you are in what is commonly called the "Coverage Gap” or "Doughnut Hole,". You reach the doughnut hole when you exceed a certain amount, which in 2013 is $2,970. As I just noted on the previous slide, this year (2013), your Part D plan will pay about 52.5% of the cost of brand-name prescription drugs and about 21% of your generic prescription drug costs while you are in the doughnut hole. By the way, exactly how much you pay out of pocket for each drug while you are in the doughnut hole will vary widely depending on the Part D plan you’ve chosen and the price your plan has negotiated with the companies that manufacture your drugs. When your total out-of-pocket expenses for drugs on your plan’s approved drug list reaches $4,750, you reach the "Catastrophic Coverage " benefit. From then until the end of the year, you pay roughly 5% of your drug costs under the catastrophic benefit. Just to clarify a bit …. your out of pocket costs include your deductible, copayments, and coinsurance. But this does not include your Part D premiums.
- You can use AARP’s Doughnut Hole Calculator to find out if or when you will hit the coverage gap and you’ll also find recommendations for less expensive drugs. When you click on the Doughnut Hole Calculator, you just enter your zip code and follow the steps. It’s easy to use and points you to ways to save right now on your drug costs. It’s at www.aarp.org/doughnuthole
- You no longer have to pay for Medicare-approved preventive care services. You will also be able to work with your doctor on a personalized prevention plan to keep you as healthy as possible. These are just a few of the examples of the preventive benefits that are now covered by Medicare. They include:A yearly wellness visit. Screenings for diabetes and certain cancers. This includes mammograms, colonoscopies, and other preventive screenings.These preventive services are in addition to the free “Welcome to Medicare” checkup available to every new person with Medicare during the first year of entering the Medicare program.The Secretary of Health & Human Services may also add other tests, screenings, or counseling, as we move forward in the future. You will not have to pay co-payments or deductibles for these Medicare-approved preventive care services.Call Medicare at 1-800-633-4227 or visit www.medicare.gov to see which of the Medicare-approved preventive care services are covered at no cost to you. Your copy of the booklet Medicare and You also has a long list of all the preventive screenings now available. You can get the booklet by calling Medicare at 1-800-633-4227.If you are in a Medicare Advantage plan, check with your plan to see if you’ll have co-payments or deductibles for any screenings or tests.
- There’s a lot to absorb about the health care law. Here are some key points to remember:The law : Increases consumer protections Makes it easier to find health insurance Improves Medicare benefits
- There is a lot to learn about the health care law and the best way to stay informed is to use AARP’s online tool Health Law Answers. AARP’s Health Law Answers is the only tool of its kind in English and Spanish. This one-of-a-kind online tool explains what the health care law means for you and your family. Health Law Answers also provides you with resources in your state. The tool can be found by visiting www.HealthLawAnswers.org
- Of course, the AARP online health law Answers, with up-to-date information at HealthLawAnswers.org. You can also distribute the AARP factsheets and brochures.You can also find answers to your Medicare questions at medicare.govor by calling Medicare at (800) 633–4227. Go to healthcare.gov for information on health insurance marketplaces and other health resources in your state. Or you can call the Marketplace toll free contact center at (800) 318-2596
- You can find listings and registration information on future web events at www.aarp.org/healthwebinars. We will have more web events on the Affordable Care Act and on Medicare and hope you will join us again!