+ Countdown to Coverage: The Affordable Care Act in IL June 7, - - PowerPoint PPT Presentation
+ Countdown to Coverage: The Affordable Care Act in IL June 7, 2013 + About IMCHC Our Projects and Initiatives: Campaign to Save Our Mothers and Babies Chicago Area Immunization Campaign Cooking Matters Illinois Coalition
June 7, 2013
Our Projects and Initiatives: Campaign to Save Our
Mothers and Babies
Chicago Area Immunization
Campaign
Cooking Matters Illinois Coalition for School
Health Centers
Illinois Premature Infant
Health Network
Health Reform Education
and Implementation
Text4baby
www.ilmaternal.org/hcr @ILMaternal kwaligora@ilmaternal.org
1.
Improving health today
2.
Transformative changes in 2014
3.
Pathways to coverage in 2014
4.
Connecting Communities
5.
Resources
Download a copy of today’s presentation at http://ilmaternal.org/hcr/acapresentations.html
Young people can stay on their
parents insurance until they are 26
Preventative and wellness
services without cost sharing
Including immunizations,
cancer screening, smoking cessation and a host of women specific provisions
Tax credits to help small
businesses offer coverage
Closing Medicaid Part D donut
hole
No pre-existing condition
exclusion for children
No lifetime limits on care and
phasing out of annual limits
No insurance recessions
except in cases of fraud/intentional misrepresentation
Protecting consumers from
unreasonable premiums Affordability & Accessibility Industry Reform
Guaranteed issue protects those with pre-existing conditions
Insurance companies cannot use health status to make any
decisions—no denials, cannot charge higher premiums
Gender rating eliminated
Makes care more accessible and affordable for women
Essential Health Benefits
Ensure comprehensive coverage for ALL Includes coverage for mental/behavioral health, maternity and
newborn coverage, and preventive/wellness services
Marketplace Tax Credits and Subsidies Medicaid
Tax Credits—Discounts on Premiums You can qualify for an upfront
discount, in the form of a tax credit…
…if you earn between $11,505 to
$46,021 for an individual or between $23,425 to $93,700 for a family of four AND don’t have affordable coverage from your employer
Subsidies for out-of pocket expenses If you earn less that $34,516 for an
individual or $70,275 for a family
get subsidies to lower out-of- pocket costs
Tax credits and subsides available to
US citizens and lawfully present immigrants
Marketplace Tax Credits and Subsidies Medicaid
The ACA expands Medicaid to
cover all people under 138%
Eliminates categorical
eligibility which currently creates a huge gap in coverage
More than 618,000 could be
eligible in IL!
Must be US Citizen or Legal
Permanent Resident of 5 years or more to qualify
100% federally funded in
the first three years, gradually reduces to 90% by 2020
Authorized by SB26 in IL
Marketplace Tax Credits and Subsidies Medicaid
Begin enrolling Oct 2013; benefits available
January 1, 2014.
Enroll in public and private health insurance, as
well as access tax credits and subsides using a single streamlined application
Exchanges are only allowed to offer high-quality,
qualified health plans that meet provider network standards, and offer at least an essential benefits package.
Give consumers the tools and power to have
control over their insurance decisions
Apples-to-Apples comparison of plans Organize based on cost, benefits, quality, and
Marketplaces will be available to US citizens and
lawfully residing immigrants for subsidized or unsubsidized coverage (Undocumented immigrants completely barred from accessing)
Marketplace Tax Credits and Subsidies Medicaid
The individual mandate requires most Americans to purchase health
insurance starting January 1, 2014 or pay a tax if they do not comply
You are exempt from the mandate tax if:
You would have to spend more than 9.5% of your household income on the
cheapest qualifying health insurance plan even after tax credits and subsidies
Your income falls below the threshold for filing federal income tax You are undocumented or not a lawfully permanent resident
You already meet this requirement if:
You have insurance through your employer or purchase individual insurance
You have insurance through Medicaid, Medicare, CHIP, Veteran’s
Administration and/or Tricare for active duty and retire military, Indian Health Services
Why do we need a mandate?
Requiring so much of health insurance companies without requiring people to
buy insurance would drive the cost of coverage to even less affordable levels
Insurance is meant to be purchased BEFORE you need it. Waiting to buy health
insurance would be like…..
Support to provide coverage for employees via tax credits Access to tools and resources made available by
Marketplace, with SHOP Marketplace offering more choices in 2015
Businesses with less than 50 employees do not need to do
anything differently!
Security for entrepreneurs who can purchase affordable,
high quality health insurance on the individual Marketplace
26,975 39,040 10,521 21,339
New Medicaid Marketplace with subsidy Marketplace without subsidy Undocumented 10,000 20,000 30,000 40,000 50,000 In Lake County 71,535 adults are uninsured (17% of the population). In 2014, the majority of these adults will have new access to affordable coverage in one of three ways.
Source: Illinoishealthmatters.org, Visualizing Health Reform tool
33% 30% 41% 67% 68% 57% Uninsured (under age 65) Household income less than $40,000 Total Yes, have enough information No, do not have enough information
NOTE: Don’t know/Refused answers not shown. SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013)
Do you feel you have enough information about the health reform law to understand how it will impact you personally, or not?
Support
paid by an health insurance provider to enroll individuals
Navigators
Support
paid by an health insurance provider to enroll individuals
In Person Counselors (IPCs)
but will go through the same training to provide application assistance
Certified Application Counselors (CACs)
Apply to be a Navigator/IPC/CAC
Listen to our recorded webinar on outreach at ilmaternal.org/webinars
Listen to IMCHC’s monthly webinars to learn more about the law
www.ilmaternal.org/webinars.html
Initiate conversations with clients when appropriate
Create a culture of coverage by leading with this statement: “You have
affordable coverage options available”
Share educational resources Connect clients with in person assisters when possible
Share feedback with IMCHC!
Success stories: http://www.ilmaternal.org/mystory.html Experiences using new systems Best practices in outreach and enrollment
Participate in IMCHC summer/fall trainings
Create a culture of coverage:
You have affordable coverage available to you!
Get buy in using one of these messages, each of which is
shown to resonate with 89% of the population!
All insurance plans have to cover doctor
visits, hospitalizations, maternity care, emergency room care, and prescriptions.
If you have a pre-existing condition, insurance plans cannot deny
you coverage
You might be able to get financial help to pay for a health
insurance plan.
All insurance plans will have to show the costs and what is
covered in simple language with no fine print.
IMCHC ACA
http://www.ilmaternal.org/h
cr
Illinois Health Matters http://www.illinoishealthmat
ters.org
Official HHS ACA site http://www.healthcare.gov Health Reform GPS http://www.healthreformgps
.org/
Kaiser Family Foundation http://healthreform.kff.org/ National Women’s Law Center http://www.nwlc.org/our-
resources
Health Insurance 101 http://101.communitycatalys
t.org/
Enroll America http://www.enrollamerica.or
g
Questions?