Affordable Care OF HEALTH NY STATE Act CERTIFICATION

Affordable Care. OF HEALTH NY STATE Act CERTIFICATION TRAINING ASSISTOR Module 1: Introduction to the Affordable Care Act nystateofhealth. ny. gov 1

Learning Objectives Affordable Care Act By the end of this lesson, you will be able to: • Understand the overview of the Assistor Certification Process. • Help consumers understand the Affordable Care Act (ACA) and how it impacts them. • Describe the types of insurance offered through the NY State of Health Marketplace. • Describe the eligibility determination process for insurance subsidies in the Marketplace. nystateofhealth. ny. gov 2

Assistor Certification Road Map 1. Affordable Care Attend three-day classroom training Act 2. Complete certification process 3. Help NYS residents nystateofhealth. ny. gov 3

Affordable Care Act Introduction Affordable Insurance Reform: Act Care • More people covered • More benefits and protections • Lower cost nystateofhealth. ny. gov 4

Affordable Care Act Goals Affordable Care Two major goals: Act • Introduce new protections for people who have health insurance. • Increase access to health care coverage for all Americans. nystateofhealth. ny. gov 5

Affordable Care Act Features For all individuals and families: Affordable Care • All insurance carriers must allow coverage for dependents up to age 26. Act o NYS law allows insurance companies to opt to cover dependents to age 29. • Cannot be denied coverage because of pre-existing conditions. • Insurance companies cannot put annual or lifetime dollar limits on coverage. • The ACA created state and federal marketplaces where consumers may purchase health insurance. • Offers full cost insurance as well as discounts for many consumers via subsidies based on household income. • Expanded Medicaid eligibility. nystateofhealth. ny. gov 6

NY State of Health Enrollment Steps Affordable Care 1. Create a NY State of Health account and complete the Act application. 2. Based on the information entered on the application, receive an eligibility determination. 3. Review their health plan options. 4. Enroll in a health plan nystateofhealth. ny. gov 7

The Individual Mandate Individuals are required to have “Minimum Essential Coverage, ” Affordable Care as defined by the ACA, or pay a penalty. Act In December 2017 the ‘Tax Cuts and Jobs Act’ was signed into law – which repealed the Individual Mandate The previous penalties for not having health insurance (2. 5% of the household income, $695 per adult, $347. 50 per child, and a maximum of $2, 085) still apply through the end of 2018. Penalties are pro-rated by the number of months without coverage. The penalty cannot be greater than the national average for the premium of a Bronze metal level plan. Exemption: Individuals who meet certain criteria may apply for an exemption HHS or the IRS will certify exempt individuals; no one can decide on their own to exempt themselves. nystateofhealth. ny. gov 8

Small Business Marketplace (SBM) • Businesses are eligible if they: Affordable Care • Have a physical business location in New York State Act • Have between 1 and 100 Full-Time Equivalent employees • Haven an Employer Identification Number The SBM will determine an employer’s eligibility for tax credits, certify available plans, and maintain a website that allows employers and employees to compare plans Navigators can assist small business owners by helping them complete the SBM application and help them understand their plan options nystateofhealth. ny. gov 9

SBM: Plan Administration and Federal Tax Credit Affordable Care • NY State of Health will maintain plan administration through March 31, 2019 for any plans that went into effect prior to April 1, 2018 Act • Health insurance plans will maintain plan administration for any new enrollments or renewals in effect after April 1, 2018 • Small business owners may be eligible for tax credits if they: • have fewer than 25 full-time equivalent employees • pay average wages of less than $53, 000 a year per full-time equivalent employee • pay at least 50% towards employees lowest cost single tier coverage • offer a SHOP-certified health plan to all full-time equivalent employees working at least 30 hours per week nystateofhealth. ny. gov 10

NY State of Health Marketplace Programs Affordable Care Act NY State of Health Marketplace Qualified Health Plans • Full Cost QHPs • Subsidized QHPs Insurance Affordability Programs: • Medicaid • CHPlus • Essential Plan nystateofhealth. ny. gov 11

Federal Poverty Level (FPL) Affordable Care • The Federal Poverty Level (FPL) is a measure of Act income issued annually by the Department of Health and Human Services (HHS). • Insurance affordability programs in the Marketplace have income eligibility criteria. • Income eligibility is expressed as percentage. nystateofhealth. ny. gov 12

Qualified Health Plan (QHP) Affordable Care An insurance plan that is certified by the Marketplace, provides Act Essential Health Benefits (EHBs), follows established limits on cost sharing (like deductibles, co-payments, and out-of-pocket maximum amounts), and meets other requirements. nystateofhealth. ny. gov 13

Insurance Affordability Programs (IAPs) Affordable Care Act • Medicaid • Child Health Plus (CHPlus) • Essential Plan (EP) • Advance Premium Tax Credit (APTC) • Cost Sharing Reduction (CSR) nystateofhealth. ny. gov 14

Affordable Care Act Matching Activity nystateofhealth. ny. gov 15

What Questions Do You Have? Affordable Care Act nystateofhealth. ny. gov 16