Health Insurance Coverage What you need to know

Health Insurance Coverage: What you need to know. Joao dos Santos Faustino Coordinator of Member Services Hudson River Health. Care October 15, 2015

Affordable Care Act The Law & Market

The ACA: the Benefits ✚ The Affordable Care Act also affords numerous consumer protections in most health insurance plans: Pre-existing conditions are covered A standardized summary of benefits must be provided Insurance companies are held accountable for rate increases ▪ Coverage as dependent is available on a parent’s policy up to age of 29 in New York ▪ Preventive care is free, e. g. immunizations, pap smears, well-woman visits, annual physicals, etc. ▪ There are no lifetime and annual benefit limits ▪ ▪ ▪

The ACA: for Consumers ✚ Since January 2014, everyone must have insurance ▪ Insurance must meet a minimum standard of quality ▪ Medicaid, Child Health Plus, Qualified Health Plans, Essential Health Plans meet this standard and are all available through the marketplace. ✚ There are some exemptions for applying for insurance. ▪ Financial hardship, undocumented immigrant, religion, incarcerated, member of Indian tribe. ✚ Penalties ▪ 2016 Penalty: greater of $695 or 2. 5% family income/max $2, 085 family

The New York State of Health www. nystateofhealth. ny. gov ✚ NYOSH is the official health plan marketplace for New York State Provides one-stop shopping for subsidized and unsubsidized coverage ▪ Easily compare health plan options ▪ The only place to check eligibility and apply for financial assistance ▪ Enroll in qualified health plans ▪ ✚ NYOSH enrollment periods Open Enrollment for Qualified Health Plans November 1 st January 31 st ▪ Year round enrollment for Medicaid, Child Health Plus and Essential Health Plan ▪ Special Enrollment Periods ▪

NYSOH: Plan Benefits ✚ All plans through the marketplace must provide Ten Essential Health Benefits: Ambulatory patient services (Doctor’s Office Services) Emergency room services Hospitalization Maternity and newborn care Mental Health and substance abuse disorders Prescription drugs Rehabilitation and habilitation services and devices Laboratory Services Preventative and Wellness services and chronic disease management ▪ Pediatric services, including oral and vision ▪ ▪ ▪ ▪ ▪

The Marketplace The Plan Options

Medicaid Expansion ✚ Medicaid income limits have increased. Those newly eligible will have the full Medicaid benefit package except institutional long term care. New Medicaid income limits are 138% of federal poverty guidelines (FPL): ▪ ▪ Individuals making less than $16, 243 per year Family of 2 making less than $21, 984 per year Family of 3 making less than $27, 725 per year Family of 4 making less than $33, 465 per year

Child Health Plus ✚ Any child under the age of 19 living in New York State is eligible for insurance ▪ ▪ Immigration status does not matter. Multiple managed care options that offer oral and vision health.

Qualified Health Plans ✚ Financial aid is available to help pay for coverage purchased in the Marketplace ▪ Premium subsidies provide money to help cut cost of health insurance is available for those with income up to 400% of the Federal Poverty Levels: ▪ ▪ Individuals making up to $47, 080 per year Family of 2 making up to $63, 720 per year Family of 3 making up to $80, 360 per year Family of 4 making up to $97, 000 per year ✚ The premium subsidies are available to people who do not have employer coverage that pays a minimum of 60% of covered medical expenses and/or has an employee share of the premium that is more than 9. 5% of income.

Advanced Premium Tax Credits ✚ APTC are Federal Tax Credits applied in advance against premiums for Qualified Health Plans Cost Sharing assistance also available in silver plans for those making less than 250% of the federal poverty level. ▪ Applicants must file taxes in the year the credit is received. ▪ ✚ QHPs offer “metal” levels of coverage with varying premiums ▪ ▪ ▪ Bronze - plan pays 60% of cost Silver - plan pays 70% of cost with possible CSR Gold - Plan pays 80% of cost Platinum - plan pays 90% of cost Each QHP must offer one silver and one gold plan

Essential Health Plan ✚ A new health plan for New Yorkers that costs much less than QHPS and offers same essential benefits. EHPs are free for some, cost $20 monthly premiums for others. ▪ There is no deductible for these plans. ▪ ✚ Lower income people who do not qualify for Medicaid or Child Health Plus can purchase EHPs. ▪ ▪ Individuals making up to $23, 540 per year Family of 2 making up to $31, 860 per year Family of 3 making up to $40, 180 per year Family of 4 making up to $48, 500 per year

THANK YOU! Joao dos Santos Faustino Coordinator of Member Services Hudson River Health. Care, Inc. 55 S Broadway Tarrytown, NY 10591 T (914) 524 -4107 x 62008 F (914) 524 -4108 jfaustino@hrhcare. org