The Affordable Care Act and Health Insurance Marketplace

The Affordable Care Act and Health Insurance Marketplace Presented by:

What Will Be Cover Today: Overview of the ACA • Overview of the Marketplace • Kansas Assisters Network •

The Affordable Care Act Brief Overview of the New Health Care Law

Patient Protection and Affordable Care Act Designed to increase access to health care: • Financial assistance makes coverage more affordable • Kids can stay on parent’s plan until 26 • Additional drug coverage for people with Medicare • More preventive services with no cost sharing • Lifetime limits and “pre-existing” conditions removed • Medicaid expansion to citizens under 138% FPL Obama signed the ACA into Law in March 2010

Individual Mandates citizens to have health insurance Shared responsibility payment: • 2. 5% of annual income or • $695 per adult and $374. 50 per child • Tax penalty for uninsured if coverage is “affordable” • In Kansas, those under 100% FPL exempt • Non-Medicaid expansion Whichever is higher

The Health Insurance Marketplace • What consumers usually refer to as “Obamacare” • A new avenue to buy health insurance • Compare private health plans side by side • Financial assistance available • Federally facilitated vs. State facilitated

Who can apply to the Health Insurance Marketplace? • • • Lawfully present Live in plans service area (KS in KS) Not “incarcerated” Not on Medicare Medicaid eligible permanent residents, under 5 years residency

Help with Costs in the Marketplace Advanced Premium Tax Credits (APTC) Lower monthly payments Cost Sharing Reductions Reduce out-of-pocket spending

Qualification for Financial Assistance • • • Between 100 -400% FPL No coverage offered elsewhere Employer coverage inadequate or unaffordable Live in plan service area (KS in KS) If married, file taxes jointly

Incomes to save on coverage Lower Monthly Premiums Lower Out-of-Pocket Costs Household Size Yearly Household Income (100%-400%) Yearly Household Income (100%250%) 1 $12, 060 - $48, 240 $12, 060 - $30, 150 2 $16, 240 - $64, 960 $16, 240 - $40, 600 3 $20, 420 - $81, 680 $20, 420 - $51, 050 4 $24, 600 - $98, 400 $24, 600 - $61, 500 5 $28, 780 - $115, 120 $28, 780 - $71, 950 6 $32, 960 - $131, 840 $32, 960 - $82, 400

QUIZ #1 What’s the penalty for not having insurance in 2017? - $695 per adult & $374. 50 per child OR 2. 5% of your annual income (whichever is higher) What are the qualifications for financial assistance? - 100 -400% FPL, no other coverage offered, file taxes jointly and live in service area

The Health Insurance Marketplace Applying for coverage

When can you apply? Open enrollment: November st 1 – December Special Enrollment Period (SEP) • • Life event causing loss of coverage or change in eligibility o changing jobs o losing Medicaid o sudden income above 100% Only 60 days to sign-up after life event th 15

How do you apply? Online Phone healthcare. gov cuidadodesalud. gov 1 -800 -318 -2596 TTY : 1 -855 -889 -4325 In-person Call United Way 2 -1 -1 getcoveredamerica. org/connector

Information You Need to Complete an Application Information you need for the entire household: Information you need ONLY for people applying for coverage: • Birthdays • Social security number • Addresses • Immigration documents • Income • Employer information o Name of employer o Phone number o Information about employer coverage if it’s offered

People to Include on Your Application • Spouses • Must file jointly to receive financial assistance • Dependents • Include these people even if they’re not applying for coverage. Anyone you claim must be insured IMPORTANT: Make sure no one else claims you as a dependent. If they do and you don’t report it, you could pay back some or all of your tax credits!

Income on Your Application • Pre-tax: not your take home pay • Modified Adjusted Gross Income (MAGI) o $$$ AGI (adjusted gross income) + some added back deductions • Ask a tax professional for help if unsure • As accurate as possible: o Adjust income during the year if it changes. o Take less tax credits if income is unstable. You may have to pay back tax credits if your final income is higher than what you put on your application!

Things to Think About When Choosing a Plan • Does anyone have a chronic illness? • Is my doctor in-network? • How often do use health care services? • What are the copays for my prescriptions? • How much will sudden injury or illness cost? • What’s important: monthly cost or healthcare costs? REMEMBER: You can’t change plans mid-year.

Paying for Your Plan Online: credit card or checking account • Automatic payments Mail: check or money order IMPORTANT: Pay 1 st premium or coverage will be CANCELED! • If not open enrollment, can’t sign-up again • 90 day grace period after 1 st month (if receiving tax credits)

Important Things to Know • • • File jointly if married Claim all dependents on application No one can claim you as a dependent Must file taxes if receiving financial assistance Save username, password and security questions If more information is needed, send within 90 days o Income: documents must match application information

QUIZ #2 Who needs to be included on your application? Tax household What income do you include on your application? MAGI – AGI (taxes) with some deductions added back

• Collaborative effort to assist with Marketplace enrollment • Funded by: HCFKC and REACH • Participating organizations: o Community Health Council of Wy. Co o Kansas Department of Health and Environment o Health Partnership Clinic o Shawnee Mission Medical Center o El Centro o Historic Northeast Midtown Association o NBCCDC o Kansas Association for the Medically Underserved

Activities • Assist with Marketplace applications and enrollment • Connecting to health care services • Health insurance literacy • ACA community outreach and education

Why is this important? • • • Avoid the penalty Avoid unforeseen medical expenses Decreases health care spending by creating accountability Increases access to health care services Promotes prevention

Health Insurance is VERY Important! Ensures access to: Emergency Care • Primary Care • Preventative Care • $$$ Average cost for a 3 -day hospital stay is $30, 000!! Keeps costs low for everyone • Hospitals absorb costs of uninsured • No surprise bills • Get treatment before illness gets worse • Access to preventative services

Enrollment Assistance Working with Your Clients

Application Steps 1. Assess the situation 2. Sign consent 3. Create Account 4. Complete application 5. Review available plans 6. Choose plan 7. Pay for plan 8. Update when necessary

Potential Snags • Lost username and/or password • No email address • Unable to verify identity • Didn’t Reconcile APTC last year • Medicaid gap • Website down • Employer offered coverage available

They’ve enrolled… now what? • Pay first premium • Select a primary care provider • Schedule a wellness exam • Obtain suggested preventative care • Update your application if changes occur

Need help? CALL MOLLY! It’s easier to ask a question than to fix an application later. 913 -371 -9298 ext. 3 mmoffett@wycohealth. com 803 Armstrong Ave. Kansas City, KS 66101