Health Insurance, Resources and Health Care Reform in Seattle

1. Health Insurance, Resources and Health Care Reform in Seattle Dancers’ Health Insurance Resource Center www.dhirc.org A program of The Actors Fund www.actorsfund.org Jim Brown, National Director of Health Services 800-798-8447 x280 / jbrown@actorsfund.org

2. What’s already happened - 2010 • Children under age 19 with pre-existing conditions can’t be denied coverage. • Young adults up to age 26 can stay on or enroll in their parents’ coverage. • Insurers can’t retroactively cancel the policies of people who get sick. • Insurers can’t impose lifetime dollar limits on medical benefits. • All new plans must cover certain preventive services, such as mammograms and tetanus shots, for free.

3. What’s already happened - 2010 • Uninsured people with pre-existing conditions may be eligible for coverage through PCIP. Pre-Existing Condition Insurance Plan www.wship.org/PCIP-WA Help for the uninsured with pre-existing medical conditions thru a temporary high-risk pool until January, 2014

4. What’s already happened - 2011 • Medicare recipients in the coverage gap or “donut hole” receive 50% off drugs • Annual wellness visits and certain preventive services are free for Medicare recipients • Increased funding to Community Health Centers

5. 2014 • Insurers can’t refuse coverage to anyone. • Most people will be mandated to have coverage or pay a penalty. • New insurance marketplaces, called Exchanges, will offer insurance to those who don’t get it elsewhere. • Subsidies will be available to people who buy insurance through an exchange with income less than 400% of the Federal Poverty Level. ($43,320) • Employers with 50 or more employees who don’t offer insurance will be fined.

6. Essential package of benefits: • All new plans will offer at a minimum an essential benefits package which limits out-of-pocket medical expenses. Including: • Ambulatory care • Emergency care and Hospitalization • Maternity and newborn care • Mental health and substance abuse • Prescription drugs • Preventive and wellness services

7. Do I have to have Insurance in 2014? • Yes! • Penalty: increases from $95 or 1% of income in 2014 to $695 or 2.5% of income in 2016. • Exceptions include: Native Americans, those w/religious objections, people who are not legal residents, those who don’t meet tax filing threshold ($9,350 single), people who’ve been uninsured for less than 3 months.

8. How will the Government know if I have Insurance? • Through the IRS! • You will likely have to file proof of coverage with your taxes.

9. Can I Keep My Current Coverage? • Yes. • Plans that were in effect on March 23, 2010 are grandfathered under the law. • Grandfathered plans don’t have to offer free preventive services or guaranteed access to OB-GYNs or comprehensive benefits

10. How Will I Afford Insurance? • If your income is $10,830 - $43,320 (single), you will receive a subsidy to buy insurance through an exchange. • Subsidies will cap the amount you spend on premiums in relation to your total income. • Subsidies will also cap your annual out-of-pocket medical costs. • Example: a person who makes $21,000/yr will have their premiums capped at 6.3% of their income, and their annual out-of-pocket medical costs will be limited to $1,983/yr (excluding premiums).

11. Are There Special Programs For People Under 30? • Under age 30: high-deductible plan option (2014). Prevention benefits and 3 primary care visits are exempt from deductible. • Under age 26: can stay on or enroll in parents’ plan. Applies regardless of living situation, marital status, student status, or financial dependence. Exclusion: if you have access to insurance through an employer.

12. Will There be More Coverage For Preventive Services? • If you have a new policy that began on or after 9/23/2010, you can get certain preventive services for free: • Blood pressure, diabetes & cholesterol tests • Breast, colon & cervical cancer screenings • Vaccines, immunizations & flu shots • HIV & STD testing • Screenings for healthy pregnancies • Well-child visits

13. What’s The Small Business Tax Credit? • Available beginning 2010 tax year • Employers with fewer than 25 FTE’s employees with average wages of less than $50,000 that purchase health insurance for employees are eligible for the tax credit • To be eligible, employer must offer a group health plan & contribute at least 50% of premium cost • 2010-2013: credit max is 35% of employer contribution (25% for tax exempt/non-profits); will increase to 50% (35% for non-profits) in 2014

14. Small Business Tax Credit • Small business will file Form 8941 when they file income tax returns • Tax exempt organizations will claim the tax credit on a revised Form 990-T www.irs.gov/newsroom/article/0,,id=223666,00.html

15. I have Medicare. How will this affect me? • No benefits will be cut, and many preventive services will be free. • Costs for drugs in the coverage gap or “donut hole” will be discounted 50% in 2011. • Supplemental or Medigap plans won’t be affected.

16. Resources & Links • Artists Health Insurance Resource Center: www.ahirc.org • Office of Consumer Information and Insurance Oversight: www.hhs.gov/ociio • Federal health care reform website: www.healthcare.gov • Kaiser Family Foundation: www.kff.org

17. How do I get health insurance now? • Employment-related coverage • Purchase private plans • Government-subsidized programs • If you leave/get laid off from a job … COBRA – Continuation of employer benefits for at least 18 months 60 days to decide/elect coverage “Sticker Shock” – guaranteed coverage, but can be expensive. Pay full premium, at group rate.

18. I can afford to buy private insurance, but I don’t know what type of plan to get. • Rights & Protections – right to receive care in a life-threatening emergency at any hospital regardless of insurance status. • Words to Know – HMO, PPO, High Deductible Plan or Catastrophic Coverage. • Choose a carrier & type of policy to meet your needs and your budget.

19. Ways to get Coverage • Colleges & Universities – Alumni Associations • Associations Plans • Chamber of Commerce • www.seattlechamber.com • Internet brokers • www.ehealthinsurance.com

20. Government Programs • Medicaid • Comprehensive • Very low income AND fit one of these categories: pregnant, blind, disabled, 65 or over, 18 or under, or be a parent living with child 18 or under • No premiums • As part of health care reform, income will be the ONLY eligibility requirement in 2014. • www.dshs.wa.gov

21. Government programs • Washington Basic Health • Low-cost, comprehensive coverage thru private health plans for residents with limited incomes. • www.basichealth.hca.wa.gov Washington Health Program • 2 plans: $75,000 or $100,000 in health insurance coverage per year. Low-cost, age rated. • www.washingtonhealth.hca.wa.gov

22. I don’t have insurance • Free, sliding scale, lower cost clinics • Washington Association of Community & Migrant Health Centers • 25 community health centers for low income and uninsured populations • www.wacmhc.org Qliance • Primary and preventive care for a monthly fee • www.qliance.com • Sliding-scale clinics • Bureau of Primary Care: ask.hrsa.gov/pc

23. I can’t afford my medications • $4 Generics @ Target and Walmart • Pharmacy Checker www.pharmacychecker.com • Partnership for Prescription Assistance www.pparx.org

24. I have dental problems but no insurance. What do I do? • Dental discount plans and dental insurance • Dental schools • University of Washington, School of Dentistry • Negotiate with your dentist • Many of the Community Clinics have low-cost or free dental clinics for people with low incomes.