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The New Health Insurance Marketplace Amy Hudson Director of Business Development

The New Health Insurance Marketplace Amy Hudson Director of Business Development. Topics for Today’s Discussion. CoOportunity Health | 4/15/2013 | 2. New Insurance Marketplace Impacts to Individual Market. CoOportunity Health | 4/15/2013 | 3. 3 Big Changes.

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The New Health Insurance Marketplace Amy Hudson Director of Business Development

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  1. The New Health Insurance MarketplaceAmy HudsonDirector of Business Development

  2. Topics for Today’s Discussion CoOportunity Health | 4/15/2013 | 2

  3. New Insurance Marketplace Impacts to Individual Market CoOportunity Health | 4/15/2013 | 3

  4. 3 Big Changes • No Lifetime or Annual Limits • No Gender Discrimination • No Pre-Existing Conditions • ACA requires that no one can be denied coverage because of pre-existing conditions • ACA will not allow insurance companies to charge higher rates based on gender • ACA prohibits health plans from imposing annual or lifetime limits on the amount of coverage an individual receive CoOportunity Health | 4/15/2013 | 4

  5. INDIVIDUAL MARKET Changes coming in 2014 New Health Insurance Marketplace opens Oct. 1 No one can be denied coverage for medical reasons Tax credits and subsidies for those who need it most $   Tax penalties start at $285 for family of 4 Rates higher for tobacco users Many states are expanding to 138% of FPL    CoOportunity Health | 4/15/2013 | 5

  6. Health Insurance Marketplace Exchange  CoOportunity Health | 4/15/2013 | 6

  7. Product Standardization Exchange  All health plans must include coverage for preventive care like annual physicals, pediatric care, maternity and newborn care CoOportunity Health | 4/15/2013 | 7

  8. Cannot be turned down for coverage Guarantee Issue  CoOportunity Health | 4/15/2013 | 8

  9. Tax credits and subsidies for those who need it most Cost Sharing Help $ Federal Register, January 24, 2013 CoOportunity Health | 4/15/2013 | 9

  10. 19 Million Nationwide Cost Sharing Help $ 25 Million 19 Million • Of those, • Will likely be eligible for Federal Premium Assistance tax credit • Individuals/families with incomes between 100% and 400% of the Federal Poverty Level • Subsidy: Individuals pay premiums equal to: • 2% of income for those at 100% of FPL • rising to • 9.5% of income for those at 400% of FPL Uninsured Unemployed Self employed in individual market now CoOportunity Health | 4/15/2013 | 10

  11. States may expand from 100 to 133% of FPL Medicaid Expansion  States that expand receive 100% of federal funding for the first 3 years, phasing to 90% in subsequent years. Gov. Branstad is leaning toward not expanding Medicaid in Iowa. CoOportunity Health | 4/15/2013 | 11

  12. Tax penalties Mandate to Buy  CoOportunity Health | 4/15/2013 | 12

  13. Exceptions Mandate to Buy  CoOportunity Health | 4/15/2013 | 13

  14. Encouraging a Tobacco-free U.S. Tobacco Usage  CoOportunity Health | 4/15/2013 | 14

  15. Who is impacted by the changes? I HAVE INSURANCE THROUGH MY EMPLOYER I DON’T HAVE INSURANCE I BUY PRIVATE INSURANCE TODAY CoOportunity Health | 4/15/2013 | 15

  16. Who is impacted by the changes? I DON’T HAVE INSURANCE GO SHOPPING • May qualify for premium and/or cost-sharing subsidies • Go to Exchange beginning October 1, 2013 to apply • Subject to tax penalties if don’t have coverage CoOportunity Health | 4/15/2013 | 16

  17. How do the changes impact you? I BUY PRIVATE INSURANCE TODAY GO SHOPPING • May qualify for premium and/or cost-sharing subsidies • Go to Exchange beginning October 1, 2013 to apply • Or, get a quote for “off Exchange” options • No medical underwriting is a “game changer” CoOportunity Health | 4/15/2013 | 17

  18. How do the changes impact you? I HAVE INSURANCE THROUGH MY EMPLOYER GO SHOPPING • May qualify for premium and/or cost-sharing subsidies • Go to Exchange beginning October 1, 2013 to understand available options CoOportunity Health | 4/15/2013 | 18

  19. 7 Things Individuals Can Do Now CoOportunity Health | 4/15/2013 | 19

  20. Huge Market Changes for Groups Small Group (1-50) Impacts Large Group (>51) Impacts CoOportunity Health | 4/15/2013 | 20

  21. What concerns you most about Healthcare Reform? ? ? ? ? ? What will it cost? How much time will this take to manage? When will my employees see a benefit? Where can I get information I can trust? Who can help make sure we’re prepared? CoOportunity Health | 4/15/2013 | 21

  22. GROUP MARKET Changes coming in 2014 Rating and market rule changes for small group SHOP Exchange for Small Group (1-50) Required coverage categories, levels and amounts    Expanded tax credits for small groups with 1-25 FTEs Employer and insurer fees to support new marketplace Requirements for groups with >50 employees  $  CoOportunity Health | 4/15/2013 | 22

  23. Small Group Market (1-50) Plan Requirements  Expanded Benefits CoOportunity Health | 4/15/2013 | 23

  24. Essential Health Benefits  Expanded Benefits • 10 categories of care must be included in all small group plans • No lifetime limits • No annual dollar limits CoOportunity Health | 4/15/2013 | 24

  25. Small Group Market Plans (1-50)  Expanded Benefits CoOportunity Health | 4/15/2013 | 25

  26. Rating and Market Rule Changes  New Rules • Big Changes for Small Groups • Small Groups (1-50) – move to adjusted community rating where ALL policyholders’ premiums only vary by location, small age bands, and tobacco use • All Group Plans • Removal of pre-existing conditions • Guaranteed issue and renewal coverage • No medical underwriting CoOportunity Health | 4/15/2013 | 26

  27. Employer Requirements, SHOP & Tax Credits CoOportunity Health | 4/15/2013 | 27

  28. Determining Employer Penalties (51+ FTEs)  Employer Mandate Large employers are those with at least 50 full-time equivalent non-seasonal employees. Full-time is an average of 30 hours or more with respect to any month. Seasonal is fewer than 120 days in a calendar year. CoOportunity Health | 4/15/2013 | 28

  29. Paying to Play in the New Insurance Marketplace  New Taxes & Fees CoOportunity Health | 4/15/2013 | 29

  30. Components Driving Pricing Impacts Rating Rules Changes Average Annual Rate Increase + Product/Benefit Enhancements Taxes & Fees CoOportunity Health | 4/15/2013 | 30

  31. Key Dates & Changes for Group Plans CoOportunity Health | 4/15/2013 | 31

  32. 7 Things Employers Can Do Now CoOportunity Health | 4/15/2013 | 32

  33. New option for Iowans and Nebraskans • Nonprofit CO-OP (consumer operated and oriented plan); member owned and governed • CO-OPs established in the Affordable Care Act • “Invented” to provide affordable options for individuals and families • 24 CO-OPs in U.S. so far • Low interest startup loans provided by federal government • Start marketing health plans October 1 • On Exchange plans for individuals and small businesses • Off Exchange plans for all market segments • Alternative to traditional commercial carriers CoOportunity Health | 4/15/2013 | 33

  34. Questions? Register for Next Webinars: April 23, 1-2 p.m.: https://cc.readytalk.com/cc/s/registrations/new?cid=u5brugyln8cz April 30, 1-2 p.m.: https://cc.readytalk.com/cc/s/registrations/new?cid=czp0k8hd7nkl CoOportunity Health | 4/15/2013 | 34

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