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Presenters Cathy Levine Executive Director, UHCAN Ohio Kathleen Gmeiner Project Director , Ohio Consumers for Health Coverage
What is UHCAN Ohio? Statewide, non-partisan, non-profit organization working to achieve quality, affordable health care for all Ohioans. www.uhcanohio.org
What Is Ohio Consumers for Health Coverage? Ohio Consumers for Health Coverage is a broad based coalition working to achieve quality, affordable health care for all Ohioans. www.ohioconsumersforhealth.org
Overview • Key facts you should know about the Marketplace and Medicaid. • Update on how enrollment is going in Ohio • What those assisting in the enrollment process are learning that you need to know • Where to go for help enrolling in the Marketplace • What you can do to help get others enrolled
Enrollment in Medicaid • October 1, 2013 - Ohio launched a new Medicaid eligibility system, Ohio Benefits - http://Benefits.Ohio.gov • December 9, 2013 – The website began taking Medicaid applications online and received 1,165 the first day! • Ohio Benefits is a simplified, self-service Website that makes it easier for Ohioans to learn about assistance that may be available to them. • Relies primarily on electronic data • Those who do not qualify for Medicaid will be directed to Federal Health Insurance Marketplace.
Enrollment in the Marketplace October 1, 2013 – Open Enrollment started December 23, 2013—Deadline to select plan to be covered January 1, 2014. Check with Insurance Company for deadline for premium payment. January 1, 2014 – Health coverage can start March 31, 2014 – Open Enrollment ends
Who is Eligible? Marketplace eligibility requires consumers to: • Live in its service area, and • Be lawfully present in the U.S. for the entire period for which enrollment is sought, and • Not be incarcerated, other than incarceration pending disposition of charges. 10
Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral* and vision care All QHPs will cover these Essential Health Benefits • Ambulatory patient services • Emergency services • Hospitalization • Maternity & newborn care • Mental health and substance abuse disorder services, including behavioral health treatment *Not required in benefit package if a stand-alone dental plan is in the Marketplace in which the plan operates.
Things to Think About When You are Choosing a Plan • Affordability of both Premium and Out of Pocket Costs • Provider Network • Prescription Drug Formulary • Visit Limits and Other Details of Specific Benefits • Insurer Participation in both the Marketplace and Medicaid (for people with low incomes likely to move back and forth in their eligibility)
Affordability: The Marketplace Olympics *In addition to monthly premium. 13
Affordability: The Advance Premium Tax Credit • The financial help people get in the Marketplace to pay their premium is called the Advance Premium Tax Credit. • It is based on two things: • Income of the person or family enrolling • The cost of the second lowest Silver Level Plan
How is the Subsidy Computed? – Example of Single Person Age 45 in Franklin County $285 Monthly Premium of 2nd lowest silver plan -$ 57 Applicant Share (4% x $17,235) ÷ 12 mo $228 Advance Premium Tax Credit (Monthly)
How Can I Use the Advance Premium Tax Credit? You can apply the credit ($228) to any plan you want, but • The tax credit is based on the price of the second cheapest silver plan. • The tax credit is the same, no matter how expensive the other plans are. • if your income does not exceed 250% of the poverty level and you want to get help with out of pocket costs, you must purchase a silver plan. Region 9 - Assume 45 year old person 17
Do I have to wait until I file my taxes to get the tax credit? • You can reduce your premium amount each month • You can choose an Advance Premium Tax Credit • Advanced payments are paid directly to the insurer on your behalf • The amount is based on projected household income • Reconciled at tax time against the actual Premium Tax Credit amount you are eligible for • Changes in circumstances, such as new family members or decrease in income, should be reported to ensure the tax credit is still accurate and the recipient does not end up owing additional taxes when filing.
Who is Eligible for Cost-sharing (Out of Pocket) Reduction? • Eligibility for reduced cost-sharing is based on: • Incomes at or below 250% FPL ($58,875 annually for a family of four in 2013) • Receiving a Premium Tax Credit • Enrolling in a Marketplace Silver-level QHP
Catastrophic Plans • Who is eligible? • Young adults under the age of 30 • Those who cannot afford coverage and obtain a hardship waiver from the Marketplace • What is catastrophic coverage? • Plans with high deductibles and lower premiums • Includes coverage of three primary care visits and preventive services with no out-of-pocket costs • Provides some protection to consumers, but high deductibles may still lead to high out-of-pocket costs
Benefits and Deductible • While essential benefits are very important, what is critical for most people making a plan choice is: • What is the co-pay for a physician visit? • What is the co-pay for a specialist visit? • Are physician and specialist visits subject to the deductible? • Plans vary. Some do not cover a specialist visit until the deductible is met. • Some do not cover a physician OR a specialist visit until the deductible is met.
Provider Network • QHPs are using small networks to keep costs down. • Very important to click the link when you are comparing plans that takes you to the plan network. • If you aren’t sure about whether your doctor is in the network, call your doctor, the plan or both.
Drug Formulary • When you are comparing plans, it is very important to click the link that takes you to the plan’s drug formulary. • A health plan providing essential health benefits must have procedures in place that allow an enrollee to request and gain access to clinically appropriate drugs not covered by the health plan. However, no one should count on being able to easily “request and gain access” to a drug not in the formulary. Will be a steep climb.
How to Look at Plans before Setting Up an Account at healthcare.gov • Go to healthcare.gov • Click “See Plans Before I Apply” • Answer questions about location, age and whether you are looking for individual/family or a business • The plans will appear and you can sort by the metal levels (bronze, silver, gold) or by premium amount. • You can see monthly premium, deductible, out-of-pocket maximum, co-payment and co-insurance information • By clicking “Details” you can see the provider network, drug formulary and the Summary of Plan Benefits.
Finding Your Likely Subsidy • Go to http://kff.org/interactive/subsidy-calculator/ or go to www.kff.org and scroll down to “Calculator” • Enter requested information • It will tell you what percent of your premium you are expected to pay • Second lowest silver plan for your age/region(get from healthcare.gov): • Subtract what you must pay. • Remainder is your subsidy.
What is Direct Enrollment? • Ohio, Texas and Florida are three demonstration states where residents are able to directly enroll in health plans and still get the benefit of the subsidies. • Stay tuned for details.
New Features of Healthcare.gov • CuidadoDeSalud, the Spanish language healthcare.gov is now available. https://www.cuidadodesalud.gov/es/ • Healthcare.gov now has a “Remove” feature that allows consumers to remove an application that has gotten “stuck” and start over. • Consumers who have filed paper applications and have not received a response can now call the federal call center (1-800-318-2596), confirm with the call center that an eligibility determination is in the system, get their ID, and go into the web site, create an account, pull up the eligibility determination and then select a plan.
Helping Others Get Enrolled • Have a conversation about whether they understand the benefits they will get from health insurance. • Guide them to a navigator or CAC at www.localhelp.healthcare.gov • Help them find an enrollment event by going to www.ohioforhealth.org Click on ‘I’m interested in attending an enrollment event” Go to “map” or “calendar.”
Helping Others Get Enrolled • Find a Federally Qualified Health Center near you. Go to www.uhcanohio.org/marketplace • The Ohio Association of Community Health Centers has started a text campaign. • Text ‘CHC4HEALTH’ to 67076. • This is the keyword for the FQHC text campaign and they will send periodic messages and updates about getting coverage to those who opt in for the messages.
POLL Have you done anything to help someone get enrolled in the Marketplace? • Yes, I have referred them to a navigator or Certified Application Counselor • Yes, I have given them the federal phone number or website. • Yes, I have sat with someone at the computer and helped them on healthcare.gov • No, I have not had an opportunity to help anyone get enrolled.
How Enrollment and Outreach is Going in Ohio • Enrollments in Ohio in October and November: 5,672 • Ohio Association of Food Banks: • Participated in 85 ACA outreach and enrollment events since Oct. 1 • Served nearly 9,000 people with Navigator services (6,954 in-person; 2,031 telephone • Reached over 1.25 million people through media and other communications
How Enrollment and Outreach is Going in Ohio (continued) • Federally Qualified Health Centers • FQHC’s reported over 2,300 assists and 650 applications submitted by end of October • assist numbers are around 10 per day and most of the CAC’s are reporting 2-4 application submissions each day since October. UHCAN Ohio • Met with 100 organizational representatives from faith and community organizations in Cleveland, Columbus, Toledo and Cincinnati to engage their interest in becoming CACs or otherwise bringing resources to their congregations/members. • Assisted three persons with enrollment in person • Outreach by phone to 23 people • Participated in two enrollment events –talked to 40+
Enrollment Assistance Help is available • The Marketplace 24/7 Toll-Free Call Center • 1-800-318-2596 (TTY 1-855-889-4325) • Go to Healthcare.gov to enroll • Go to localhelp.healthcare.gov to find local help • Ohio Association of Food Banks, Certified Navigator 1-800-648-1176
Other Assisters in Ohio – Federal Contractors • Enrollment Assistance Center-SRA International, Inc. • Bethel Rd in Columbus • Rocky River Drive in Cleveland • Red Bank Rd in Cincinnati • Cognosante • Cleveland • 300 E Business Way Cincinnati • Campus View Columbus
Certified Application Counselors in Ohio • The following is a list of many of Ohio’s Certified Application Counselors that are not hospitals or health centers. It is not meant to be a complete listing. Find contact info at localhelp.healthcare.gov • Libraries • Dayton Metro Library • Summit County Public Library • Jefferson Township Public Library • Community Action Agencies • Impact (Columbus) • Delaware, Union, Madison County CAA; • Wayne-Medina; • Columbiana Cty; • Cincinnati/Hamilton County CAA; • Fayette County
CACs in Ohio (continued) • Faith and Community Based Organizations • May Dugan Center -- Cleveland • Lutheran Metropolitan Ministry—Cleveland • Southeast Seventh Day Adventist Church – Cleveland • Nueva Luz Urban Resource Center -- Cleveland • Santa Maria Community Services -- Cincinnati • Stonewall Columbus • AIDS Task Force of Greater Cleveland • Refuge Ministries Development – Cleveland Recovery Organizations • P.E.E.R. Center—Columbus • The Main Place—Mt. Vernon (Knox County); Newark (Licking)
CACs in Ohio (continued) • Legal Services • Legal Aid of SW Ohio • Other Advocacy and Partnership Organizations • UHCAN Ohio • Health Care Action Now—Cincinnati • Community Action Partnership Of The Greater Dayton Area • ARC Ohio—Columbus • Planned Parenthood
OhioAssociation of Foodbanks, All 88 Counties Access Health Mahoning Valley (AHMV), Mahoning and Trumbull Counties Asian Services in Action, Inc. (ASIA), Cuyahoga, Franklin, Hamilton, Lucas, Montgomery, and Summit Counties Carmella Rose Health Foundation (CRHF), Cuyahoga County Cuyahoga Health Access Partnership (CHAP), Cuyahoga County Community Action Committee of Pike County (CACPC), Jackson, Pike, and Scioto Counties Disability Rights Ohio (DRO), All 88 Counties FreestoreFoodbank, SouthwestOhio Ohio Association of Foodbanks Navigator Consortium • Toledo/Lucas County CareNet Allen, Ashland, Auglaize, Crawford, Defiance, Erie, Fulton, Hancock, Hardin, Henry, Huron, Lucas, Mercer, Ottawa, Paulding, Putnam, Richland, Sandusky, Seneca, VanWert, Williams, Woods, and Wyandot Counties • Ohio Association of Free Clinics (OAFC), 40 Counties Across Ohio • Ohio Department of Health (ODH), All 88 Counties • The Community Action Program Corporation of Washington Morgan Counties (WMCAP), Morgan and Washington Counties
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For More Information Visit These Websites: Need Help? Call our helpline at 614-456-0060 x233 www.uhcanohio.org www.ohioconsumersforhealth.org www.healthcare.gov www.aarp.org www.kff.org
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Thanks for Participating! Cathy Levine UHCAN Ohio firstname.lastname@example.org 614-456-0060 x222 www.uhcanohio.org Kathleen Gmeiner Ohio Consumers for Health Coverage email@example.com 614-456-0060 x223 www.ohioconsumersforhealth.org UHCAN Ohio Ohio Consumers for Health @UHCANOhio @CathyUHCANOhio @KathleenOCHC A copy of this powerpoint will be sent to you in a follow—up email