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Morning Plenary: Implementation of The Affordable Care Act

The Affordable Care Act & Access to Health Care Along the Gulf Coast: A Symposium. Morning Plenary: Implementation of The Affordable Care Act . Presented by: Johnston Associates Sponsored by: Alliance Institute November 15, 2013. We need Access to Affordable Health Care on the Gulf Coast.

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Morning Plenary: Implementation of The Affordable Care Act

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  1. The Affordable Care Act & Access to Health Care Along the Gulf Coast: A Symposium Morning Plenary: Implementation of The Affordable Care Act Presented by: Johnston Associates Sponsored by: Alliance Institute November 15, 2013

  2. We need Access to Affordable Health Care on the Gulf Coast

  3. Morning Plenary: Panelists Marjorie Petty Regional Director Region VI US Department of HHS Tony Garr Enroll America Oscar Gomez Health Outreach Partners Moderated by: Philip W. Johnston

  4. Presented by Marjorie Petty, HHS Regional Director, Region VI Health InsuranceMarketplace 101 The Marketplaceisopen! Findhealth optionsthat meet needsandfit care your your budget. November2013

  5. GEOGRAPHIC DIVERSITY OF THE UNINSURED Number Uninsured PercentUninsured

  6. ch2010,President Obama signed the The Health Care Law  In Mar Affordable Care Act into lawallowing • Youngadults up toage 26to their parents’ plan Additionaldrug coverage for withMedicare stayon • people • • More freepreventiveservices Lifetime limitsremovedfromhealth insurance And morestartingJanuary1,2014 • November 2013 HealthInsuranceMarketplace101 2

  7. What’snewon January1, 2014?  Discriminationduetopre-existingconditionsor gender is prohibited AnnualLimits onInsuranceCoverageareeliminated AdvancedPremium TaxCreditsareavailable The SmallBusinessTax Creditwillincrease More peopleareeligiblefor Medicaid (in some states)      Coveragethrough begins the Health Insurance Marketplace • As early as January 1,2014 November 2013 3 HealthInsuranceMarketplace101

  8. Whatis the HealthInsuranceMarketplace?  Part of theAffordableCare Actof 2010 • Wherequalified individuals directly compareprivate insuranceoptions Known asQualified Health Plans(QHPs) Candirectly compareonthe basisof price, benefits, quality, and otherfactors Alsoknownas Exchanges orObamacare health • •  SmallBusinessHealthOptionsProgram(SHOP) • Marketplace for smallbusinesses November 2013 HealthInsuranceMarketplace101 4

  9. The Marketplace…  It’s a waytoshopforhealth coverage • • Simplifiesthe search Withone streamlined applicationan individual orfamily canexplore everyqualifiedinsurance plan inthe area Most people areabletoget a break on costs  • 90%of peoplewhoare currentlyuninsuredwillqualify for savings onhealth insurance  Clearoptionswith apples-to-applescomparisons • Allhealth insuranceplansin the Marketplacepresenttheir price and benefitinformationinplainlanguage November 2013 HealthInsuranceMarketplace101 5

  10. MarketplaceEstablishment  Eachstatecan chooseto • • Createandrunits ownMarketplace Partner with theFederalGovernmenttorunsome Marketplace functions • Have a Marketplace established theFederalGovernment and operated by November 2013 HealthInsuranceMarketplace101 6

  11. QualifiedHealthPlansCover EssentialHealthBenefits  EssentialHealthBenefitsincludeatleastthese10 categories • Ambulatory Patient Services • Emergencyservices • Hospitalization • Maternityandnewborn care • Mentalhealthandsubstanceuse disorderservices, includingbehavioral healthtreatment • Prescription drugs • Rehabilitativeandhabilitativeservicesanddevices • Laboratoryservices • Preventiveandwellness servicesandchronic diseasemanagement • Pediatricservices, includingoraland vision care (pediatricoral servicesmaybe providedby stand-aloneplan) 7 November 2013 HealthInsuranceMarketplace101

  12. How QualifiedHealthPlans Can Vary   Someplansmaycoveradditionalbenefits Youmayhavetoseecertainprovidersorusecertain hospitals Thepremiums,copays,andcoinsurancearedifferent differentplans Thequalityofcarecanvary Thecoveragelevel canvarywithineachplan Somespecialtypesofplansarestructureddifferently  in    • Like high-deductible(catastrophic)plans November 2013 HealthInsuranceMarketplace101 8

  13. PlanLevels of Coverage LowestPremiums HighestOut-of-Pocket HighestPremiums Costs Lowest Out-of-Pocket Costs 60% Covered 70% Percent of 80% Total Costof 90% CareCovered November 2013 HealthInsuranceMarketplace101 9

  14. CatastrophicPlans  What is catastrophiccoverage? • • • Planswithhigh deductiblesand lowerpremiums You pay allmedicalcostsup toacertain amount Includes coverage of 3primary care visits per year preventiveserviceswithno out-of-pocket costs Protectsconsumers fromhighout-of-pocket costs and •  Whois eligible? • • Youngadults under30years of age Thosewhoobtainahardshipexemption from the Marketplace November 2013 HealthInsuranceMarketplace101 10

  15. Small BusinessHealthOptionsProgram (SHOP) Marketplace  Astreamlined wayforsmallbusinesses health insurance Part of theMarketplace Offers accesstoQualifiedHealth Plans Works with new insurancereforms and to offer    tax credits to lower barriers toofferinghealth insurance SHOPMarketplace Help Deskforemployers  • 1-800-706-7893(TTY 1-800-706-7915) November 2013 HealthInsuranceMarketplace101 11

  16. Eligibilityinthe IndividualMarketplace  Marketplace eligibility requiresyouto • • • Liveinits service area,and BeaU.S.citizenornational,or Beanon-citizenwhoislawfullypresentin theU.S.for theentireperiodforwhichenrollmentissought Notbeincarcerated • Canapply charge Canapply forMarketplaceifpendingdisposition of forMedicaid/CHIPatanytime November 2013 HealthInsuranceMarketplace101 12

  17. Lower Premium Costs  A refundableorAdvancedPremium thecostofQualifiedHealthPlans Eligibilityisbasedon TaxCredit (APTC)lowers  • Householdincome,and familysize (atendofyear) Incomebetween100%to400%ofthe federalpovertylevel(FPL) ($23,550–$94,200forafamilyoffourin2013) Obtainingqualified health insurancethroughthe Marketplace Ineligibilityforgovernment-sponsoredcoverage, affordable employer-sponsoredinsurance,orcertain otherminimum essential coverage • • November 2013 HealthInsuranceMarketplace101 13

  18. Ways to Use a Premium Tax Credit Willyou get a Willyou haveto Is your monthly crediton Federal payback Ifyou chooseto… premiumlower? tax return? money?* Use all ofyour premiumtax credit Use partofyour premiumtax credit Use none ofyour premiumtax credit Yes Notlikely Maybe Yes Maybe Notlikely No Yes No *Youshouldreportchangesinhouseholdsize andincomeassoonaspossibleto ensureyouaregetting the right premiumtaxcreditamountandavoidhavingto payanythingback. November 2013 HealthInsuranceMarketplace101 14

  19. Who is Eligiblefora Cost-Sharing Reduction?  Eligibilityforreducedcostsharingisbased on • Income at or below250%of theFPL ($58,875 annually fora family offour in 2013) ReceivingthePremium Tax Credit Enrollmentina Marketplace Silver-level plan • •  MembersofFederally-recognizedIndianTribes • Nocostsharingif income is <300%FPL November 2013 HealthInsuranceMarketplace101 15

  20. MedicaidEligibilityin2014  StateshavetheoptiontoexpandMedicaideligibilityto • Adults ages 19– 64withincomesup to133%of the federal poverty level(FPL)($15,282/yearforan individual, $31,322/yearforafamilyof 4(2013amounts))  EnsuresMedicaidcoverageforallchildren •Withincomesup to133%of theFPL Shiftstosimplifiedwayofcalculatingincometodetermine Medicaid/CHIPeligibility  • Known asModified AdjustedGrossIncome(MAGI)-based method November 2013 HealthInsuranceMarketplace101 16

  21. Startingin2014, everyonemusteither: 1.HaveMinimum 2.HaveaCoverage 3.Pay afee Essential Exemption (Shared OR OR Coverage Theyare already coveredand don’t needtodo anything. November 2013 Theydon’thave to getcoverage and won’thavetopay a feefornothaving coverage. HealthInsuranceMarketplace101 Responsibility Payment) Theyshould consider getting coverage.If they don’t,they willpay a fee. 17

  22. 1. Whatis MinimumEssentialCoverage?  Ifyouhavecoveragefromanyofthefollowing, youare coveredanddon’thaveto doanything • • • • • • • Employer-sponsored,including COBRAand retiree Medicare Medicaid Children’s Health Insurance Program(CHIP) Marketplace Coverage IndividualCoverage (outsidethe Marketplace) TRICAREorcertain types of VAcoverage coverage About85%ofAmericansalreadyhave MinimumEssential Coverage. November 2013 HealthInsuranceMarketplace101 18

  23. 2. Who cangeta coverageexemption nothave to pay a fee? and  Youmaygetacoverageexemptionifyou • • • • • • • Are Are Are conscientiouslyopposed(religiousconscience) a member ofa recognizedhealth caresharingministry a member ofa FederallyrecognizedIndiantribe Don’tmakethe minimumincome required tofile taxes Have ashortcoveragegap(>3 consecutivemonths) Suffered a hardship Didnothaveaccessto affordablecoverage (costof available coverage>8% ofhousehold income) • • Were Were incarcerated (unlesspendingdispositionof charges) notlawfullypresent HealthInsuranceMarketplace101 November 2013 19

  24. 3. You May Pay a Fee  You may pay a feewhen youfileyour 2014 Federaltax returnin 2015(andthereafter) • If you don’thave minimumessential coverage, and You don’t qualify foran exemption •  Paying the coverage fee does not provide health Less than 2%ofAmericans areexpected to havetopay the fee. November 2013 HealthInsuranceMarketplace101 20

  25. You May Pay a Fee (Continued)  You pay the greater of the flat dollar amount or the percentage of income 2014 2015 2016 andbeyond Flatdollar $95 peradult $325 peradult $695 peradult** amount 50%ifunder18* 50%ifunder18* 50%ifunder18* (annual) Or Or Or Percentageof 1%ofhousehold 2%ofhousehold 2.5% of income income income household (annual) income *Maximumof$285 perfamilyin2014(appliestothoseforwhomthe$95 per adult/$47.50 perchildis lessthan1%ofincome).Higherinsubsequentyears. **After 2016-Plusanincreasebasedoncost ofliving November 2013 HealthInsuranceMarketplace101 21

  26. WhenYouCanEnroll inthe IndividualMarket  MarketplaceInitialOpenEnrollmentPeriod • October1,2013-March31,2014  AnnualOpenEnrollmentPeriods • 2014andbeyond,October 15-December 7  SpecialEnrollmentPeriods • Availableincertain circumstances during the year November 2013 HealthInsuranceMarketplace101 22

  27. How the Marketplace Works HealthInsuranceMarketplace101 November 2013 23

  28. 4 Ways to Get Marketplace Coverage November 2013 HealthInsuranceMarketplace101 24

  29. InPerson Assistance  Marketplaceinpersonhelpisavailable • CertifiedAssisters Navigators Non-Navigatorassistancepersonnel CertifiedApplicationCounselors Agents andbrokers To find assistance inyour area,go to Localhelp.HealthCare.gov • • Visit Marketplace.cms.gov forinformationonyour becomingaChampion forCoverage organization November 2013 HealthInsuranceMarketplace101 25

  30. MarketplaceandPeopleWith…  Medicare • Medicareisn’tpartof the Marketplaceso you don’t needtodo anything  COBRA • You can dropCOBRAandenrollinthe Marketplace Duringthe MarketplaceOpen EnrollmentPeriod Within60 daysof COBRAexpiring(SpecialEnrollmentPeriod)  Pre-existing ConditionInsurance Plan(PCIP) • • EndsDecember31,2013 Need toapplyfor Marketplacecoverageby December15, 2013, to avoid abreakincoverage(noautomatictransition) November 2013 HealthInsuranceMarketplace101 26

  31. Key Pointsto Remember  TheMarketplaceisanewwaytofindandbuy insurance Qualifiedindividualsandsmallbusinessescan healthinsurancethatfitstheirbudget health  shopfor   States haveflexibilitytoestablishtheirownMarketplace Individualsandfamiliesmaybeeligibleforlowercosts theirmonthlypremiumsandout-of-pocketcosts Thereisassistanceavailabletohelpyougetthebest coverageforyourneeds on  November 2013 HealthInsuranceMarketplace101 27

  32. RemembertheMarketplace’s Important Dates Open Enrollment Started October 1, 2013 Lastdayto enrollforcoverageto beginJanuary1, 2014 December15,2013 Coveragecanstartas earlyas January1, 2014 Open enrollment ends March 31,2014 November 2013 HealthInsuranceMarketplace101 After March31,2014, you canonly enrollaftera qualifyingevent or duringthe nextannual open enrollment (Oct15,2014– Dec7,2014). 28

  33. Marketplace.cms.gov Get thelatest resourcestohelp people apply, enroll, andget coverage 2014 in Click “Get Training” for helpfulvideos November 2013 HealthInsuranceMarketplace101 29

  34. onnected Want moreinformation about the Marketplace?  Stay Connected • Signup togetemailand textalerts at HealthCare.gov/subscribe CuidadoDeSalud.gov forSpanish • Updates and resourcesforpartner available atMarketplace.cms.gov Twitter@HealthCareGov Facebook.com/Healthcare.gov organizations are • • November 2013 HealthInsuranceMarketplace101 30

  35. Alliance Institute: ACA DiscussionNovember 15, 2013 Tony Garr Southeast State Assistance Manage

  36. Get Covered America Mission

  37. Sampling of Our Partners

  38. Enroll America’s Mission: Maximize Coverage For Uninsured Americans Enroll America is executing a national education and enrollment campaign 1. Educate and Engage 2. Mobilize to Enroll 3. Work with Partners to Ensure System works Successful implementation of ACA requires all-out effort by government, not-for-profits, insurers, hospitals, community health centers, health providers, and others

  39. State Presence As of September 23, 2013 Staff on the ground Working with partners Alaska Hawaii

  40. Our Research Tells Us…

  41. Alabama Assistance Coordinating Organization: Alabama Arise http://www.arisecitizens.org/index.php/policy-research-topmenu-71/health-topmenu-29 Requesting Enrollment Assistance: • AIDS Alabama, Enroll Alabama: http://www.enrollala.com/ • Access Alabama: http://www.alaaccess.com/AHA_Home.aspx • Alabama Primary Health Care Assn Outreach & Enrollment: http://www.alaaccess.com/AHA_Home.aspx • Healthcare.gov –https://www.healthcare.gov/ • Find Local Help: https://localhelp.healthcare.gov/ • Call Center: 1-800-318-2596; TTY: 1-855-889-4325 • Enroll America: http://www.getcoveredamerica.org/

  42. Florida Assistance Coordinating Organization: Florida Primary Care Association: http://www.fachc.org/ Requesting Enrollment Assistance: • Florida Consumer Services: 1-877-693-5236 • Healthcare.gov –https://www.healthcare.gov/ • Find Local Help: https://localhelp.healthcare.gov/ • Call Center: 1-800-318-2596; TTY: 1-855-889-4325 • Enroll America: http://www.getcoveredamerica.org/

  43. Louisiana Assistance Coordinating Organization: Southwest Louisiana AHEC - http://lahealthcarenav.com/ Requesting Assistance: • Reach us by Email at: info@lahealthcarenav.com • By Phone: North LA - Toll Free - 1-877-946-4644; Central LA - 318-443-2855;Southwest – Toll Free - 1-800-435-2432; Southeast – Toll Free - 1-866-428-4173 • Enrollment Assistance: http://lahealthcarenav.com/request-enrollment-assistance/ • Louisiana Primary Care Assn Outreach & Enrollment: http://lpca.net/main/inside.php?page=Outreach_and_Enrollment • Events in Your Area: http://lahealthcarenav.com/events/ • Healthcare.gov –https://www.healthcare.gov/ • Find Local Help: https://localhelp.healthcare.gov/ • Call Center: 1-800-318-2596; TTY: 1-855-889-4325 • Enroll America: http://www.getcoveredamerica.org/

  44. Mississippi Assistance Coordinating Organization: Cover Mississippi - http://coverms.org/ Requesting Enrollment Assistance: • Coordinator: Morgan Miller, miller@mhap.org or 601-355.0025 (p) • Cover Mississippi: http://coverms.org/index.php/site/help • Mississippi Primary Care Assn Outreach & Enrollment: http://www.mphca.com/outreach-and-enrollment-resources • Events in Your Area: http://coverms.org/index.php/events • Healthcare.gov –https://www.healthcare.gov/ • Find Local Help: https://localhelp.healthcare.gov/ • Call Center: 1-800-318-2596; TTY: 1-855-889-4325 • Enroll America: http://www.getcoveredamerica.org/

  45. As A Result, Enrollment Will Be A Challenge To Overcome Many of the uninsured still don’t know about their options November 2012 August 2013 of the uninsured don’t know about the new health insurance options of the uninsured don’t know about the new health insurance marketplace options 78% 43% Enroll America still has work to do, but the uninsured are hearing more and more about the new options available to them Source: Enroll America, November 2012 Source: Kaiser Family Foundation, August 2013 Lack of awareness provides opportunity for education with effective messaging

  46. Segmentation

  47. Campaign Strategies and Tactics

  48. In-reach and Outreach tools

  49. Outreach – Commitment Card

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