New Health Insurance Marketplace: Opportunities for Public Health Open Enrollment Began October 1, 2013 Coverage Starts

1. New Health Insurance Marketplace: Opportunities for Public HealthOpen Enrollment Began October 1, 2013Coverage Starts January 1, 2014

2. Health Insurance Marketplace—HealthCare.gov • The Health Insurance Marketplace is a new and easier way to find affordable health insurance. • Many people can get a break on costs at the Marketplace. New tax credits can reduce insurance premiums right away. • Every health plan offers comprehensive coverage from doctors to medications to hospital visits to free preventive care. • Through the same streamlined application process, many can find out if they are eligible for Medicaid or CHIP.

3. Covering more people with health insurance improves population health. • People can get care they needto stay healthy. • Many preventive care services are free for new health plans. • People with health coverage get more preventive care and report better physical and mental health. Baicker K, Taubman SL, Allen HL, et al. The Oregon experiment -- Effects of Medicaid on clinical outcomes. N Engl J Med 2013;368:1713-1722. Baicker K, Finkelstein A. The effects of Medicaid coverage -- learning from the Oregon experiment. N Engl J Med 2011;365:683-685

4. Essential Health Benefits • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental Health and substance abuse disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services/devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care

5. Mental Health and Substance Use Disorder Coverage • The Affordable Care Act requires that health insurance plans on the Health Insurance Marketplace cover mental health and substance abuse disorder services. • Because of the law, health plans must now cover preventive services like depression screening for adults and behavioral assessments for children at no cost. • And starting in 2014, most plans won’t be able to deny you coverage or charge you more due to pre-existing health conditions, including mental illnesses.

6. Preventative and Wellness Services Most insurance plans, including all plans on the Marketplace, provide many free preventive services. Examples include: • Blood pressure, diabetes, and cholesterol tests • Cancer screenings, including mammograms and colonoscopies • Counseling to help quit smoking, lose weight, eat healthfully, identify depression, reduce alcohol use, and avoid sexually transmitted infections • Screenings for sexually transmitted infections • Regular well-woman, well-baby, and well-child visits • Routine vaccinations against flu, pneumonia, measles, polio, meningitis, and many other diseases • Care to ensure healthy pregnancies healthcare.gov/what-are-my-preventive-care-benefits

7. Financial Assistance • Premium tax credits • Will reduce the premium amount the consumer owes each month • Available to eligible consumers with household incomes between 100% and 400% of the federal poverty level ($45,960 for an individual and $94,00 for a family of 4) • Based on household income and family size for the taxable year • Paid each month to the insurer or consumer can wait until they file taxes to receive the premium tax credit

8. Financial Assistance • Cost Sharing Reductions • Reduce out-of-pocket costs (deductibles, coinsurance, copayments) • Generally available to those with income at 250% of the federal poverty level or below ($27,925 for and individual and $57625 for a family of 4 in 2012) • Based on household income and family size for the taxable year

9. Marketplace Enrollment • Open October 1, 2013 to March 31, 2014 • Open October 15 to December 7 each year beginning in 2014 • Special Enrollment Periods available in certain circumstances during the year (childbirth, employment changes, etc.) • Medicaid and CHIP enrollment open year-round Apply by December 15, 2014 for coverage starting on January 1, 2014.

10. Basic Information to Enroll • To enroll in the Marketplace, individuals should be prepared to provide basic information, such as: • Names of family members who need insurance coverage • Birthdates • Social security numbers • Income information

11. PA Marketplace • Pennsylvania will be a Federally Facilitated Marketplace • 1.3 million uninsured in PA • 600,000 Pennsylvanians eligible to enroll through the marketplace • If Medicaid is expanded in PA, an additional 650,000 Pennsylvanians will be eligible for health insurance • 15 insurance companies participating • 56 plans available

12. Marketplace Navigators • Health Insurance Marketplace Navigators can help you • Understand how the Marketplace works • Complete eligibility and enrollment forms • In PA, The Advocacy Alliance, Mental Health America Westmoreland County, Mental Health Association in PA, and PA Mental Health Consumers’ Association offer • Trained navigators with a special focus on helping people who use or need behavioral health services • Language interpreter services • Navigator help to anyone who contacts us

13. Get Help • If you have behavioral health needs and want help understanding and using the Marketplace, contact one of our Health Insurance Marketplace Navigators • 1-855-724-5626 (toll free) • centralPAnav@pmhca.org • easternPAnav@theadvocacyalliance.org • westernPAnav@mhawc.org • Visit HealthCare.gov • Learn about available health coverage choices • Find community-based Navigators that will provide unbiased advice about coverage choices • Sign up for coverage online or on the phone

14. Additional Navigators in Pennsylvania • Find Local Help https://localhelp.healthcare.gov/#address=PENNSYLVANIA&start=50&num=83&filter=off&lang_filter=0&navc_filter=1&shop_filter=0&chip_filter=0 • Mental Health America / Mental Health Association of Southeastern PA • 267-507-3894 or health@mhasp.org • PA Association of Community Health Centers • Resources for Human Development (RHD) • http://www.rhd.org/navigator/partners/partnerscontact.aspx

15. Resources For more information • HealthCare.gov; CuidadoDeSalud.gov • Sign up to get updates at healthcare.gov/subscribe, twitter.com/HealthCareGov, and facebook.com/Healthcare.gov • 24/7 Call Center: 1-800-318-2596 ( 1-855-889-4325 TTY/TDD) • http://www.pmhca.org

16. Information About the Health Insurance Marketplace • Marketplace Application Checklist: http://marketplace.cms.gov/getofficialresources/publications-and-articles/marketplace-application-checklist.pdf • Tips for Helping Consumers Navigate the Marketplace: http://marketplace.cms.gov/getofficialresources/publications-and-articles/tips-for-assisters-to-help-consumers-navigate-the-marketplace.pdf • Things for Consumers to Think About When Choosing A Plan: http://marketplace.cms.gov/getofficialresources/publications-and-articles/things-to-think-about-when-choosing-a-plan.pdf

17. Resources Information About the Health Care Law and Health Insurance Marketplace • How the health care law is making a difference for the people of Pennsylvania: http://www.hhs.gov/healthcare/facts/bystate/pa.html • Articles about the Health Insurance Marketplace; Using the Marketplace; Getting Lower Costs on Coverage; Young Adults; Rights, Protections, and the Law; Prevention; and more: https://www.healthcare.gov/all-topics/ • Videos about the Health Insurance Marketplace: http://www.youtube.com/HealthCareGov

18. The project described was supported by Funding Opportunity Number CA-NAV-13-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services.  • The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

19. Thank you • Navigator Toll Free Number • 1-855-724-5626 • Presenter Contact Information