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Health Insurance Know Your Options. Affordable Care Act Basics. What is the Affordable Care Act?

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affordable care act basics
Affordable Care Act Basics

What is the Affordable Care Act?

  • The Patient Protection and Affordable Care Act (PPACA),commonly called the Affordable Care Act (ACA) or Obamacare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010.
  • The ACA aims to increase the quality and affordability of health insurance and lower the uninsured rate by expanding public and private insurance coverage.
affordable care act basics1
Affordable Care Act Basics

The Affordable Care Act increases access to health coverage for consumers through:

  • Access to certain free preventative services
  • Health coverage for pre-existing conditions
  • Access to health coverage through the Marketplace
  • Health coverage for young adults up to age 26 on their parents’ health plan
affordable care act basics2
Affordable Care Act Basics

The Affordable Care Act adds new requirements for health insurance companies.

  • Health insurance companies can no longer cancel health coverage for reasons other than lack of payment of premium or deliberately providing misinformation to the company.
  • The ACA prohibits lifetime limits on coverage.
affordable care act basics3


Affordable Care Act Basics

Medicaid Expansion

  • The Affordable Care Act provided temporary federal money to states that wanted to expand Medicaid.
  • Tennessee has chosen not to accept Federal money to expand its Medicaid program at this time.
  • Even though Tennessee did not participate consumers may still be eligible for programs to help lower their costs through the marketplace.
the health insurance marketplace
The Health Insurance Marketplace
  • What is the Health Insurance Marketplace?
  • The Health Insurance Marketplace or “Exchange” is an online system that provides consumers with a new way to shop for health coverage
    • shows if applicants are eligible for programs to help lower their cost using a single application
    • allows for “apples to apples” comparison for qualified health plans (QHPs)
the health insurance marketplace1
The Health Insurance Marketplace
  • Types of Marketplaces
  • Tennessee is a federally-facilitated marketplace (FFM).
marketplace health insurance plans
Marketplace Health Insurance Plans

Coverage Options

  • Health plans in the Marketplace are separated into four health plan categories:
    • Bronze
    • Silver
    • Gold
    • Platinum
  • Health plan categories are based on the plans actuarial value (AV).
    • AV is the percentage of total average cost for covered benefits that a plan will cover.
marketplace health insurance plans1
Marketplace Health Insurance Plans

Coverage Options (continued)

60% 70% 80% 90%

Lower monthly premium Higher monthly premium

Higher out-of-pocket costs Lower out-of-pocket costs

** Health plan categories do not reflect the quality or amount of care the plans provide.

marketplace cost savings
Marketplace Cost Savings

When consumers get health coverage through the Marketplace, depending on income and family size, they may be able to save money.

Types of cost savings include:

  • Advanced Premium Tax Credits
  • Cost-Sharing Reduction
  • Medicaid
  • CoverKids
marketplace cost savings1
Marketplace Cost Savings

Premium Tax Credits

Some consumers may be able to lower the cost of their monthly premiums through advanced premium tax credits.

  • The amount the consumers’ eligible to save through premium tax credit depends on the consumer’s income and family size.
    • The lower consumer’s income, the higher his or her savings will be.
marketplace cost savings2
Marketplace Cost Savings
  • Premium tax credits are available to consumers who make up to 400% FPL, which is:
    • up to $45,960 for individuals
    • up to $62,040 for a family of two
    • up to $94,200 for a family four
marketplace cost savings3
Marketplace Cost Savings

Advanced Premium Tax Credits

  • To qualify, consumers must apply and enroll in coverage thorough the Marketplace.
  • If they meet income requirements, consumers will immediately see the amount of savings for which their eligible reflected in the premium cost shown for available QHPs.
  • Consumers must reconcile tax credit payments on their federal income tax returns.
marketplace cost savings4
Marketplace Cost Savings

Cost-Sharing Reductions

Cost-sharing reductions lower howmuch consumers pay for deductibles, copayments, and coinsurance. To be eligible for cost-sharing reductions, a consumer must:

  • Apply and enroll in health coverage through the Marketplace
  • Have a household income less than or equal to 250% FPL
  • Receive the premium tax credit
  • Enroll in a silver level plan through the Marketplace – a plan that pays 70% of the average overall cost of providing essential health benefits to members
the health insurance marketplace2
The Health Insurance Marketplace

There are two ways to access the Marketplace:

  • Individual Marketplace
    • Individuals and families
  • SHOP Marketplace
    • Small business owners and their employees
the shop marketplace
The SHOP Marketplace

For 2014, the SHOP Marketplace is open to employers with 50 or fewer full-time-equivalent employees (FTEs).

the health insurance marketplace3
The Health Insurance Marketplace

Enrollment and Coverage Dates

  • Open enrollment for health coverage through the Marketplace began October 1, 2013 and ends March 31, 2014.
exemptions available
Exemptions Available

Exemptions through the Marketplace

  • Health care sharing ministry
  • Incarceration status
  • Native American/Native Alaskan status
  • Religious conscience
  • Hardship
health insurance options
Health Insurance Options

How to Get Insurance

Health insurance inside the marketplace – Consumers were able to enroll in health coverage through the marketplace until March 31, 2014.

Health insurance outside the marketplace – Consumers can obtain health coverage through a health insurance company that sells insurance outside of the marketplace.

Job-based insurance – Consumers who are currently employed may be able to purchase health coverage through their employer, called employer-sponsored or job-based.

Insurance under a parent’s policy – Younger adults ( up to 26 years old) are eligible to enroll in health coverage under their parents health insurance plans if those plans cover dependents.

health insurance options1
Health Insurance Options

Additional Health Coverage Options

Medicaid – a joint federal and state administered health insurance program for low income families and children, pregnant women, the elderly, people with disabilities, and in some states, other adults.

Medicare – Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).


Children’s Health Insurance Program (CHIP) - a program jointly funded by state and federal government that provides health coverage to low income children and, in some states, pregnant women, and families who earn too much to qualify for Medicaid, but they cannot afford private health insurance.

TRICARE – is the Department of Defense (DoD) healthcare program available to eligible members and their families of the seven uniform services: the US Army, US Navy, US Air Force, US Marine Corps, US Coast Guard, commissioned Corps of the US Public health service, and the National Oceanic and Atmospheric Administration.

Veteran’s Affairs (VA) Health Benefits– the Department of Veterans Affairs (VA) administers a variety of benefits and services that provide financial and other forms of assistance to service members, veterans, their dependents and survivors. As part of these benefits and services, the VA provides health coverage for eligible veterans who served in the US military.