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Health Care Reform, Health Insurance and Health Care in Houston: An Overview. The Artists Health Insurance Resource Center www.ahirc.org A program of The Actors Fund www.actorsfund.org with funding from The Doris Duke Foundation.

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health care reform health insurance and health care in houston an overview

Health Care Reform, Health Insurance and Health Care in Houston: An Overview

The Artists Health Insurance Resource Center www.ahirc.org

A program of The Actors Fund www.actorsfund.org

with funding from The Doris Duke Foundation

what s already happened 2010
What’s already happened - 2010
  • Children under age 19 with pre-existing conditions can’t be denied coverage.
  • Young adults up to age 26 can stay on or enroll in their parents’ coverage.
  • Insurers can’t retroactively cancel the policies of people who get sick.
  • Insurers can’t impose lifetime dollar limits on medical benefits.
  • All new plans must cover certain preventive services, such as mammograms, flu shot and tetanus shots, for free.
slide3
2010
  • Uninsured people with pre-existing conditions may be eligible for coverage through PCIP.

Pre-Existing Condition Insurance Plan

www.pcip.gov

Help for the uninsured with pre-existing medical conditions thru

a temporary high-risk pool until January, 2014

Have to be uninsured for 6 months.

Monthly Premium Cost: 19-34 $207, 35-44 $249,

45-54 $319, 55+ $444

slide4
2011
  • Medicare recipients with Part D-drug coverage in the coverage gap or “donut hole” received 50% off drugs. In 2013, you pay 47.5% for brand name and 79% for generic drugs. By 2020, 25% all the time.
  • Annual wellness visits and certain preventive services are free for Medicare recipients.
  • Increased funding to Community Health Centers
slide5
2014
  • Insurers can’t refuse coverage to anyone.
  • Most people will be mandated to have coverage or pay a penalty.
  • New insurance marketplaces, called Exchanges, will offer insurance to those who don’t get it elsewhere.
  • Subsidies will be available to people who buy insurance through an exchange with income less than 400% of the Federal Poverty Level. ($43,320)
  • Employers with 50 or more employees who don’t offer insurance will be fined.
essential package of benefits
Essential package of benefits:
  • All new plans will offer at a minimum an essential benefits package which limits out-of-pocket medical expenses.

Including:

  • Ambulatory care
  • Emergency care and Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse
  • Prescription drugs
  • Preventive and wellness services
do i have to have insurance in 2014
Do I have to have Insurance in 2014?
  • Yes!
  • Penalty: increases from $95 or 1% of income in 2014 to $695 or 2.5% of income in 2016.
  • Exceptions include: Native Americans, those w/religious objections, people who are not legal residents, those who don’t meet tax filing threshold ($9,350 single), people who’ve been uninsured for less than 3 months.

Can I keep my current coverage?

YES. Plans that were in effect on March 23, 2010 are grandfathered under the law.

how will i afford insurance
How Will I Afford Insurance?
  • If your income is $10,830 - $43,320 (single), you will receive a subsidy to buy insurance through an exchange.
  • Subsidies will cap the amount you spend on premiums in relation to your total income.
  • Subsidies will also cap your annual out-of-pocket medical costs.
  • Example: a person who makes $21,000/yr will have their premiums capped at 6.3% of their income, and their annual out-of-pocket medical costs will be limited to $1,983/yr (excluding premiums).
are there special programs for people under 30
Are There Special Programs For People Under 30?
  • Under age 30: high-deductible plan option (2014). Prevention benefits and 3 primary care visits are exempt from deductible.
  • Under age 26: can stay on or enroll in parents’ plan. Applies regardless of living situation, marital status, student status, or financial dependence. Exclusion: if you have access to insurance through an employer.
will there be more coverage for preventive services
Will There be More Coverage For Preventive Services?
  • If you have a new policy that began on or after 9/23/2010, you can get certain preventive services for free:
    • Blood pressure, diabetes & cholesterol tests
    • Breast, colon & cervical cancer screenings
    • Vaccines, immunizations & flu shots
    • HIV & STD testing
    • Screenings for healthy pregnancies
    • Well-child visits
what s the small business tax credit
What’s the small business tax credit?
  • Available since the 2010 tax year
    • Employers with fewer than 25 FTE’s employees with average wages of less than $50,000 that purchase health insurance for employees are eligible for the tax credit
  • To be eligible, employer must offer a group health plan & contribute at least 50% of premium cost
  • 2010-2013: credit max is 35% of employer contribution (25% for tax exempt/non-profits); will increase to 50% (35% for non-profits) in 2014
small business tax credit
Small business tax credit
  • Small business will file Form 8941 when they file income tax returns
  • Tax exempt organizations will claim the tax credit on a revised Form 990-T

www.irs.gov/newsroom/article/0,,id=223666,00.html

FAQ:

www.irs.gov/newsroom/article/0,,id=220839,00.html

resources links
Resources & Links
  • Artists Health Insurance Resource Center: www.ahirc.org
  • Fractured Atlas

www.fracturedatlas.org

  • Office of Consumer Information and Insurance Oversight: www.hhs.gov/ociio
  • Federal health care reform website: www.healthcare.gov
  • Kaiser Family Foundation: www.kff.org
how do i get health insurance now
How do I get health insurance now?
  • Employment-related coverage
  • Purchase private plans
  • Government-subsidized programs
  • If you leave/get laid off from a job …

COBRA – Continuation of employer benefits for at least 18 months

60 days to decide/elect coverage

“Sticker Shock” – guaranteed coverage, but can be expensive. Pay full premium, at group rate.

i can afford to buy insurance but i don t know what type to get
I can afford to buy insurance, but I don’t know what type to get.
  • Words to Know – HMO, PPO, High Deductible Plan or Catastrophic Coverage.
    • Choose a carrier & type of policy to meet your needs and your budget. Consider your medical risk and financial limits.
  • Internet brokers
    • www.ehealthinsurance.com
www texashealthoptions com
www.texashealthoptions.com
  • A State of Texas Resource for Finding Health Insurance Coverage
  • Consider your medical and financial risk limits
  • Choose a carrier & type of policy to meet your needs and your budget
texas health insurance pool premiums are rated up
Texas Health Insurance Pool – Premiums are “Rated Up
  • www.txhealthpool.com
  • Schools and Alumni Associations
  • Chambers of Commerce
    • Example: Texas Association of Business

www.txbiz.org/Insurance

government programs
Government Programs
  • Medicaid
    • Comprehensive
    • Very low income AND fit one of these categories: pregnant, blind, disabled, 65 or over, 18 or under, or be a parent living with child 18 or under
    • No premiums
    • No pre-existing condition waiting periods
    • 2 month application process
    • 1-800-252-8263
government programs for kids
Government Programs for kids
  • Children’s Health Insurance Program
    • Must be 18 or younger
    • Household income below 200% FPL
    • Must be uninsured for 90 days (some exceptions)
    • Comprehensive
    • No premiums, small co-pays
    • www.chipmedicaid.org
i have a special health condition are there programs that cover it
I have a special health condition. Are there programs that cover it?
  • Breast & Cervical Cancer Early Detection Program
    • Free mammograms for women age 40+
    • Free pap smears for women age 18+
    • Must go to a participating provider
    • Must be uninsured and have income under 250% FPL

www.dshs.state.tx.us/bcccs/default.shtm

    • CHIP Perinatal

www.hhsc.state.tx.us/chip/perinatal/index.htm

i don t have insurance i can t afford insurance
I don’t have insurance/I can’t afford insurance.
  • Free, sliding scale, lower cost clinics
    • Harris Health System
    • Gateway to Care
    • Texas Association of Community Health Centers
    • Retail Clinics
      • Minute Clinics
      • RediClinics
i can t afford my medications
I can’t afford my medications
  • $4 Generics @ Target and Walmart
  • Costco discount program
  • Pharmacy Checker

www.pharmacychecker.com

  • Partnership for Prescription Assistance

www.pparx.org