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Affordable Care Act. What does it mean for our families and communities?. Overview. Review of Affordable Care Act (ACA) Private insurance reforms and the Marketplace ACA and immigrants/refugees. Already Have Insurance?.

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Affordable Care Act

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affordable care act

Affordable Care Act

What does it mean for our families and communities?

  • Review of Affordable Care Act (ACA)
  • Private insurance reforms and the Marketplace
  • ACA and immigrants/refugees

already have insurance
Already Have Insurance?
  • Everyone needs to have insurance by March 31, 2014 with some exceptions
  • If you have insurance through your employer that is affordable, you don’t have to do anything
  • If you have private insurance that complies with the base requirements, you don’t have to do anything
  • If you are on public insurance (Medicare, Medicaid), you don’t have to do anything and your coverage will be getting better

key dates
Key Dates
  • October 1, 2013
    • “Get Covered Illinois” opens to buy health care insurance
  • December 15, 2013
    • Last day to sign up for insurance to have a January 1, 2014 effective date
  • January 1, 2014
    • New health insurance coverage purchased on “Get Covered Illinois” begins
  • March 31, 2014
    • Last day to sign up for health care insurance for 2014

why is the new health care law important
Why is the new health care law important?

Currently and after 2014:

  • Insurance companies will cover some of the costs
  • Preexisting conditions
  • Preventive care services
  • Women
  • Medicare patients
  • Children under the age of 26
  • Small businesses
  • Lifetime limits
  • High-risk pool
  • Medicaid
  • Tax credits

Changes today:

  • Costs
  • Preexisting condition
  • Lifetime limit
  • Underinsured
  • Women
available now
Available Now
  • Dependent Coverage up to age 26
  • Consumer protections/transparency
  • No pre-existing condition exclusion for children
  • No lifetime limits
  • Health plans cannot drop people when they get sick
  • Insurers are required to spend 80-85% of premium dollars on patient care (and refund consumers when they spend less!)
  • Preventative Services – no co-pay for many services in private insurance & Medicare
  • Small business tax credits
  • Increased primary care rates for Medicaid providers in 2013-2014
  • Closing of Medicare Part D “donut hole” (entirely by 2020)
starting in 2014 and beyond
Starting in 2014 and beyond
  • State or federal “Health Insurance Marketplace” – new marketplaces with Essential Health Benefits package (Enrollment begins Oct. 1, 2013)
  • Large Medicaid Expansion to Adults up to 138% FPL
  • No pre-existing condition exclusion
  • Consumer protections – no annual limits, no rating by health status or gender only by age, location & smoker/non-smoker
  • Shared Responsibility Provisions
  • Individual Mandate
  • Employer Mandate (for orgs with 50+ FTEs) – postponed until 2015
essential health benefits package what is it
Essential Health Benefits Package: What is it?
  • Ambulatory patient services;
  • Emergency services;
  • Hospitalization;
  • Maternity and newborn care;
  • Mental health and substance use disorder services;
  • Prescription drugs;
  • Rehabilitative and habilitative services and devices;
  • Laboratory services;
  • Preventive and wellness services including chronic disease management;
  • Pediatric services including oral and vision care.
  • All non-grandfathered health plans in individual & small group market must cover these essential benefits at a minimum
  • Illinois has chosen BCBS Blue Advantage as the Benchmark Plan supplemented by AllKids for dental and Federal VIP for vision for children. Illinois is currently developing their Medicaid Expansion Benchmark – most likely similar to FamilyCare.
the marketplace get covered illinois
The Marketplace (“Get Covered Illinois):
  • User friendly format to understand terms, compare benefits & services across plans
  • Enables you to:
    • Enroll in Medicaid and possibly other public benefits
    • Find out if you’re eligible for financial assistance that make coverage more affordable
  • Health plans required to have enough doctors, perform well on quality measures
  • Will keep health insurance low

list of insurance companies selling plans in the marketplace
List of Insurance Companies selling plans in the Marketplace
  • Blue Cross & Blue Shield of Illinois
  • Humana, Inc.
  • Aetna Inc.
  • Land of Lincoln Health Inc. Co-Op
  • Coventry Health Care Inc.
  • Carle Foundation
  • These 6 Insurance companies will be selling over 150 plans in the Marketplace.

individual mandate responsibility provision
Individual Mandate/Responsibility Provision
  • Requires most individuals (including children) to carry “minimum essential” health coverage
  • Many exemptions:
    • Religious reasons
    • Undocumented non citizen
    • Household income is below the minimum threshold for filing a tax return(Go to for tax assistant)
    • Unaffordable coverage (insurance premiums exceed 8% of family income)
  • Payment, exemption or penalty is through the federal income tax return:

aca s new medicaid eligibility category
ACA’s New Medicaid Eligibility Category

Current Program

New Category

Why it is good for Illinois?

current specialized medicaid programs in il
Current Specialized Medicaid Programs in IL
  • On top of the traditional Federal program, Illinois has three programs for families and children

medicaid s new eligibility category
Medicaid’s New Eligibility Category
  • In 2014:
    • U.S. Citizens, Lawfully Residing Immigrants and LPRs with five years in U.S., ages 19-64 with incomes up to 133% FPL ($14,856 individual)
    • Enrollment is via Get Covered Illinois or through ABE (Application for Benefits Eligibility –
    • Also able to apply for SNAP and cash benefits at same time



  • A new Medicaid program
  • Who?
    • Lives in Cook County.
  • Be 19-64 years old
  • Have income at or below 133% of the FPL ($14,856 individual;$20,123 couple-annually)
  • Not be eligible for “State Plan” Medicaid (Parent, Pregnant, Blind or receiving disability income)
  • Not be eligible for Medicare
  • Be a legal immigrant for 5 years or more OR be a US citizen
  • Have a SS# or have applied for one

the aca and immigrants
The ACA and Immigrants

Naturalized Citizens

Legally present immigrants