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Understanding Health Care Reform & Health Care Resources in Los Angeles. The Dancers Health Insurance Resource Center www.dhirc.org A program of The Actors Fund www.actorsfund.org with Funding from The Doris Duke Foundation. What’s already happened - 2010.

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understanding health care reform health care resources in los angeles

Understanding Health Care Reform & Health Care Resources in Los Angeles

The Dancers Health Insurance Resource Center www.dhirc.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 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.ca.gov

Help for the uninsured with pre-existing medical conditions thru a temporary high-risk pool until January, 2014

slide4
2011
  • Medicare recipients in the coverage gap or “donut hole” will receive 50% off drugs
  • Annual wellness visits and certain preventive services will be 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)
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.
  • You will likely have to file proof of coverage with your taxes.
  • This “individual mandate” is the issue heard by the Supreme Court in March: 1)Tax vs. Penalty, 2) Individual Mandate: Can it be severed from the rest of 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).
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 beginning 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
  • 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 private insurance but i don t know what type of plan to get
I can afford to buy private insurance, but I don’t know what type of plan to get.
  • Rights & Protections – right to receive care in a life-threatening emergency at any hospital regardless of insurance status.
  • Words to Know – HMO, PPO, High Deductible Plan or Catastrophic Coverage.
    • Choose a carrier & type of policy to meet your needs and your budget.
ways to get coverage
Ways to get Coverage
  • Industry Advantage Insurance Services

an affiliate of The Motion Picture & TV Fund

Plans vary in terms of price and type of coverage.

Contact Carla @ 888 558 – 4247

  • MPTF Health Centers
    • Bridge to Health
ways to get coverage1
Ways to get Coverage
    • Colleges & Universities – Alumni Associations
    • Associations Plans
  • Internet brokers
    • www.ehealthinsurance.com
government programs
Government Programs
  • Medi-Cal
    • Comprehensive coverage / No premiums
    • 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
    • As part of health care reform, income will be the ONLY eligibility requirement in 2014.

www.medi-cal.ca.gov

      • Healthy Way LA
government programs1
Government programs
  • Healthy Families
    • A low cost insurance for children and teens providing health, dental and vision coverage to children who do not have insurance and do not qualify for Medi-Cal.
    • www.healthyfamilies.ca.gov
    • LACountyHelpsis a free and easy way to find out if you can get help from the many different health and human services programs.
    • www.lacountyhelps.org
i don t have insurance
I don’t have insurance
  • Free, sliding scale, lower cost clinics
  • Performing Artist Medical Clinic - Venice Family Clinic
    • Valley Community Clinic
    • Saban Free Clinic
    • Minute Clinics @ select CVS
  • Sliding-scale clinics
    • Bureau of Primary Care: http://findahealthcenter.hrsa.gov
i can t afford my medications
I can’t afford my medications
  • $4 Generics @ Target, Ralphs and Walmart
  • Pharmacy Checker

www.pharmacychecker.com

  • Needy Meds

www.needymeds.org

i have dental problems but no insurance what do i do
I have dental problems but no insurance. What do I do?
  • Dental discount plans and dental insurance
  • Dental schools
    • UCLA School of Dentistry
    • USC School of Dentistry
  • Negotiate with your dentist
  • Many of the Community Clinics have low-cost or free dental clinics for people with low incomes.