The Affordable Health Care Act (for Libraries)

The Affordable Health Care Act(for Libraries)

What We Need to Knowfor October 1

Road Map What It Is How Signing Up Works Expert Advice – Protips Our Responsibilities Referral Agencies

What the Health Insurance Marketplace Is Designed to DoThe Basics

The New Face of Healthcare

All Marketplace Plans Provide Coverage Options for the Same

Set of “Essential Health Benefits”

• Outpatient Care• Emergency Services• Hospitalization• Maternity & Newborn Care• Mental Health &

Substance Abuse Services (including counseling and psychotherapy)

• Prescription Drugs• Rehabilitative Services

& Devices• Laboratory Services• Preventative &

Wellness• Chronic Disease

Management• Pediatric Care• Oral & Vision Care

Important Limitsto Help Prevent Crippling Health Care Debt

Out-of-Pocket MaximumA maximum amount of money the individual pays out-of-pocket will exist on each plan – the amount is determined by which plan is chosen and the level of coverage offered.

No Yearly or Maximum LimitsOnce an individual hits their out-of-pocket maximum, any remaining health care expenses MUST be paid by the insurance plan, no matter how much it is or how quickly it is acquired.

Do I have to???Yes.

Signing up is Required if You Are Not Currently Insured

The annual fee for those who do not enroll for 2014 will be $95 for an adult and $47.50 for a child and cannot go higher than $285 for a family or 1 percent of the family’s income (whichever is higher).

In 2015, the fee will increase. The fee for an adult without insurance will be $325, and the fee for a child will be $347.50, and will not go higher than $2,085 for a family or 2.5 percent of the family’s income (whichever is higher).

*The fee will be subjectto change every following year.

A Basic OverviewHow It Works

The Federal Website for Health Carewww.healthcare.govDesigned as a “one-stop-shop” for those seeking health insurance

It has:• “Knowledge base” with FAQs and live chat• Information about tax credits• Information about CHIP, SHOP, and Medicaid

*It will even refer you directly to your state’s health care marketplace.

The Marketplace in Maryland:www.marylandhealthconnection.com

1) Create an account

2) Compare plans

3) Choose the appropriate plan for you and/or your family

4) Enroll in a plan

5) See if you are eligible for financial assistance

6) See if you qualify for public health programs (like Medicaid and CHIP)

What Choices Will Be Available?

• 13 insurance companies in Maryland are participating in the Marketplace

• 7 managed care organizations (MCOs) in Maryland are participating for Medicaid

• Different levels of coverage – bronze, silver, gold, and platinum – with varying premiums, deductibles, and out-of-pocket costs

What if I really, really, really, really hate computers?

Patrons DO have the option of signing up with a paper

form or via phone

In Person:The Walnut Street Community Health Center24 N. Walnut Street, Hagerstown

By Phone:855-642-8572 -or- TTY 855-642-8573

Black Belt Healthcare HelpNot For Beginners

Children’s Health Insurance Program(CHIP)• For low-income families with children

• “Children” defined as up to 19 years of age

• Designed for median-income families who are making too much to qualify for Medicaid but whose income is at or below 200% of the Federal Poverty Level

• In Maryland, pregnant women of any age may qualify if their income is at or below 250% of the Federal Poverty Level

Federal Aid InsuranceMedicare

What it is:Health insurance offered regardless of income; serves primarily people 65+ and younger disabled people

• People who currently receive Medicare don’t need to do anything

• People who receive Medicare CANNOT apply for a marketplace plan in addition to their existing benefits – instead they should apply for Medicare Supplement Insurance (Medigap)

MedicaidWhat it is:An assistance program that serves low-income people of every age • Medicaid benefits are expanding

in many states (including MD), so people should check to see if they qualify under the new rules

• They can do this by filling out an application in the Marketplace; if anyone qualifies, the Medicaid agency will be informed

*For more info,see the Maryland State Medicaid page

Small Business Health Options Program(SHOP)• Designed for small business owners (50 employees

or fewer) who wish to purchase a health insurance plan for their employees

• The small business owner can shop for plans the same way individuals do but through the Small Business Marketplace

• The small business owner can decide what they will pay toward premiums, then the employees can enroll

• Small business owners may qualify for a small business health care tax credit

Three Important Things to Keep in MindWhat Is Our Responsibility?

3 Primary Responsibilities

TECH EXPERTS: Give people access to the internet & help them with computer-related problems

INFO PROVIDERS: Provide appropriate printed material & documentation that may help them

GUIDES: Have enough familiarity with the Affordable Health Care Act to know where to forward people with questions

Questions Beyond Our Purview:Where Can We Forward Them?

ONLINEHealthcare.gov

Marylandhealthconnection.gov

BY PHONEHealthcare.gov: 800-318-2596

MD Health Connection: 855-642-8572

IN PERSONWalnut Street Community Health Center24 N. Walnut Street / Hagerstown, MD

301-745-3777

In Summary…