Affordable Care Act Marketplace Implementation Briefing PA Breast Cancer Coalition Annual Conference October 5, 2015 H EALTH C ARE.GOV Joanne Corte Grossi,

Affordable Care ActAffordable Care ActMarketplace Implementation Briefing Marketplace Implementation Briefing

PA Breast Cancer Coalition Annual PA Breast Cancer Coalition Annual ConferenceConference

October 5, 2015October 5, 2015

HEALTHCARE.GOV

Joanne Corte Grossi, MIPPJoanne Corte Grossi, MIPPRegional DirectorRegional Director

U.S. Department of Health & Human U.S. Department of Health & Human Services, Region III Services, Region III

Pennsylvania, Delaware, District of Columbia, Pennsylvania, Delaware, District of Columbia, Maryland, Virginia, West VirginiaMaryland, Virginia, West Virginia

Affordable Care Act OverviewAffordable Care Act Overview

17.6 million adults gained health 17.6 million adults gained health insurance since the beginning of open insurance since the beginning of open enrollment 2013 through September 12, enrollment 2013 through September 12, 2015.2015.

5.4 million young adults gained coverage5.4 million young adults gained coverage

12.3 million enrolled in Medicaid & CHIP12.3 million enrolled in Medicaid & CHIP

Uninsured rate dropped to 9.4% - lowest Uninsured rate dropped to 9.4% - lowest since they began keeping recordssince they began keeping records

Affordable Care Act Affordable Care Act OverviewOverview

Provides coverage to young adults up to Provides coverage to young adults up to the age of 26the age of 26

Strengthens Medicare benefits with lower Strengthens Medicare benefits with lower prescription drug costs for those in the prescription drug costs for those in the ‘donut hole,’ chronic care, and free ‘donut hole,’ chronic care, and free preventive carepreventive care

Prohibits plans from imposing lifetime and Prohibits plans from imposing lifetime and annual limits on the dollar value of annual limits on the dollar value of benefits, and from rescinding coverage benefits, and from rescinding coverage when you get sickwhen you get sick

Affordable Care Act OverviewAffordable Care Act Overview Rein in insurance premiums ratesRein in insurance premiums rates

Prevent denials of coverage, including for Prevent denials of coverage, including for pre-existing conditionspre-existing conditions

Make health insurance affordable for Make health insurance affordable for middle class familiesmiddle class families

Make health insurance affordable for Make health insurance affordable for small businesses with tax cutssmall businesses with tax cuts

Pennsylvania is a Federally Facilitated Pennsylvania is a Federally Facilitated Marketplace Marketplace

549,205 Pennsylvanians enrolled during 549,205 Pennsylvanians enrolled during 2014 open enrollment2014 open enrollment

472,697 Pennsylvanians enrolled during the 472,697 Pennsylvanians enrolled during the 2015 open enrollment 2015 open enrollment

479,00 enrolled in Medicaid through 479,00 enrolled in Medicaid through Medicaid expansionMedicaid expansion

Marketplace Implementation Marketplace Implementation

15 insurance carriers offering 50 health 15 insurance carriers offering 50 health plansplans

80 percent of Pennsylvania consumers 80 percent of Pennsylvania consumers qualified for an average tax credit of $226 qualified for an average tax credit of $226 per monthper month

51 percent obtained coverage for $100 or 51 percent obtained coverage for $100 or lessless

Marketplace Implementation Marketplace Implementation

Actuarial ValueActuarial Value The ACA requires plans inside the Marketplace The ACA requires plans inside the Marketplace

to meet particular actuarial value (AV) targetsto meet particular actuarial value (AV) targets• Bronze = 60% AVBronze = 60% AV• Silver = 70% AVSilver = 70% AV• Gold = 80% AVGold = 80% AV• Platinum = 90% AVPlatinum = 90% AV

““Metal Levels” will enable consumers to Metal Levels” will enable consumers to compare plans with similar levels of coverage, compare plans with similar levels of coverage, promote competition on premiums, and allow promote competition on premiums, and allow plans flexibility to design cost sharing plans flexibility to design cost sharing structuresstructures

Essential Health BenefitsEssential Health Benefits• Ambulatory patient servicesAmbulatory patient services• Emergency servicesEmergency services• HospitalizationHospitalization• Maternity and newborn careMaternity and newborn care• Mental health and substance use disorder Mental health and substance use disorder

services, including behavioral health treatmentservices, including behavioral health treatment• Prescription drugsPrescription drugs• Rehabilitative and habilitative services/devicesRehabilitative and habilitative services/devices• Laboratory servicesLaboratory services• Preventive and wellness services and chronic Preventive and wellness services and chronic

disease managementdisease management• Pediatric services, including oral and vision Pediatric services, including oral and vision

carecare

Quality InsuranceQuality Insurance

Open EnrollmentOpen Enrollment

Special Enrollment PeriodSpecial Enrollment Period

Qualifying Life EventsQualifying Life Events

Next Open Enrollment:Next Open Enrollment:• November 1, 2015 – January 31, November 1, 2015 – January 31,

20162016

From Coverage to CareFrom Coverage to Care Understand your coverage – know what Understand your coverage – know what

services are coveredservices are covered Find a provider – Check your plan’s list of Find a provider – Check your plan’s list of

providersproviders Know where to go for care – use ER’s only Know where to go for care – use ER’s only

for life threatening situationsfor life threatening situations Stay healthy with screenings and manage Stay healthy with screenings and manage

chronic conditionschronic conditions Make an appointment – make sure your Make an appointment – make sure your

plan is accepted by the provider & take plan is accepted by the provider & take your insurance card with youyour insurance card with you

Individual Mandate PenaltyIndividual Mandate Penalty For 2016:For 2016:

• 2.5% of yearly household income or2.5% of yearly household income or• The higher of $695 per person (up to 3 people The higher of $695 per person (up to 3 people

or $2,085)or $2,085)

Fee is paid on the federal income tax Fee is paid on the federal income tax return you file for the year you don’t have return you file for the year you don’t have coveragecoverage

Medicaid ExpansionMedicaid Expansion

• 479,000 Pennsylvanians are newly 479,000 Pennsylvanians are newly covered since January 1, 2015 for health covered since January 1, 2015 for health insurance with Medicaid expansioninsurance with Medicaid expansion

• 100% federally funded for first three 100% federally funded for first three years (2014-2016)years (2014-2016)

• Federal funding gradually reduced to Federal funding gradually reduced to 90% in 2020 90% in 2020

Navigators/CACs in PANavigators/CACs in PA PA Navigators received $3.1 million from CMSPA Navigators received $3.1 million from CMS Consumer Health Coalition Consumer Health Coalition

consumerhealthcoalition.org (412) 456-1877consumerhealthcoalition.org (412) 456-1877

Penn Asian Senior Services Penn Asian Senior Services passi.us (215) 572-1234passi.us (215) 572-1234

PA Association of Community Health Centers PA Association of Community Health Centers pachc.com (717) 761-6443pachc.com (717) 761-6443

PA Mental Health Consumers’ AssociationPA Mental Health Consumers’ Association pmhca.org 717-564-4930 pmhca.org 717-564-4930

Public Health Management Corporation Public Health Management Corporation phmc.org (215) 985-2500phmc.org (215) 985-2500

Young Women’s Christian Assn. of Pittsburgh Young Women’s Christian Assn. of Pittsburgh ywcapgh.org (412) 391-5100ywcapgh.org (412) 391-5100

Resources:

Affordable Care Act website –Affordable Care Act website –www.healthcare.gov

Navigators/CACs - Navigators/CACs - localhelp.healthcare.govlocalhelp.healthcare.gov Tax Tools – Tax Tools – https://www.healthcare.gov/taxeshttps://www.healthcare.gov/taxes

Affordable Care Act Spanish website Affordable Care Act Spanish website – – www.cuidadodesalud.gov

Thank you!Contact:

[email protected]