Missouri and The Affordable Care Act in 2014

A new age in health care: Insurance that works,

Navigators to show the way

Kit WagarAffordable Care Act SpecialistU.S. Department of Health and Human Services

Region 7 – Missouri, Kansas, Iowa, Nebraska

The Affordable Care Act

1

Enrollment schedule: The first enrollment period began Oct. 1, and ends on March 31,

2014 We are in only the fourth week of a six-month enrollment period

Coverage through the Marketplaces begins as early as Jan. 1, 2014

Must be enrolled by Dec. 15, 2013, for coverage to begin in January

In subsequent years, enrollment runs from October 15 to December 7

Enrollment is a marathon, not a sprintEnrollment is a marathon, not a sprint

Moving ahead

Two benchmarks from the first three weeks: Nearly 20 million unique visitors have checked out Healthcare.gov Nearly 700,000 people have completed online applications nationwide

But the health reform law is not just a website: It’s a new approach that makes health insurance more affordable and

health care more accessible to everyone

Marketplaces – A fairer system In 2014, private insurers will no longer deny coverage or charge a

higher price based on a person’s medical history

Prices for individuals will vary based only on four criteria: Age – a maximum of 3 times the price of younger applicants Tobacco use – a maximum of 50 percent higher than non-smokers

Location – states can establish rating areas

Family size

Ending gender discrimination Women will no longer be charged more than

men the same age

Currently, 22-year-old women are often charged 50 percent more than men their age simply because women bear children

A fairer market – Essential Health Benefits

Ambulatory patient services Emergency Services Hospitalization Maternity and newborn care Mental health and substance abuse

services, including behavioral health treatment

In 2014, all health insurance plans must cover the following services: Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care

Currently, many plans offered in the individual market leave out major categories of coverage

Consumers often don’t realize the omission until they need the coverage 62 percent don’t have maternity benefits 34 percent don’t cover substance abuse 18 percent don’t provide mental health coverage 9 percent don’t cover prescription medication

Key requirements of a Marketplace Marketing of policies

These functions include: Toll-free phone number Website Presenting benefits in a standardized format Single application for Medicaid/CHIP/private insurance Providing electronic calculator to determine actual cost of policy

Includes premium subsidies for less than 400% of poverty level Cost-sharing reductions for households at less than 250% of poverty

Determining eligibility for Medicaid and CHIP Certifying people too poor to make personal responsibility payments

Review insurance plans for eligibility in the marketplace In Kansas & Missouri, insurers had to file their proposed plans and rates by May 3 They were reviewed last summer and approved in September

Making insurance affordable

Help for the middle class

Beginning in 2014: Workers without health benefits receive tax credits to help buy

insurance through the marketplaces Credits will be available up to 400 percent of the poverty level

Maximum income of: $45,960 for 1 person $94,200 for family of 4

The IRS estimates the average credit will be more than $5,000

These credits: allow family farmers and the self-employed to obtain health insurance as if

they had an employer helping them buy it help small business owners that can’t afford health insurance to compete

for employees with large companies that provide generous benefits

Affordable Health Plans

Expected contribution to insurance premiums, silver-level plan

For an individual: Reduction in Consumer’s Expected Maximum Out-of-Pocket Portion of

Annual Income % of FPL Contribution Monthly Premium Maximum Total costs

$13,788 120* 2% of income $23 2/3 6% $16,200 141 3.5% $47 2/3 6% $20,107 175 5.15% $86 2/3 13% $25,852 225 7.18% $155 1/2 27% $31,597 275 8.78% $231 0 30% $40,215 350 9.5% $318 0 30%

Incomes below 250% of the poverty level qualify for lower co-pays and deductibles

* This level of income would be eligible for Medicaid in states that expand their programs in accordance with the Affordable Care Act

Affordable Health Plans

Expected contribution to insurance premiums, silver-level plan

For a family of 4: Reduction in Consumer’s Expected Maximum Out-of-Pocket Portion of

Annual Income % of FPL Contribution Monthly Premium Maximum Total costs

$28,260 120* 2% of income $47 2/3 6% $33,205 141 3.5% $97 2/3 6% $41,212 175 5.15% $177 2/3 13% $52,987 225 7.18% $317 1/2 27% $64,762 275 8.78% $474 0 30% $82,425 350 9.5% $653 0 30%

Incomes below 250% of the poverty level qualify for lower co-pays and deductibles

* This level of income would be eligible for Medicaid in states that expand their programs in accordance with the Affordable Care Act

Individual policies, lowest-priced plan in each category:

Annual Plan Monthly Actual Size ofAge County income level premium payment Discount27 Boone $20,107 Silver $242 $76 $16627 Boone $20,107 Bronze $195 $29 $16627 Boone $25,852 Silver $242 $145 $9727 Boone $25,852 Bronze $195 $98 $97

27 St. Louis $20,107 Silver $196 $66 $13027 St. Louis $20,107 Bronze $147 $17 $13027 St. Louis $25,852 Silver $196 $135 $6127 St. Louis $25,852 Bronze $147 $86 $61

Many rural areas, which traditionally have higher insurance prices than urban areas, get bigger discounts to even out the costs

Actual prices in the Missouri MarketplaceActual prices in the Missouri Marketplace

Family of 4, lowest-priced plan in each category:

Annual Plan Monthly Actual Size ofCounty Income level premium payment DiscountBoone $41,212 Silver $816 $141 $675Boone $41,212 Bronze $659 $0 $675*Boone $52,987 Silver $816 $281 $535Boone $52,987 Bronze $659 $124 $535

St. Louis $41,212 Silver $663 $110 $553St. Louis $41,212 Bronze $496 $0 $553**St. Louis $52,987 Silver $663 $250 $413St. Louis $52,987 Bronze $496 $83 $413

* In Boone County, 1 plan would produce a $0 monthly premium; 1 plan would produce a monthly premium of $5.

**In St. Louis County, 2 bronze plans would produce a $0 monthly premium

Actual prices in the Missouri MarketplaceActual prices in the Missouri Marketplace

When you apply for lower costs in the Marketplace, you’ll need to estimate your household income for 2014 Most people can use their household’s adjusted gross income for this estimate

If you know your 2013 adjusted gross income, use that and take into account any changes you expect in 2014

You could also add up the following items for everyone in your household, based on what you think they’ll receive in 2014:

Wages Salaries Tips Net income from any self-employment or business Unemployment compensation Social Security payments Other kinds of income to include when estimating your 2014 income are:

rental income, interest, dividends, capital gains, annuities, alimony, and some retirement and pensions.

Calculating your income Calculating your income

Individual responsibility Beginning in 2014, individuals can choose to:

carry health insurance, or pay a fee to offset the cost of treating the uninsured

Qualifying coverage: Medicare, Medicaid, Veterans’ coverage , Tricare, employer coverage, private insurance

The fee is the greater of: $95 per person in the household or 1% of your income that exceeds

the tax filing threshold in 2014 $325 per person or 2 percent of income in 2015 $695 per person or 2.5% of income in 2016 and thereafter

Maximum per household is the income percentage or 3 times the flat fee

The flat fee for each child is half the adult amount

Consumer assistance

Enrollment Assistance

NavigatorsConsumer Assistance Programs

Public Eligibility Workers

Insurance Agents and

Brokers

Unions

Community-Based

Organizations

Health Care

Providers

Community Health Centers

Chambers of Commerce

County MH and SA Depts.

No wrong door to enrollment

Links to key questions consumers have about health insurance, eligibility & enrollment

Offers Web chat capability to answer users’ questions

Directs users to appropriate destination based on geography

Footer contains links for non-consumer users to find information

You can create an account* You provide family and income

information to qualify for discounts* You peruse the health plan options* You enroll in the plan best for you**We’re working out the kinks

Healthcare.gov (aka “The Culprit”)

Call Center launched in June 1-800-318-2596TTY/TDD line for hearing-impaired callers: 1-855-889-4325

Helps with wide range of questions, including: Health insurance and how it works Premium assistance and health care affordability programs Steps to take now to get ready for open enrollment beginning Oct. 1 General inquiries, such as “I have insurance. How will I be affected?”

After Oct. 1, the call center will help with: Filling out the application Plan selection

Assistance is Available 24/7 in English and Spanish Help in 150 other languages is available

Marketplace Call Center Marketplace Call Center

Small Business Health Options Program – “The SHOP” SHOP Call Center launched in August 1-800-706-7893

TTY/TDD line for hearing-impaired callers: 1-800-706-7915 Hours: 8 a.m. to 4 p.m. (central time) Beginning Oct. 1: 8 a.m. to 6 p.m. (central)

Information on tax credits that cover up to 50 percent of the cost of employee health insurance for two years at eligible small employers

New, more competitive pricing for health insurance policies Plans grouped by “metal level” to let employers compare plans with truly similar benefits Metal levels – bronze, silver, gold, platinum – reflect the generosity of the plan’s coverage

SBA Fact Sheets, Training Materials and insurance finder tool: http://www.sba.gov/content/affordable-care-act-training-materials Information based on your business location, size, and whether you now offer insurance

SHOP enrollment expected to begin in November

Help for small employers Help for small employers

Finding the right health plan Once an account is created, the

website offers: A comparison tool to evaluate policies

A calculator to estimate each plan’s: premiums co-payments deductibles maximum out-of-pocket costs

Filtering options to let the user narrow the choices based on specific criteria

The most relevant plans are presented first, based on the applicant’s answers

Key data listed with links to plan details

In-person assistance

Sources of enrollment help Navigators

Navigators received grants from Marketplace funds

They must provide community outreach and education programs

They are agencies or individuals trained to work with the uninsured and the underinsured and with employers buying health benefits for employees

Key groups that Navigators will work with include: Young people who may never have had health insurance The self-employed, many of whom previously could never afford insurance Vulnerable populations, including

Low-income groups Non-English-speaking populations People with disabilities Workers between jobs

To ensure that their advice is impartial, Navigators cannot accept compensation directly or indirectly from any health insurer

Navigators will be listed on the Marketplace website under “Find Local Help”

Navigator funding was announced Aug. 15:Missouri received $1.8 million for navigator organizations

Primaris Healthcare Business Solutions $1,045,624 Primaris will lead a coalition of 11 community partners to provide free and unbiased information about insurance plans offered on the Marketplace

Primaris already works with health care providers to improve quality of care Primaris also operates the Medicare CLAIM program, which provides counseling to help people choose the most appropriate Medicare Advantage plan

Missouri Alliance of Area Agencies on Aging $ 750,000

These agencies have an extensive network of contacts and experience dealing with vulnerable populations They will provide navigators in most of Missouri, outside Kansas City

Missouri Navigators Missouri Navigators

Sources of enrollment help Application Counselors

They receive similar, but less extensive, training than Navigators. They must pass a similar, though less comprehensive test

Training is available online at http://marketplace.cms.gov/training/get-training.html

Counselors are certified by the organization they work or volunteer for Individuals can take the training and provide assistance, but they will not be listed on the

Marketplace website as certified application counselors No funding is attached to becoming an application counselor

Most counselors are likely to be staff and volunteers of organizations with a business interest or a social mission to get people insured

Clinics, hospitals, health care providers, social agencies are encouraged to become designated to certify their staff members as application counselors

Counselors must show applicants all insurance options available

To ensure unbiased advice, counselors cannot accept compensation in connection with enrollment and must disclose any potential conflict

Agencies designated as certified application counselors will be listed on the www.healthcare.gov website under “Find local help”

Questions about becoming a certified application counselor or agency can be sent to [email protected]

Becoming a CAC agency Becoming a CAC agency

To apply to be designated as a certified application counselor agency, go to:

http://marketplace.cms.gov/help-us/cac.html

Licensed health Insurance agents and brokersTo enroll individuals, must undergo training on:

website enrollment Marketplace affordability programs Medicaid options security of personal information

Paid by insurers

Brokers and agents represent certain insurance companies and are not required to show applicants all insurance options

Broker training in the federally run Marketplaces is available at: http://www.cms.gov/CCIIO/programs-and-initiatives/health-insurance-marketpl

aces/a-b-resources.html

Sources of enrollment help Sources of enrollment help

Navigators and application counselors must: comply with the Marketplace privacy policies follow Marketplace rules on security of personal information

Information entered on paper applications should not be retained Information in electronic applications is secure within applicant’s online account

Designated application counselor organizations must: screen staff and volunteers to ensure they protect personal information confirm in writing that its workers will comply with privacy and security rules

All certified application counselors must: obtain authorization from each consumer before obtaining personal information maintain a record of the authorization

The consumer can revoke the authorization at any time

Organizations or individuals who violate privacy and security standards are subject to monetary penalties Fraudulent activity will be investigated and addressed under federal law

Security of personal informationSecurity of personal information

Learn about different types of health coverage The Marketplace lets you choose a health plan with the right balance of costs and

coverage. You’ll be better prepared if you understand different types of coverage

Make sure you understand how coverage works, including things such as premiums, deductibles, out-of-pocket maximums, copayments, and coinsurance. You'll want to consider these details while you're looking for health insurance

Gather basic information about your household income Most people using the Marketplace will qualify for discounts on monthly premiums or

out-of-pocket costs. To find out your savings, you'll need income information from documents such as your W-2 form, current pay stubs, or your tax return.

Steps to take now Steps to take now

Set your budget Different types of health plans meet different

needs and budgets. You'll need to figure out how much you want to spend on premiums each month.

“Opportunity is missed by most people because it is dressed in overalls and looks like work.“

----Thomas Edison

A final thought