ACA Booklet

What’s InsIde:

A basic ACA overview 2

Wyoming healthcare statistics 4

How is the ACA going to affect you? 6

Warnings about penalties 12

Key dates you need to know 14

HealtHcare reformThe Affordable Care Act, Wyoming, and You

tHe “wHen”• For2014,theOpen

EnrollmentPeriodisOctober1,2013–March31,2014

• For2015andlateryears,theOpenEnrollmentPeriodisOctober1toDecember7

FormoreinformationaboutSpecialEnrollmentPeriodsandQualifyingLifeEvents,visitwinhealthplans.com.

tHe “wHat”ThePatientProtectionandAffordableCareAct(ACA)isthecomprehensivefederalhealthcarereformlawenactedinMarch2010.

KEyPrOviSiOnSOFThEACT:

• nomoreexclusionsforpre-existingconditions

• newwaystopurchasecoverageplans

• Expandedcoverageforyoungadults

• Taxpenaltiesfortheuninsured

• AdvancedPremiumTaxCredits(APTC),i.e.subsidies

• Taxcreditsforqualifiedsmallemployers

GrEETinGS,

As the healthcare industry enters a new era of change, I’d like to take this

opportunity to reach out to you with information about your choice in health care

and possible changes for next year and into the future.

The Affordable Care Act created in 2010 is now becoming

a reality. For us, it’s been a journey to develop our plans so

that they not only meet the federal requirements, but also

give our members the best value we can. For you, it’s a new

opportunity to explore your options for healthcare plans,

benefits, and costs.

At WINhealth, we’ve long recognized the need for healthcare to

do more than just provide protection against those “what if”

moments in life– your healthcare plan should help you live your best life. Through

personal customer service, wellness programs, and education, we empower our

members to take control of their own health.

I’m pleased to let you know that we have added new benefits to our health plans.

Beginning in January, WINhealth plans will cover a set of preventive services,

such as preventive visits and immunizations, plus screening tests including

mammograms, colonoscopies and cholesterol tests, at no cost to our members,

regardless of whether deductibles have been met. Also, coverage limits will

disappear with new plans purchased for 2014.

The

5 W

s of

Th

e A

CA

stephen K. Goldstone

2 hEALThCArErEFOrM

tHe “wHy”intendedtoaddressrisinghealthcosts,theACAisdesignedtoprovidemoreoversightofinsurancepremiumsandpractices,emphasizepreventivecare,reducehealthcarefraudandabuse,andfostercomparison-shoppingtoincreasecompetitionandpricetransparency.

tHe “wHere”ThehealthinsuranceMarketplaceisanewwaytofindqualityhealthcoverage.itcanhelpifyoudon’thavecoveragenow,orifyouhaveitbutwanttolookatotheroptions.WithoneMarketplaceapplication,youcanlearnifyoucangetlowerpremiumsbasedonyourincome,compareyourcoverageoptionsside-by-side,andenroll.

tHe “wHo”nooneplanstogetsickorhurt,butmostpeopleneedmedicalcareatsomepoint.healthinsurancecoversthesecostsandprotectsyoufromveryhighexpenses.in2011,almost48millionAmericanswereuninsured.TheACAseekstomakeiteasierandmoreaffordablefortheuninsuredtogetcoverage.

Our new plans will meet – and in many instances exceed – the Essential Health

Benefits criteria for the ACA and we are excited to announce that we are able

to offer them on the new insurance exchange, known as the Health Insurance

Marketplace (Federally Facilitated Marketplace).

If you’re curious about our new plans, you can see them now that the

Marketplace is open by visiting: winhealthplans.com and clicking the link at the

top left of the homepage. On the Marketplace, you can also see if you qualify

for an Advanced Premium Tax Credit or subsidy, and select a WINhealth ACA-

compliant plan through the exchange.

We hope you will call us if you have any questions about your health plan options.

We are available at (307) 773-1300, or you can visit our website any time at

winhealthplans.com.

Sincerely,

Stephen K. Goldstone

President & CEO, WINhealth

ThEAFFOrDAbLECArEACT,WyOMinG,AnDyOu3

Seeourcalendarofimportantdates

onpage14tobesureyouwon’tmissthe

windowofeligibilityfortheMarketplace.

the affordable Care act (aCa) can be confusing – it’s long, complicated, and

affects millions of people. It can be difficult to decipher just how it will have an

impact on you or the residents of Wyoming. Below are some aCa facts and figures

to help clarify what’s new, what’s changing, and what it means to you in Wyoming:

4 hEALThCArErEFOrMW

yom

ing

heA

lThC

Are

Fac

ts &

Fig

ures

8382,494

that’s 17%

the percentage of Wyoming residents currently insured through health care plans. For them, the aCa will provide more health plan choices and stronger coverage.

the number of Wyomingites who are not currently insured. For these individuals, along with families and

businesses who purchase their own health care coverage, the health Insurance Marketplace will make

new options available.

10•1•131•1•14

the open enrollment start date for the health Insurance Marketplace, also known as the health exchange.

the earliest coverage start date if you sign up for health insurance

during open enrollment (no later than december 15, 2013).

OCt 1

Jan 1

1

5 6

2

3

4

26 80the maximum age

at which children

can remain on their

parents’ health

insurance plans.

the number of cents

per premium dollar

that health insurance

companies are required

to spend on health care

or improvements to

care, or else they must

provide a refund.


$15,888,085the amount of funding provided to Wyoming community health centers to support ongoing health center operations and to establish new health center sites, expand services, and/or support major capital improvement projects.

10

7 9

8

11 12

13

196,000 62

136,000

$2.2 $10

48,752

the number of people in Wyoming who are already free from worrying about lifetime dollar limits on health coverage. the aCa also currently restricts the use of annual limits and bans them completely in 2014.

the number of national health service Corps (nhsC) clinicians providing primary care services in Wyoming. the nhsC repays educational loans and provides scholarships to certain primary care providers who practice in areas of the country that have too few health care professionals to serve the population.

the number of Wyomingites with private health insurance who gained preventive service coverage with no cost-sharing in 2011 and 2012.

the grant money received from the federal prevention and public health Fund to support effective policies in Wyoming and its communities.

the amount of money that Wyomingites saved on prescription drugs due to the aCa.

data provided by the U.s. department of health & human services, as of July 29, 2013.Visit www.hhs.gov/healthcare/facts/bystate/wy.html for more information.

MilMil

the number of Wyoming individuals with traditional Medicare who used one or more free preventive services in 2012.

hoW is The ACA going to affect you?

6 HealtHcare reform

healthcare reform is going to impact all of us differently, based on our lifestyles,

incomes, employment, and family status.

We’d like to introduce you to five people here in Wyoming who wanted to

explore how health care reform will affect them.

here are theIr storIes.

7

8

9

10

11

CarrIe pre-eXIstInG MedICal CondItIon

erIC hUsBand & Father

MarCUs sMall BUsIness oWner

alICe loYal patIent

toM & sUsan neW parents

a:


Meet CarrIe | pre-eXIstInG MedICal CondItIon

Carrie, 24, loves her job, but struggles to pay the monthly health insurance premium on her employer-provided plan and her rent, as well as other expenses. she doesn’t want to drop coverage because she takes several medications and needs regular health screenings to manage her bi-polar disorder. how will the aCa help her?

By checking the Marketplace, Carrie may find that a WINhealth plan

is an affordable health insurance option. Since her bi-polar disorder

is a pre-existing condition, she can’t be denied coverage or charged a

higher premium because of it. Plus, mental health services and treatments will

now be covered by the Ten Essential Health Benefits provision. Carrie may qualify

for an Advanced Premium Tax Credit (APTC), sometimes referred to as a premium

subsidy, or she may decide she still cannot afford insurance and may be able to

access dependent coverage on her parents’ plan until she is 26 years old.

8 hEALThCArErEFOrM

eric and his family have always received health insurance through an employer-provided plan, but recently he received a letter saying that his employer will cover only employees next year. Can his family get coverage through the Marketplace? What about eric?

Both individual and family plans are offered by WINhealth on the

Marketplace. Some families will learn that they qualify for subsidies

to help offset their monthly premiums or a tax break for signing up for

insurance through the Marketplace. If Eric has questions about the plans available

to his family, he should call a WINhealth advisor, a licensed broker, or a Navigator

who will help him understand his options. Eric can also change plans along with

his family during the Open Enrollment Period of Oct. 1, 2013 through March 31,

2014, but if Eric’s group (employer) plan meets the Affordability & Adequacy criteria,

he would not be eligible for the APTC subsidy and he may decide to stick with his

employer’s plan.

a:

Meet erIC | hUsBand and Father


Marcus is a small business owner with less than 25 employees. he values his employees and believes that providing benefits such as health care is one important factor in helping to attract and retain talented workers. even though he wants to continue to offer health benefits, the costs have continued to rise higher and higher over the past few years, and now he’s not sure he can afford the rates or that his employees are happy with the limited coverage. What are his options?

Small businesses with fewer than 50 full-time employees face different

obligations for the ACA and may have more advantages than larger

businesses. The Small Business Healthcare Options Program (SHOP)

Marketplace will offer small employers a choice of qualified health plans that

make it easy to compare prices and benefits side-by-side. Marcus can get help

from an insurance broker, a Navigator, or work with WINhealth to evaluate how

much of his budget he can contribute toward his employees’ health care and he

can explore his eligibility for the Small Business Healthcare Tax Credit.

a:

Meet MarCUs | sMall BUsIness oWner

10 hEALThCArErEFOrM

alice likes her doctor, but she wonders if there is a more affordable health insurance option available to her. Can she keep her doctor?

Depending on the plan Alice chooses in the Marketplace, she may

be able to keep her current doctor. When comparing plans in the

Marketplace, like the WINhealth plans, she will see a link to a list of

providers in each plan’s network. If staying with her current doctors is important

to her, she can check to see if they are included before choosing a plan.

a:

Meet alICe | loYal patIent

do you have specific questions or concerns about how

the aCa will affect you? share your story with us at

winhealthplans.com and we’ll be glad to discuss your

options with you.


tom makes a great hourly wage, but his company doesn’t provide benefits. his wife susan works full-time but really wants to stay home with their new baby. susan has high blood pressure and diabetes and has been told that if she leaves her job, she would have limited health insurance for the first two years because of her “pre-existing” conditions. tom’s salary is enough to allow them to meet their expenses, especially if they don’t have to pay for childcare anymore, but susan continues to work so the family can keep their access to affordable insurance. they both wonder if the affordable Care act (aCa) will allow them to change their lifestyle?

The ACA prevents insurance companies from limiting or denying

coverage to people with pre-existing conditions, so Susan may find

that a WINhealth plan available through the Marketplace would allow

her to make the career change she has been seeking. Getting WINhealth insurance

through the Marketplace eliminates the need to depend on an employer for

benefits, allowing members to switch jobs or stop working and still access

affordable, quality health care.

a:

Meet toM & sUsan | neW parents

A WArning about penalties

12 hEALThCArErEFOrM

WhY do We all need to

haVe InsUranCe?

When someone without health coverage

needs urgent (often expensive) medical

treatment but cannot pay the bill, these

“uncompensated” costs spread across

everyone else and we all end up paying

a higher price.

What IF I don’t haVe health

CoVeraGe In 2014?

there are a few exemptions,

but people who can afford to

take responsibility for their

healthcare and choose not to

have coverage will have to pay

a penalty.

What’s the BIG ConCern?

anyone without health coverage will also have to pay the entire cost of all his

or her medical care and there’s no more protection from very high medical bills

that can sometimes lead to bankruptcy.

the fee in 2014 is 1% of your yearly income or $95 per person for the year, whichever is higher. the fee increases every year. In 2016 it is 2.5% of income or $695 per person, whichever is higher. In 2014 the fee for uninsured children is $47.50 per child. the most a family would have to pay in 2014 is $285.

Remember, if a person fails to enroll during Open Enrollment, he or she won’t be eligible to enroll or receive a subsidy (APTC) until the next open enrollment period unless there is a qualifying event.

For more information about exemptions or insurance that qualifies as minimum essential coverage, visit winhealthplans.com.

$95pp

$695pp

2014 2016

the penaltIes

The 10 essenTiAl health benefitsall private health insurance plans offered in the Marketplace will include the same set of essential health benefits. these are services all plans must cover. the essential health benefits include at least the following items and services:

Ambulatory patient services (outpatient care you get without being admitted to a hospital)

Emergency services

Hospitalization (such as surgery)

Maternity and newborn care (care before and after your baby is born)

Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

Prescription drugs

Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

Laboratory services

Preventive and wellness services and chronic disease management

Pediatric services

If you’d like more explanation about

what these benefits mean or if you

have questions about any of these

services, please visit our website

or contact us.


Winhealth

plansmeetthe

requirementsforall10

Essentialhealthbenefits

andevenprovideadditional

coverageforourmembers.See

exactlywhateachplanoffers

andcompareyouroptions

side-by-sideinthe

Marketplace.

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24

JanUarY 2014

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19 20 21 22 23 24 25

26 27 28 29 30 31

noVeMBer 2013

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14 hEALThCArErEFOrM

oCtoBer 2013

dATes To remember

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

FeBrUarY 2014

1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28

deCeMBer 2013

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

MarCh 2014

1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

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25 26 27 28 29


oCtoBer1: Open enrollment begins

for individuals

Employers must notify employees of the ACA health insurance exchange

noVeMBer15: Last day to apply for or renew

a Freedom plan

16: WINhealth begins offering only ACA-compliant plans

deCeMBer15: Last date to enroll in order to start

coverage on Jan 1, 2014

JanUarY1: Coverage begins for individuals and

premium tax credits will be available to certain low-income individuals

Individual Mandate starts, requiring individuals to obtain minimum essential coverage or pay a personal income tax penalty

15: Last date to enroll in order for coverage to begin Feb 1, 2014

FeBrUarY15: Last date to enroll in order for

coverage to begin Mar 1, 2014

MarCh15: Last date to enroll in order for

coverage to begin Apr 1, 2014

31: Open enrollment closes; last date to enroll in order for coverage to begin May 1, 2014

Wehopeyou

willcallusif

youhaveany

questionsaboutyour

healthplan.Weareavailable

at(307)773-1300, oryoucanvisitour

websiteanytimeat

winhealthplans.com.

enrollment reopens on october 1, 2014. If you’re not sure what to do in between that timeframe, call us and we’ll help you understand your options.

CheCklisT to get ready

create an ACCOunT

APPLyFOr COvErAGE*

PiCKA PLAn

enroll

Go to WInhealthplans.CoM,

ClICK the lInK to the MarKetplaCe,

then FolloW these steps.

YoU WIll also need:

social security numbers (or document

numbers for legal immigrants)

employer and income information for every member of your household who needs coverage (for example, from

pay stubs or W-2 forms—Wage and Tax

Statements)

policy numbers for any current health insurance plans covering members of your household

a completed employer Coverage tool (you can find this on our website) for every job-based plan you or someone in your household is eligible for. (You’ll

need to fill out this form even for coverage

you’re eligible for but don’t enroll in.)

PRSRT STD

US POSTAGE

PAID

CHEYENNE, WY

PERMIT NO. 161

1200 East 20th Street Cheyenne, WY 82001

Visit our website to learn more, or stay up to date with us on Facebook at facebook.com/winhealthpartners

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ACA Booklet

Documents

Transcript of ACA Booklet