Explaining the Health Insurance Marketplace October 2013

Copyright © 2013 Holy Family Memorial. All rights reserved.

October 23, 2013 hfmhealth.orghfmhealth.org

What you need to knowWhat you need to knowShawn Daughenbaugh, MHA

hfmhealth.orghfmhealth.org

Education GoalsEducation Goals

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• What is the marketplace• When does it begin• Who is affected• How to enroll• Doing What’s Right


The Marketplace The Marketplace ExplainedExplained

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In Wisconsin… land of In Wisconsin… land of cheesecheese

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• Wisconsin is operating a Federally Facilitated Marketplace– Initial set up and operation controlled by

federal government– No state involvement in operations

• Marketplace is an online entity• National hotline and website at

healthcare.gov


Participating Participating insurersinsurers

• Including HFM– Common Ground Healthcare Coop– WPS Health Plan, Inc. (Arise)– Dean Health Plan, Inc. (Preva 360)

• Not including HFM– Molina Healthcare of WI, Inc– Compcare Health Services Ins. Corp. (Anthem)

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hfmhealth.orghfmhealth.orgPremiumsPremiumswww.healthcare.gov/find-premium-estimates/

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hfmhealth.orghfmhealth.orgReimbursementReimbursementFinancial Impact on HFM

• Reimbursement will remain at current negotiated rates for each insurer

• While contracted rates will remain the same, the ability of individuals to pay deductible and copayments may be an issue

• What will private insurance do?7

hfmhealth.orghfmhealth.orgTiers of CoverageTiers of Coverage“Metal Plans”

• Each metal indicates the actuarial value

8Source:HealthPocket

hfmhealth.orghfmhealth.orgTax CreditTax CreditHow it works

• An “advanced premium” paid directly to insurer

• Based on federal poverty level, the individual may get 2% to 9.5% of income back for credit

• Credit is based on benchmark– That difference between 2nd lowest silver

and specified percent from above

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Mathematical Mathematical example example All figures are annual costs

• Smith Family: Married couple with 2 children

• Income: $47,100; equals 200% of FPL– This means the Smith family gets 6.3% of

$47,100 back to them. Equals $2,968 per year

• 2nd lowest silver plan premium $10,000/ year

• Credit due to Smith Family is $7,032– $10,000 minus $2,968

10Source: Health Affairs


Ready or Not!Ready or Not!

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hfmhealth.orghfmhealth.orgThe days of infamy The days of infamy

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hfmhealth.orghfmhealth.orgWho is affected?Who is affected?

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Fantastic. How does one Fantastic. How does one enroll?enroll?

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hfmhealth.orghfmhealth.orgCommunity HelpCommunity Help

• Community “Mobilizers” are key• Manitowoc County will have 3,000-

5,000 individuals affected• HFM stepped up to Do What’s Right

– Manitowoc County Community Action Enrollment Coalition

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hfmhealth.orghfmhealth.orgAt HFMAt HFMWhere to find help

• Insights is already hard at work– The point of contact for most patients with

concerns– Activity

• www.hfmhealth.org/EnrollAmerica– Website hosted by HFM for citizens

• CAEC Toolkits at Wellness Center, Main Entrance, Clinics, ER, EVERYWHERE!

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Enroll America: Answers for Enroll America: Answers for youyou

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hfmhealth.orghfmhealth.orgRecapRecap

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• Nationally speaking uneven expansion of Medicaid leaves many holes

• Health Insurance Marketplaces will insure millions of Americans –though many may remain or become uninsured

hfmhealth.orghfmhealth.orgRecap ContinuedRecap Continued

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• Qualified Health Plans will be sold with different levels of coverage – several options tailored to peoples’ need but will be confusing

• Open Enrollment is from October 1-March 31

•Healthcare.gov

Explaining the Health Insurance Marketplace October 2013

Education

Transcript of Explaining the Health Insurance Marketplace October 2013