Get Connected. Get Covered.

Get Connected. Get Covered.

Affordable Care Act (ACA) 101Enroll DuPage Navigators

January 2014


The Affordable Care Act (ACA) improves how millions of Americans access health care and makes insurance more affordable. • Marketplace• Medicaid Expansion

Get Connected. Get CoveredYoung Adults in US

Under the Affordable Care Act, up to 16.7 million of America’s 19 million uninsured young adults could be eligible for free or reduced cost coverage through expanded Medicaid (if all states expanded) or tax credits/cost sharing (via the Marketplace).

Get Connected. Get CoveredYoung Adults in Illinois

Get Connected. Get Covered.Medicaid Expansion

• Eligibility • Benefits• Funding

Status of State Medicaid Expansion Decisions, as of December 11, 2013

WY WI*

WV

WA

VA

VT

UT

TX

TN

SD

SC

RI PA*

OR

OK

OH

ND

NC

NY

NM

NJ

NH

NV NE

MT

MO

MS

MN MI*

MA

MD

ME

LA

KY KS

IA* IN* IL

ID

HI

GA

FL

DC

DE

CT

CO CA

AR*AZ

AK

AL

Implementing Expansion in 2014 (26 States including DC)Seeking to Move Forward with Expansion post-2014 (2 States)Not Moving Forward at this Time (23 States)


Improved Coverage• No rule out for pre-existing conditions• No lifetime caps• Covered through parents up to age 26 or 30

years old if veteran• Premium equality between genders• 100% coverage of preventive services (no

copays/coinsurance)• Must include Essential Health Benefits

Get Connected. Get CoveredEssential Health Benefits

• Ambulatory patient services• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance use

disorder services• Prescription drugs

• Rehabilitative and habilitative services and devices

• Laboratory services• Preventative and wellness

services including chronic disease management

• Pediatric services including oral and vision care

Get Connected. Get Covered.Preventive Care Benefits

1.Abdominal Aortic Aneurysm one-time screening

2.Alcohol Misuse screening and counseling

3.Aspirin use to prevent cardiovascular disease

4.Blood Pressure screening

5.Cholesterol screening

6.Colorectal Cancer screening

7.Depression screening

8.Diabetes (Type 2) screening (high blood pressure)

9.Diet counseling

10.HIV screening

11.Immunization vaccines for adults

12.Obesity screening and counseling

13.Sexually Transmitted Infection (STI) prevention counseling

14.Syphilis screening

15.Tobacco Use screening


Financial Assistance• Premium Tax Credits– Up to 400% of FPL

• Cost Sharing Subsidies– Up to 250% of FPL

• Medicaid– Up to 138% of FPL


Individual Responsibility2014 must enroll by 3/31/14 to avoid penalty

– $95 per adult– $47.50 per child (50%)– Or 1% of family income, whichever is greater.

• Paid thru federal income tax

Get Connected. Get CoveredYour Rights Under ACA

• The right to stay on your parents’ family health insurance plan until age 26.

• The right to coverage that cannot be dropped when an unexpected condition or accident makes your care expensive.

• The right to an appeal if coverage for needed care is denied by your insurer.

• The right to information about the cost of insurance and the quality of insurance benefits so that you can choose the plan that works best for you.

• The right to choose your own primary care doctor or pediatrician and to see an OB/GYN without a referral.

• The right to emergency care when and where you need it without huge out-of-pocket network costs.

• The right to a rebate if your insurer spends less than 80% of premium dollars on care.

• The right to free preventive care to keep you healthy and your health care costs down.

• The right to get covered, even if you have a pre-existing health condition.

Source: Illinois Public Interest Research Group

Get Connected. Get CoveredWhat Young Adults are Saying

http://www.youtube.com/watch?feature=player_embedded&v=-ebFKQqhBS4

http://www.youtube.com/watch?v=csgnKOl3sLM&feature=player_embedded

Source: Young Invincibles.org, 2013






Source: Illinois PIRG, Health Insurance 101 Guide, 2013

Get Connected. Get Covered.Illinois Health Insurance Marketplace


Compare Plans. Determine Eligibility.

Enroll.

What Can I Do on the Marketplace?

Pay Initial Premium.


For IndividualsMarketplace Plan Compare Sample Monthly Premium Deductible

Out of Pocket Maximum

Copayments/Coinsurance

$x(# enrollees)

$x/yr Family $x/yrFamily

Primary: $xSpecialist: $xGeneric rx: $xER visit: $x

$x/yrIndividual

$x/yrIndividual

Get ConnectedGet Covered

www.enrolldupage.orgCall Center: 888-724-0077

Monday-Friday 8am-9pm; Saturday 8am-2pm

http://www.enrolldupage.org/

Get Connected. Get Covered.

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Transcript of Get Connected. Get Covered.