State HealtH RefoRm Impact modelIng pRoject - HIV Health Reform
Health Insurance, Health Care Reform and Resources in Chicago
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Transcript of Health Insurance, Health Care Reform and Resources in Chicago
Dancers’ Health Insurance Resource Center
A program of The Actors Fundwith support from The Doris Duke Foundation
Presenter: Jim Brown, Director of Health Services [email protected]
Children under age 19 with pre-existing conditions can’t be denied coverage.
Young adults up to age 26 can stay on or enroll in their parents’ coverage.
Insurers can’t retroactively cancel the policies of people who get sick.
Insurers can’t impose lifetime dollar limits on medical benefits.
All new plans must cover certain preventive services, such as mammograms and tetanus shots, for free.
Uninsured people with pre-existing conditions may be eligible for coverage through PCIP.
Pre-Existing Condition Insurance Plan http://insurance.illinois.gov/ipxp/
Help for the uninsured with pre-existing conditions through a temporary high-risk pool until January 2014.
Premium rates:http://www.insurance.illinois.gov/ipxp/aso-1000ipxpratetable-1210.pdf
Also: Illinois Comprehensive Health Insurance Plan (CHIP) www.chip.state.il.usHIPAAwww.dol.gov/ebsa/faqs/faq_consumer_hipaa.html
Medicare recipients in the coverage gap or “donut hole” received 50% off drugs
Annual wellness visits and certain preventive services free for Medicare recipients.
Increased funding to community health centers.
Insurers can’t refuse coverage to anyone. Most people* will be mandated to have coverage or
pay a penalty.** New insurance marketplaces, called Exchanges, will
offer insurance to those who don’t get it elsewhere. Subsidies will be available to people who buy
insurance through an exchange with income less than 400% of the Federal Poverty Level. ($43,320)
* Exceptions include: Native Americans, those w/religious objections, people who are not legal residents, those who don’t meet tax filing threshold ($9,350 single), people who’ve been uninsured for less than 3 months.
** Penalty: increases from $95 or 1% of income in 2014 to $695 or 2.5% of income in 2016.
All new plans must offer at a minimum an essential benefits package which limits out-of-pocket medical expenses.
Including: Ambulatory care Emergency care and Hospitalization Maternity and newborn care Mental health and substance abuse Prescription drugs Preventive services
If you have a new policy that began on or after 9/23/2010, you can get certain preventive services for free:Blood pressure, diabetes & cholesterol testsBreast, colon & cervical cancer screeningsVaccines, immunizations & flu shotsHIV & STD testingMammograms for women over 40
• Plans that offer essential benefits can offer varying levels of coverage, labeled “bronze,” “silver,” “gold,” and “platinum.” These levels refer to the percentage of costs that will be paid for by the plan: A bronze plan will pay for 60 percent of the cost of covered benefits, a silver plan will pay for 70 percent, a gold plan will pay for 80 percent, and a platinum plan will pay for 90 percent.
• Plans can also offer a lesser level of coverage to individuals under the age of 30. These “catastrophic plans” must still cover essential benefits but will have very high deductibles ($5,950 for an individual in 2010, to be updated annually by premium inflation).
Plans must limit enrollees’ out-of-pocket expenses (including the deductible) to $5,950 for an individual or $11,900 for a family (2010 figures, to be updated based on premium inflation).
If your income is $10,830 - $43,320 (single), you will receive a subsidy to buy insurance through an Exchange.
Subsidies will cap the amount you spend on premiums in relation to your total income.
Subsidies will also cap your annual out-of-pocket medical costs.
Example: a person who makes $21,000/yr will have their premiums capped at 6.3% of their income, and their annual out-of-pocket medical costs will be limited to $1,983/yr (excluding premiums).
Became available beginning 2010 tax year
Employers with fewer than 25 FTE’s employees with average wages of less than $50,000 that purchase health insurance for employees are eligible for the tax credit
To be eligible, employer must offer a group health plan & contribute at least 50% of premium cost
2010-2013: credit max is 35% of employer contribution (25% for tax exempt/non-profits); will increase to 50% (35% for non-profits) in 2014
Small business will file Form 8941 when they file income tax returns
Tax exempt organizations will claim the tax credit on a revised Form 990-T
www.irs.gov/newsroom/article/0,,id=223666,00.html
Artists Health Insurance Resource Center: www.ahirc.org
Office of Consumer Information and Insurance Oversight: www.hhs.gov/ociio
Federal health care reform website: www.healthcare.gov
Kaiser Family Foundation: www.kff.org
Questions on the ACAand Health Care Reform?
» Access: Access to quality health care is directly tied to having health insurance. Without health insurance or unlimited funds, you will have little or no say in the care you receive or in the choice of providers of that care.
» Cost: The cost of care is so great that a surgery, a day or two in the hospital, treatment for a chronic condition, a prescription for on-going drug therapy, or even several hours in a hospital emergency room can throw you into considerable, even ruinous, debt if you are uninsured.
» Better outcomes: People without health insurance frequently delay care, and are more likely to be sicker when they seek care. Not surprisingly, the mortality rates for cancer and other diseases are higher among the uninsured.
Employer/union/guild related coverage Purchase private plans Government subsidized programs
If you leave/get laid off from a job …COBRA – Continuation of employer benefits for at least 18 months60 days to decide/elect coverage“Sticker Shock” – guaranteed coverage, but can be expensive.Pay full premium .. at the group rate
◦ Illinois offers health, dental and vision insurance benefits of one member of a domestic partnership to also apply to the other member much in the same way as married couples can be covered by the same policy. To be eligible, both members of the domestic partnership must be over the age of 18 and not in another domestic partnership. They must live in the same household, not be related, and have "an emotional and economic interdependence." They need to have lived together for at least one year and continue to so for the duration of the insurance coverage.
»» Actors’ Equity: www.equityleague.org »» American Federation of Television and
Radio Artists: www.aftrahr.com»» Screen Actors Guild: www.sagph.org/index2.html
»» American Federation of Musicians Local 10-208: www.cfm10208.com
»» IATSE Local 2: http://iatselocal2.com
Terms to know: HMO, PPO, HAS, High-deductible (“catastrophic”), Short-term
Internet brokers◦ www.ehealthinsurance.com
2012 Poverty Guidelines for the48 Contiguous States and the District of Columbia
Persons infamily/household Poverty guideline
1 $11,170 2 $15,130 3 $19,090 4 $23,050
The Illinois Department of Healthcare and Family Services
www.hfs.illinois.gov
Medicaid [Note: Changes begin January 1, 2014]www.hfs.illinois.gov/medicalbrochures/hfs591.htmlIllinois FamilyCarewww.familycareillinois.comAll Kidswww.allkids.comMedicarewww.medicare.gov
ADAP and Continuation of Health Insurance Coverage Programwww.idph.state.il.us/aids/materials/less.htm
The National Breast and Cervical Cancer Early Detection Program
http://cancerscreening.illinois.gov/Note:
http://articles.chicagotribune.com/2012-02-17/health/ct-met-breast-cancer-screening-20120217_1_free-mammogram-screening-mammograms-abnormal-mammograms
ProjectHUGS: Helping Uninsured Get Surgery1-855-367-4847 www.projectHUGS.org
◦ Access to Carewww.accesstocare.org708-531-0680
◦ Community Clinicshttp://findahealthcenter.hrsa.gov
> CommunityHealth Chicago2611 W. Chicago Ave 773.395.9900641 W. 63rd St. 773.994.1515www.communityHealth.org> Community Counseling Centers of Chicagowww.c4chicago.org
◦ Retail clinics [Fee determined by diagnosis]e.g., Minute Clinics in CVS
www.minuteclinic.com
Illinois Hospital Report Cardwww.healthcarereportcard.illinois.gov/
HealthGradeshttp://www.healthgrades.com/
Leslieslisthttp://leslieslist.org/chicago
Pharmacy Checkerwww.pharmacychecker.com
◦ $4 Generics @ Target/Walmart
◦ Costco/Walgreens/CVS discount programs
◦ NeedyMeds www.needymeds.org
◦ Partnership for Prescription Assistancewww.pparx.org
◦ Illinois Cares Rx www.illinoiscaresrx.com
◦ www.lowestmed.com App for iPhone & Android
Dental discount programswww.dentalplans.com
Note: Examine closely before joining! The Chicago Dental Society
http://www.cds.org/Find_a_Dental_Clinic/Find_a_Dental_Clinic.aspx
Note: Some community clinics have dental services-Erie Dental Health Center 4751 N. Kedzie Ave-Eleanor Wester Dental Clinic 7648 N. Paulina
Dental Schools◦ The University of Illinois at Chicago College of
Dentistry http://dentistry.uic.edu/
The University of Illinois at Chicago Health in the Arts Program(312) 996-7420
Dance/USA Task Force on Dancer Healthhttp://www.danceusa.org/dancerhealth?s=task%20force
Performing Arts Medicine Association (PAMA) www.artsmed.org
Chicago Artists Resourcewww.chicagoartistsresource.org
Uninsured in Chicagowww.uninsuredinchicago.com
Any additional resources to add?
www.ahirc.org [everyone in the arts]800-798-8447 x265
www.dhirc.org [everyone in dance]800-798-8447 x280
[email protected] [Jim Brown]
Actors Fund/Chicago 312-372-0989