How to Efficiently and Effectively Help Consumers Navigate Plan Selection
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Transcript of How to Efficiently and Effectively Help Consumers Navigate Plan Selection
© 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org
Dave Chandra, Senior Policy Analyst, Center on Budget and Policy Priorities | 06.11.15
How to Effectively and Efficiently Help Consumers Navigate Plan Selection
1. Trends in Marketplace QHPs 2. Analyzing QHPs in your Region 3. Assisting Consumers in Plan Selection - Demonstration 4. Assisting Consumers in Plan Selection - Interactive
exercise
2 Presentation Overview
Trends in Marketplace QHPs
Overview of Marketplace Health Plan Elements
1. Premium 2. Cost Sharing
– Deductible – Co-pays/Co-insurance – Out-of-Pocket Maximum
3. Benefits/Drug Formulary 4. Provider Network
4
Copays
Fixed dollar amount per visit or per day paid by the enrollee.
Coinsurance
Percent of a medical fee/bill paid by the enrollee
Copays and Coinsurance
Overview
Source: HealthCare.gov, Kaiser Permanente KP VA 0/20/Dental and KP VA 1000/20/Dental Gold Plans for Fairfax County, VA
5
Increase of Coinsurance in QHPs 6
Source: HealthCare.gov, Highmark Health Savings Blue PPO 2750 Silver plan for Westmoreland County, PA
Copays and Coinsurance
Prescription Drug Copay Tiers
7
Source: HealthCare.gov, UPMC Advantage Value Silver Select plan for Westmoreland County, PA
Additional Tiering of Prescription Drug Copays 8
Source: Summary of Benefits and Coverage for Humana Silver 4600/AusRn HMOx in Travis County, TX
Additional Tiering of Prescription Drug Copays 9
SourceHumana Silver 4600/AusRn HMOx in Travis County, TX
Services/Copays Exempt from the Deductible 10
Source: HealthCare.gov, Anthem HealthKeepers Silver X 3350 15 plan for Fairfax County, VA
deduc%ble applies
Services/Copays Exempt from the Deductible 11
Source: HealthCare.gov, Anthem HealthKeepers Silver X 3350 15 plan for Fairfax County, VA
deduc%ble does not apply
HSA vs. Non-HSA Plans 12
Source: HealthCare.gov, Kaiser Permanente Bronze 4500/5-‐/HAS/Dental/Ped Dental and Bronze 4500/5-‐/Dental/Ped Dental plans in Fairfax County VA
“3 Step Copay” (Copay/Deductible/Coinsurance) 13
Source: Summary of Benefits and Coverage for Anthem HealthKeepers Bronze X 4500 35 in Fairfax County, VA
“3 Step Copay” (Copay/Deductible/Coinsurance) 14
Source: HealthCare.gov, Anthem HealthKeepers Bronze X 4500 35 in Fairfax County, VA
Cost Sharing Reduction (CSR) Plans 15
FPL% Silver Plan Eligibility
< 150% 94% variant
151% -‐ 200% 87% variant
201% -‐ 250% 73% variant
> 251% 70% base plan
Cost Sharing Reduction (CSR) Plans 16
Cost Sharing Reduction (CSR) Plans 17
Essential Health Bene!ts 18
Pediatric Dental Bene!t
Source: healthcare.gov, InnovaRon Health-‐Aetna INOVA Silver $10 Copay plan and Kaiser Permanente VA Silver 1750/25%/HSA/Dental/Ped Dental plan for Fairfax County, VA
19
Essential Health Bene!ts
Other Covered Services
20
Source: Summary of Benefits and Coverage for New Mexico Health ConnecRons Healthy Connect Bronze HMO in Albuquerque, NM
21
Type Name PCP Required?
Referrals Required?
Out-‐of-‐Network Coverage?
PPO Preferred Provider Organiza%on No No Yes
POS Point of Service Yes Maybe Yes
HMO Health Maintenance Organiza%on Yes Yes No*
EPO Exclusive Provider Organiza%on No No No*
*except for emergency care
Health Plan Network Types
QHPs with Narrow Provider Networks
Health plans are using narrow provider networks to keep costs down
22
QHPs with Tiered Networks 23
Source: Plan Brochure for Independence Blue Cross HMO Silver ProacRve Plan in Philadelphia County, PA
Tiered Provider Networks 24
Source: Summary of Benefits and Coverage for Independence Blue Cross HMO Silver ProacRve Plan in Philadelphia County, PA
Confusion and Inaccuracies in Provider Directories 25
Source: HealthCare.gov and Provider Search site for BlueCross BlueShield BlueCare SoluRons Plan in Sedgwick County, KS
Preparing for Open Enrollment III
Analyzing QHPs in your Region
Comparing 2014 and 2015 Marketplace Plans 27
Source: ProPublica, h`p://projects.propublica.org/aca-‐enrollment/#
Comparing 2014 and 2015 Marketplace Plans 28
Source: ProPublica, h`p://projects.propublica.org/aca-‐enrollment/#
Analyzing Changes to QHPs in Your Region 29
Comparing QHPs in Your Region 30
Comparing QHPs in Your Region – Additional Bene!ts 31
Service CareFirst BCBS Innova%on Health
Kaiser Permanente
Acupuncture Bariatric Surgery X X ChiropracCc Care X X X CosmeCc Surgery Coverage Outside the U.S. X Dental Care for Adults X Dental Care for Children X Hearing Aids Hearing Aids InferClity Treatment X Long-‐Term/Custodial Nursing Home Care Non-‐Emergency Care when Traveling Outside the US X
Private-‐Duty Nursing X X X Eye Care for Adults X X RouCne Foot Care RouCne Hearing Tests X Weight Loss Programs
Demonstration
Assisting Consumers in Plan Selection
CBPP Marketplace Plan Comparison Worksheet
available at: hQp://
www.healthreformbeyondthebasics.org/marketplace-‐plan-‐comparison-‐worksheet/
33
Scenario 1: James and Ann (married couple) 34
James Ann
Age 52 45
County Oakland County, MI
Zip Code 48324
Income $0 $23,000
Federal Poverty Level 144%
Employer coverage? no no
Insurance status uninsured uninsured
Scenario 1: James and Ann (married couple) 35
Scenario 1: James and Ann (married couple) 36
Scenario 1: James and Ann (married couple) 37
Scenario 1: James and Ann (married couple) 38
Applicant Name: Tax Credit (monthly): Date:
Number of people in the plan: Eligible for cost-‐sharing reducCons? □ No □ 73% □ 87% □ 94%
Marketplace Plan Comparison Worksheet
Option 1 Option 2 Option 3
Insurance company
Health plan name
Metal tier (Bronze, Silver, Gold, Platinum)
Plan type (HMO, PPO, POS, EPO, or other)
Monthly premium (after tax credit)
Scenario 1: James and Ann (married couple) 39
Applicant Name: James and Ann Tax Credit (monthly): $549.66 Date: 6/11/15
Number of people in the plan: 2 Eligible for cost-‐sharing reducCons? □ No □ 73% □ 87% ý 94%
Marketplace Plan Comparison Worksheet
Option 1 Option 2 Option 3
Insurance company
Health plan name
Metal tier (Bronze, Silver, Gold, Platinum)
Plan type (HMO, PPO, POS, EPO, or other)
Monthly premium (after tax credit)
40
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit
Specialist visit
Pres
crip
tions
Generic drugs
Preferred brand name drugs
Non-preferred brand name drugs
Specialty drugs
Emergency Room (ER) visit
Inpatient hospital stay
Other service:
Other service:
Option 1 Option 2 Option 3
Insurance company
Health plan name
Plan type (HMO, PPO, POS, EPO, or other)
Monthly premium (after tax credit)
Deductible (medical/drug or combined)
Out-of-Pocket Maximum (OOP Max)
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider:
Other provider or hospital:
Current prescription drugs:
Scenario 1: James and Ann (married couple)
41
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit
Specialist visit
Pres
crip
tions
Generic drugs
Preferred brand name drugs
Non-preferred brand name drugs
Specialty drugs
Emergency Room (ER) visit
Inpatient hospital stay
Other service: Laboratory Services
Other service: X-rays and Diagnostic Imaging
Option 1 Option 2 Option 3
Insurance company
Health plan name
Plan type (HMO, PPO, POS, EPO, or other)
Monthly premium (after tax credit)
Deductible (medical/drug or combined)
Out-of-Pocket Maximum (OOP Max)
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider:
Other provider or hospital:
Current prescription drugs:
Scenario 1: James and Ann (married couple)
Scenario 1: James and Ann (married couple)
Scenario 1: James and Ann (married couple)
44 Scenario 1: James and Ann (married couple)
45 Scenario 1: James and Ann (married couple)
46 Scenario 1: James and Ann (married couple)
47
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit
Specialist visit
Pres
crip
tions
Generic drugs
Preferred brand name drugs
Non-preferred brand name drugs
Specialty drugs
Emergency Room (ER) visit
Inpatient hospital stay
Other service: Laboratory Services
Other service: X-rays and Diagnostic Imaging
Option 1 Option 2 Option 3
Insurance company
Health plan name
Plan type (HMO, PPO, POS, EPO, or other)
Monthly premium (after tax credit)
Deductible (medical/drug or combined)
Out-of-Pocket Maximum (OOP Max)
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider:
Other provider or hospital:
Current prescription drugs:
Scenario 1: James and Ann (married couple)
48
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit
Specialist visit
Pres
crip
tions
Generic drugs
Preferred brand name drugs
Non-preferred brand name drugs
Specialty drugs
Emergency Room (ER) visit
Inpatient hospital stay
Other service: Laboratory Services
Other service: X-rays and Diagnostic Imaging
Option 1 Option 2 Option 3
Insurance company Humana
Health plan name Silver 4600/Detroit HMOx
Plan type (HMO, PPO, POS, EPO, or other) HMO
Monthly premium (after tax credit) $36
Deductible (medical/drug or combined) $1,000 (combined)
Out-of-Pocket Maximum (OOP Max) $1,500
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider:
Other provider or hospital:
Current prescription drugs:
Scenario 1: James and Ann (married couple)
49
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit $25
Specialist visit $35
Pres
crip
tions
Generic drugs $17*
Preferred brand name drugs $50 ü
Non-preferred brand name drugs 50% ü
Specialty drugs 50% ü
Emergency Room (ER) visit 20% ü
Inpatient hospital stay 20% ü
Other service: Laboratory Services 20% ü
Other service: X-rays and Diagnostic Imaging 20% ü
Option 1 Option 2 Option 3
Insurance company Humana
Health plan name Silver 4600/Detroit HMOx
Plan type (HMO, PPO, POS, EPO, or other) HMO
Monthly premium (after tax credit) $36
Deductible (medical/drug or combined) $1,000 (combined)
Out-of-Pocket Maximum (OOP Max) $1,500
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider:
Other provider or hospital:
Current prescription drugs:
Scenario 1: James and Ann (married couple)
50
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit $25 $10
Specialist visit $35 $30 ü
Pres
crip
tions
Generic drugs $17* 1A - $4, 1B - $20
Preferred brand name drugs $50 ü 25% ü
Non-preferred brand name drugs 50% ü 50% ü
Specialty drugs 50% ü 20% ü
Emergency Room (ER) visit 20% ü $100/10% ü
Inpatient hospital stay 20% ü 10% ü
Other service: Laboratory Services 20% ü no charge ü
Other service: X-rays and Diagnostic Imaging 20% ü 10% ü
Option 1 Option 2 Option 3
Insurance company Humana Blue Care Network of MI
Health plan name Silver 4600/Detroit HMOx Metro Detroit HMO Silver
Plan type (HMO, PPO, POS, EPO, or other) HMO HMO
Monthly premium (after tax credit) $36 $73
Deductible (medical/drug or combined) $1,000 (combined) $350 (combined)
Out-of-Pocket Maximum (OOP Max) $1,500 $1,000
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider:
Other provider or hospital:
Current prescription drugs:
Scenario 1: James and Ann (married couple)
51
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit $25 $10 $10 n/a
Specialist visit $35 $30 ü $20 n/a
Pres
crip
tions
Generic drugs $17* 1A - $4, 1B - $20 no charge n/a
Preferred brand name drugs $50 ü 25% ü $15 n/a
Non-preferred brand name drugs 50% ü 50% ü $50 n/a
Specialty drugs 50% ü 20% ü $50 n/a
Emergency Room (ER) visit 20% ü $100/10% ü $75 n/a
Inpatient hospital stay 20% ü 10% ü no charge n/a
Other service: Laboratory Services 20% ü no charge ü no charge n/a
Other service: X-rays and Diagnostic Imaging 20% ü 10% ü $20 n/a
Option 1 Option 2 Option 3
Insurance company Humana Blue Care Network of MI Total Health Care USA
Health plan name Silver 4600/Detroit HMOx Metro Detroit HMO Silver Totally You (Silver)
Plan type (HMO, PPO, POS, EPO, or other) HMO HMO HMO
Monthly premium (after tax credit) $36 $73 $96
Deductible (medical/drug or combined) $1,000 (combined) $350 (combined) $0
Out-of-Pocket Maximum (OOP Max) $1,500 $1,000 $1,500
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider:
Other provider or hospital:
Current prescription drugs:
Scenario 1: James and Ann (married couple)
52
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit $25 $10 $10 n/a
Specialist visit $35 $30 ü $20 n/a
Pres
crip
tions
Generic drugs $17* 1A - $4, 1B - $20 no charge n/a
Preferred brand name drugs $50 ü 25% ü $15 n/a
Non-preferred brand name drugs 50% ü 50% ü $50 n/a
Specialty drugs 50% ü 20% ü $50 n/a
Emergency Room (ER) visit 20% ü $100/10% ü $75 n/a
Inpatient hospital stay 20% ü 10% ü no charge n/a
Other service: Laboratory Services 20% ü no charge ü no charge n/a
Other service: X-rays and Diagnostic Imaging 20% ü 10% ü $20 n/a
Option 1 Option 2 Option 3
Insurance company Humana Blue Care Network of MI Total Health Care USA
Health plan name Silver 4600/Detroit HMOx Metro Detroit HMO Silver Totally You (Silver)
Plan type (HMO, PPO, POS, EPO, or other) HMO HMO HMO
Monthly premium (after tax credit) $36 $73 $96
Deductible (medical/drug or combined) $1,000 (combined) $350 (combined) $0
Out-of-Pocket Maximum (OOP Max) $1,500 $1,000 $1,500
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider: D. Willens, MD
Other provider or hospital:
Current prescription drugs:
Scenario 1: James and Ann (married couple)
53
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit $25 $10 $10 n/a
Specialist visit $35 $30 ü $20 n/a
Pres
crip
tions
Generic drugs $17* 1A - $4, 1B - $20 no charge n/a
Preferred brand name drugs $50 ü 25% ü $15 n/a
Non-preferred brand name drugs 50% ü 50% ü $50 n/a
Specialty drugs 50% ü 20% ü $50 n/a
Emergency Room (ER) visit 20% ü $100/10% ü $75 n/a
Inpatient hospital stay 20% ü 10% ü no charge n/a
Other service: Laboratory Services 20% ü no charge ü no charge n/a
Other service: X-rays and Diagnostic Imaging 20% ü 10% ü $20 n/a
Option 1 Option 2 Option 3
Insurance company Humana Blue Care Network of MI Total Health Care USA
Health plan name Silver 4600/Detroit HMOx Metro Detroit HMO Silver Totally You (Silver)
Plan type (HMO, PPO, POS, EPO, or other) HMO HMO HMO
Monthly premium (after tax credit) $36 $73 $96
Deductible (medical/drug or combined) $1,000 (combined) $350 (combined) $0
Out-of-Pocket Maximum (OOP Max) $1,500 $1,000 $1,500
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider: D. Willens, MD
Other provider or hospital: # of oncologists
Current prescription drugs:
Scenario 1: James and Ann (married couple)
54
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit $25 $10 $10 n/a
Specialist visit $35 $30 ü $20 n/a
Pres
crip
tions
Generic drugs $17* 1A - $4, 1B - $20 no charge n/a
Preferred brand name drugs $50 ü 25% ü $15 n/a
Non-preferred brand name drugs 50% ü 50% ü $50 n/a
Specialty drugs 50% ü 20% ü $50 n/a
Emergency Room (ER) visit 20% ü $100/10% ü $75 n/a
Inpatient hospital stay 20% ü 10% ü no charge n/a
Other service: Laboratory Services 20% ü no charge ü no charge n/a
Other service: X-rays and Diagnostic Imaging 20% ü 10% ü $20 n/a
Option 1 Option 2 Option 3
Insurance company Humana Blue Care Network of MI Total Health Care USA
Health plan name Silver 4600/Detroit HMOx Metro Detroit HMO Silver Totally You (Silver)
Plan type (HMO, PPO, POS, EPO, or other) HMO HMO HMO
Monthly premium (after tax credit) $36 $73 $96
Deductible (medical/drug or combined) $1,000 (combined) $350 (combined) $0
Out-of-Pocket Maximum (OOP Max) $1,500 $1,000 $1,500
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider: D. Willens, MD
Other provider or hospital: # of oncologists
Current prescription drugs: metformin
Scenario 1: James and Ann (married couple)
55 Scenario 1: James and Ann (married couple)
56 Scenario 1: James and Ann (married couple)
57 Scenario 1: James and Ann (married couple)
58 Scenario 1: James and Ann (married couple)
59 Scenario 1: James and Ann (married couple)
60 Scenario 1: James and Ann (married couple)
61 Scenario 1: James and Ann (married couple)
62
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit $25 $10 $10 n/a
Specialist visit $35 $30 ü $20 n/a
Pres
crip
tions
Generic drugs $17* 1A - $4, 1B - $20 no charge n/a
Preferred brand name drugs $50 ü 25% ü $15 n/a
Non-preferred brand name drugs 50% ü 50% ü $50 n/a
Specialty drugs 50% ü 20% ü $50 n/a
Emergency Room (ER) visit 20% ü $100/10% ü $75 n/a
Inpatient hospital stay 20% ü 10% ü no charge n/a
Other service: Laboratory Services 20% ü no charge ü no charge n/a
Other service: X-rays and Diagnostic Imaging 20% ü 10% ü $20 n/a
Option 1 Option 2 Option 3
Insurance company Humana Blue Care Network of MI Total Health Care USA
Health plan name Silver 4600/Detroit HMOx Metro Detroit HMO Silver Totally You (Silver)
Plan type (HMO, PPO, POS, EPO, or other) HMO HMO HMO
Monthly premium (after tax credit) $36 $73 $96
Deductible (medical/drug or combined) $1,000 (combined) $350 (combined) $0
Out-of-Pocket Maximum (OOP Max) $1,500 $1,000 $1,500
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider: D. Willens, MD
Other provider or hospital: # of oncologists
Current prescription drugs: metformin
Scenario 1: James and Ann (married couple)
63
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit $25 $10 $10 n/a
Specialist visit $35 $30 ü $20 n/a
Pres
crip
tions
Generic drugs $17* 1A - $4, 1B - $20 no charge n/a
Preferred brand name drugs $50 ü 25% ü $15 n/a
Non-preferred brand name drugs 50% ü 50% ü $50 n/a
Specialty drugs 50% ü 20% ü $50 n/a
Emergency Room (ER) visit 20% ü $100/10% ü $75 n/a
Inpatient hospital stay 20% ü 10% ü no charge n/a
Other service: Laboratory Services 20% ü no charge ü no charge n/a
Other service: X-rays and Diagnostic Imaging 20% ü 10% ü $20 n/a
Option 1 Option 2 Option 3
Insurance company Humana Blue Care Network of MI Total Health Care USA
Health plan name Silver 4600/Detroit HMOx Metro Detroit HMO Silver Totally You (Silver)
Plan type (HMO, PPO, POS, EPO, or other) HMO HMO HMO
Monthly premium (after tax credit) $36 $73 $96
Deductible (medical/drug or combined) $1,000 (combined) $350 (combined) $0
Out-of-Pocket Maximum (OOP Max) $1,500 $1,000 $1,500
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider: D. Willens, MD û û û
Other provider or hospital: # of oncologists
Current prescription drugs: metformin
Scenario 1: James and Ann (married couple)
64 Scenario 1: James and Ann (married couple)
65 Scenario 1: James and Ann (married couple)
66
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit $25 $10 $10 n/a
Specialist visit $35 $30 ü $20 n/a
Pres
crip
tions
Generic drugs $17* 1A - $4, 1B - $10 no charge n/a
Preferred brand name drugs $50 ü 25% ü $15 n/a
Non-preferred brand name drugs 50% ü 50% ü $50 n/a
Specialty drugs 50% ü 20% ü $50 n/a
Emergency Room (ER) visit 20% ü $100/10% ü $75 n/a
Inpatient hospital stay 20% ü 10% ü no charge n/a
Other service: Laboratory Services 20% ü no charge ü no charge n/a
Other service: X-rays and Diagnostic Imaging 20% ü 10% ü $20 n/a
Option 1 Option 2 Option 3
Insurance company Humana Blue Care Network of MI Total Health Care USA
Health plan name Silver 4600/Detroit HMOx Metro Detroit HMO Silver Totally You (Silver)
Plan type (HMO, PPO, POS, EPO, or other) HMO HMO HMO
Monthly premium (after tax credit) $36 $73 $96
Deductible (medical/drug or combined) $1,000 (combined) $350 (combined) $0
Out-of-Pocket Maximum (OOP Max) $1,500 $1,000 $1,500
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider: D. Willens, MD û û û
Other provider or hospital: # of oncologists
Current prescription drugs: metformin
Scenario 1: James and Ann (married couple)
67
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit $25 $10 $10 n/a
Specialist visit $35 $30 ü $20 n/a
Pres
crip
tions
Generic drugs $17* 1A - $4, 1B - $20 no charge n/a
Preferred brand name drugs $50 ü 25% ü $15 n/a
Non-preferred brand name drugs 50% ü 50% ü $50 n/a
Specialty drugs 50% ü 20% ü $50 n/a
Emergency Room (ER) visit 20% ü $100/10% ü $75 n/a
Inpatient hospital stay 20% ü 10% ü no charge n/a
Other service: Laboratory Services 20% ü no charge ü no charge n/a
Other service: X-rays and Diagnostic Imaging 20% ü 10% ü $20 n/a
Option 1 Option 2 Option 3
Insurance company Humana Blue Care Network of MI Total Health Care USA
Health plan name Silver 4600/Detroit HMOx Metro Detroit HMO Silver Totally You (Silver)
Plan type (HMO, PPO, POS, EPO, or other) HMO HMO HMO
Monthly premium (after tax credit) $36 $73 $96
Deductible (medical/drug or combined) $1,000 (combined) $350 (combined) $0
Out-of-Pocket Maximum (OOP Max) $1,500 $1,000 $1,500
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider: D. Willens, MD û û û
Other provider or hospital: # of oncologists 33 (10 mi.), 69 (20 mi.) 49 (10 mi.), 174 (25 mi.) 17 (10 mi.), 96 (25 mi.)
Current prescription drugs: metformin
Scenario 1: James and Ann (married couple)
68 Scenario 1: James and Ann (married couple)
69 Scenario 1: James and Ann (married couple)
70 Scenario 1: James and Ann (married couple)
71 Scenario 1: James and Ann (married couple)
72 Scenario 1: James and Ann (married couple)
73
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit $25 $10 $10 n/a
Specialist visit $35 $30 ü $20 n/a
Pres
crip
tions
Generic drugs $17* 1A - $4, 1B - $20 no charge n/a
Preferred brand name drugs $50 ü 25% ü $15 n/a
Non-preferred brand name drugs 50% ü 50% ü $50 n/a
Specialty drugs 50% ü 20% ü $50 n/a
Emergency Room (ER) visit 20% ü $100/10% ü $75 n/a
Inpatient hospital stay 20% ü 10% ü no charge n/a
Other service: Laboratory Services 20% ü no charge ü no charge n/a
Other service: X-rays and Diagnostic Imaging 20% ü 10% ü $20 n/a
Option 1 Option 2 Option 3
Insurance company Humana Blue Care Network of MI Total Health Care USA
Health plan name Silver 4600/Detroit HMOx Metro Detroit HMO Silver Totally You (Silver)
Plan type (HMO, PPO, POS, EPO, or other) HMO HMO HMO
Monthly premium (after tax credit) $36 $73 $96
Deductible (medical/drug or combined) $1,000 (combined) $350 (combined) $0
Out-of-Pocket Maximum (OOP Max) $1,500 $1,000 $1,500
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider: D. Willens, MD û û û
Other provider or hospital: # of oncologists 33 (10 mi.), 69 (20 mi.) 49 (10 mi.), 174 (25 mi.) 17 (10 mi.), 96 (25 mi.)
Current prescription drugs: metformin
Scenario 1: James and Ann (married couple)
74
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit $25 $10 $10 n/a
Specialist visit $35 $30 ü $20 n/a
Pres
crip
tions
Generic drugs $17* 1A - $4, 1B - $20 no charge n/a
Preferred brand name drugs $50 ü 25% ü $15 n/a
Non-preferred brand name drugs 50% ü 50% ü $50 n/a
Specialty drugs 50% ü 20% ü $50 n/a
Emergency Room (ER) visit 20% ü $100/10% ü $75 n/a
Inpatient hospital stay 20% ü 10% ü no charge n/a
Other service: Laboratory Services 20% ü no charge ü no charge n/a
Other service: X-rays and Diagnostic Imaging 20% ü 10% ü $20 n/a
Option 1 Option 2 Option 3
Insurance company Humana Blue Care Network of MI Total Health Care USA
Health plan name Silver 4600/Detroit HMOx Metro Detroit HMO Silver Totally You (Silver)
Plan type (HMO, PPO, POS, EPO, or other) HMO HMO HMO
Monthly premium (after tax credit) $36 $73 $96
Deductible (medical/drug or combined) $1,000 (combined) $350 (combined) $0
Out-of-Pocket Maximum (OOP Max) $1,500 $1,000 $1,500
Health Care Providers In Network/Covered? In Network/Covered? In Network/Covered?
Current doctor/provider: D. Willens, MD û û û
Other provider or hospital: # of oncologists 33 (10 mi.), 69 (20 mi.) 49 (10 mi.), 174 (25 mi.) 17 (10 mi.), 96 (25 mi.)
Current prescription drugs: metformin yes (tier 1 & 2) yes (tier 1A) yes (tier 1 & 3)
Scenario 1: James and Ann (married couple)
• Cheapest monthly payment? • Manageable deductible? • Low copays/coinsurance? • Having “first dollar” coverage? (i.e.
some services exempt from the deductible)?
• Prescription drugs covered? • Current doctor in network? • Size of network?
Identify James’s and Ann’s Priorities for Insurance 75
76
*Jennifer can be claimed as a tax dependent as a qualifying relaRve because she is receives more than half of her support from her parents and makes less than $3,950
Scenario 2: the Green Family (family of 5)
Rosa Dan Jennifer* Kristy Cara
Age 43 43 20 16 10
County (Zip Code) Greenville County, SC (29607)
Income $25,000 $20,000 $0 $0 $0
FPL 161 %FPL
Employer coverage no no no no no
Insurance status uninsured uninsured uninsured on Medicaid on Medicaid
77 Scenario 2: the Green Family (family of 5)
Scenario 2: the Green Family (family of 5) 78
Applicant Name: Tax Credit (monthly): Date:
Number of people in the plan: Eligible for cost-‐sharing reducCons? □ No □ 73% □ 87% □ 94%
Marketplace Plan Comparison Worksheet
Option 1 Option 2 Option 3
Insurance company
Health plan name
Metal tier (Bronze, Silver, Gold, Platinum)
Plan type (HMO, PPO, POS, EPO, or other)
Monthly premium (after tax credit)
Scenario 2: the Green Family (family of 5) 79
Applicant Name: Rosa, Dan, Jennifer Tax Credit (monthly): $548.80 Date: 6/11/15
Number of people in the plan: 3 Eligible for cost-‐sharing reducCons? □ No □ 73% ý 87% □ 94%
Marketplace Plan Comparison Worksheet
Option 1 Option 2 Option 3
Insurance company
Health plan name
Metal tier (Bronze, Silver, Gold, Platinum)
Plan type (HMO, PPO, POS, EPO, or other)
Monthly premium (after tax credit)
Scenario 2: the Green Family (family of 5) 80
Scenario 2: the Green Family (family of 5) 81
Scenario 2: the Green Family (family of 5) 82
Scenario 2: the Green Family (family of 5) 83
84
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit
Specialist visit
Pres
crip
tions
Generic drugs
Preferred brand name drugs
Non-preferred brand name drugs
Specialty drugs
Emergency Room (ER) visit
Inpatient hospital stay
Option 1 Option 2 Option 3
Insurance company
Health plan name
Plan type (HMO, PPO, POS, EPO, or other)
Monthly premium (after tax credit)
Deductible (in-network/out-of-network)
OOP Maximum (in-network/out-of-network)
Other Considerations
Other Consideration:
Other Consideration:
Other Consideration:
Scenario 2: the Green Family (family of 5)
85
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit no charge ü
Specialist visit no charge ü
Pres
crip
tions
Generic drugs no charge ü
Preferred brand name drugs no charge ü
Non-preferred brand name drugs no charge ü
Specialty drugs no charge ü
Emergency Room (ER) visit no charge ü
Inpatient hospital stay no charge ü
Option 1 Option 2 Option 3
Insurance company Consumers’ Choice
Health plan name Bronze HDP 1
Plan type (HMO, PPO, POS, EPO, or other) EPO
Monthly premium (after tax credit) $0
Deductible (in-network/out-of-network) $11,000
OOP Maximum (in-network/out-of-network) $11,000
Other Considerations
Other Consideration:
Other Consideration:
Other Consideration:
Scenario 2: the Green Family (family of 5)
86
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit no charge ü $40
Specialist visit no charge ü $150
Pres
crip
tions
Generic drugs no charge ü $20
Preferred brand name drugs no charge ü $80
Non-preferred brand name drugs no charge ü $150
Specialty drugs no charge ü 20% ü
Emergency Room (ER) visit no charge ü 20% ü
Inpatient hospital stay no charge ü 20% ü
Option 1 Option 2 Option 3
Insurance company Consumers’ Choice Consumers’ Choice
Health plan name Bronze HDP 1 Bronze 10
Plan type (HMO, PPO, POS, EPO, or other) EPO EPO
Monthly premium (after tax credit) $0 $13
Deductible (in-network/out-of-network) $11,000 $12,600
OOP Maximum (in-network/out-of-network) $11,000 $13,200
Other Considerations
Other Consideration:
Other Consideration:
Other Consideration:
Scenario 2: the Green Family (family of 5)
87
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit no charge ü $40 T1: $15, T2: $50 ~
Specialist visit no charge ü $150 $75 for 1/$75 ~
Pres
crip
tions
Generic drugs no charge ü $20 T1 & 2: $20
Preferred brand name drugs no charge ü $80 T1 & 2: $45 ü
Non-preferred brand name drugs no charge ü $150 T1 & 2: $75 ü
Specialty drugs no charge ü 20% ü T1 & 2: 40% ü
Emergency Room (ER) visit no charge ü 20% ü $250 for 2/$250 ~
Inpatient hospital stay no charge ü 20% ü T1: $250, T2: $500 ü
Option 1 Option 2 Option 3
Insurance company Consumers’ Choice Consumers’ Choice Coventry
Health plan name Bronze HDP 1 Bronze 10 Bronze $15 Copay Upstate
Plan type (HMO, PPO, POS, EPO, or other) EPO EPO POS
Monthly premium (after tax credit) $0 $13 $56
Deductible (in-network/out-of-network) $11,000 $12,600 T1: $10,000/T2: $12,500
OOP Maximum (in-network/out-of-network) $11,000 $13,200 $13,200
Other Considerations
Other Consideration:
Other Consideration:
Other Consideration:
Scenario 2: the Green Family (family of 5)
88
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit no charge ü $40 T1: $15, T2: $50 ~
Specialist visit no charge ü $150 $75 for 1/$75 ~
Pres
crip
tions
Generic drugs no charge ü $20 T1 & 2: $20
Preferred brand name drugs no charge ü $80 T1 & 2: $45 ü
Non-preferred brand name drugs no charge ü $150 T1 & 2: $75 ü
Specialty drugs no charge ü 20% ü T1 & 2: 40% ü
Emergency Room (ER) visit no charge ü 20% ü $250 for 2/$250 ~
Inpatient hospital stay no charge ü 20% ü T1: $250, T2: $500 ü
Option 1 Option 2 Option 3
Insurance company Consumers’ Choice Consumers’ Choice Coventry
Health plan name Bronze HDP 1 Bronze 10 Bronze $15 Copay Upstate
Plan type (HMO, PPO, POS, EPO, or other) EPO EPO POS
Monthly premium (after tax credit) $0 $13 $56
Deductible (in-network/out-of-network) $11,000 $12,600 T1: $10,000/T2: $12,500
OOP Maximum (in-network/out-of-network) $11,000 $13,200 $13,200
Other Considerations
Other Consideration: out-of-network coverage? û û ü
Other Consideration:
Other Consideration:
Scenario 2: the Green Family (family of 5)
89
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit no charge ü $40 T1: $15, T2: $50 ~
Specialist visit no charge ü $150 $75 for 1/$75 ~
Pres
crip
tions
Generic drugs no charge ü $20 T1 & 2: $20
Preferred brand name drugs no charge ü $80 T1 & 2: $45 ü
Non-preferred brand name drugs no charge ü $150 T1 & 2: $75 ü
Specialty drugs no charge ü 20% ü T1 & 2: 40% ü
Emergency Room (ER) visit no charge ü 20% ü $250 for 2/$250 ~
Inpatient hospital stay no charge ü 20% ü T1: $250, T2: $500 ü
Option 1 Option 2 Option 3
Insurance company Consumers’ Choice Consumers’ Choice Coventry
Health plan name Bronze HDP 1 Bronze 10 Bronze $15 Copay Upstate
Plan type (HMO, PPO, POS, EPO, or other) EPO EPO POS
Monthly premium (after tax credit) $0 $13 $56
Deductible (in-network/out-of-network) $11,000 $12,600 T1: $10,000/T2: $12,500
OOP Maximum (in-network/out-of-network) $11,000 $13,200 $13,200
Other Considerations
Other Consideration: out-of-network coverage? û û ü
Other Consideration: Spanish speaking PCPs
Other Consideration:
Scenario 2: the Green Family (family of 5)
Scenario 2: the Green Family (family of 5) 90
Scenario 2: the Green Family (family of 5) 91
Scenario 2: the Green Family (family of 5) 92
Scenario 2: the Green Family (family of 5) 93
94
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit no charge ü $40 T1: $15, T2: $50 ~
Specialist visit no charge ü $150 $75 for 1/$75 ~
Pres
crip
tions
Generic drugs no charge ü $20 T1 & 2: $20
Preferred brand name drugs no charge ü $80 T1 & 2: $45 ü
Non-preferred brand name drugs no charge ü $150 T1 & 2: $75 ü
Specialty drugs no charge ü 20% ü T1 & 2: 40% ü
Emergency Room (ER) visit no charge ü 20% ü $250 for 2/$250 ~
Inpatient hospital stay no charge ü 20% ü T1: $250, T2: $500 ü
Option 1 Option 2 Option 3
Insurance company Consumers’ Choice Consumers’ Choice Coventry
Health plan name Bronze HDP 1 Bronze 10 Bronze $15 Copay Upstate
Plan type (HMO, PPO, POS, EPO, or other) EPO EPO POS
Monthly premium (after tax credit) $0 $13 $56
Deductible (in-network/out-of-network) $11,000 $12,600 T1: $10,000/T2: $12,500
OOP Maximum (in-network/out-of-network) $11,000 $13,200 $13,200
Other Considerations
Other Consideration: out-of-network coverage? û û ü
Other Consideration: Spanish speaking PCPs
Other Consideration:
Scenario 2: the Green Family (family of 5)
95
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit no charge ü $40 T1: $15, T2: $50 ~
Specialist visit no charge ü $150 $75 for 1/$75 ~
Pres
crip
tions
Generic drugs no charge ü $20 T1 & 2: $20
Preferred brand name drugs no charge ü $80 T1 & 2: $45 ü
Non-preferred brand name drugs no charge ü $150 T1 & 2: $75 ü
Specialty drugs no charge ü 20% ü T1 & 2: 40% ü
Emergency Room (ER) visit no charge ü 20% ü $250 for 2/$250 ~
Inpatient hospital stay no charge ü 20% ü T1: $250, T2: $500 ü
Option 1 Option 2 Option 3
Insurance company Consumers’ Choice Consumers’ Choice Coventry
Health plan name Bronze HDP 1 Bronze 10 Bronze $15 Copay Upstate
Plan type (HMO, PPO, POS, EPO, or other) EPO EPO POS
Monthly premium (after tax credit) $0 $13 $56
Deductible (in-network/out-of-network) $11,000 $12,600 T1: $10,000/T2: $12,500
OOP Maximum (in-network/out-of-network) $11,000 $13,200 $13,200
Other Considerations
Other Consideration: out-of-network coverage? û û ü
Other Consideration: Spanish speaking PCPs 19 (10 mi.) 26 (20 mi.) 19 (10 mi.) 26 (20 mi.) T1: 46, T2: 15 (10 mi.)
Other Consideration:
Scenario 2: the Green Family (family of 5)
Scenario 2: the Green Family (family of 5) 96
Scenario 2: the Green Family (family of 5) 97
98
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit no charge ü $40 T1: $15, T2: $50 ~
Specialist visit no charge ü $150 $75 for 1/$75 ~
Pres
crip
tions
Generic drugs no charge ü $20 T1 & 2: $20
Preferred brand name drugs no charge ü $80 T1 & 2: $45 ü
Non-preferred brand name drugs no charge ü $150 T1 & 2: $75 ü
Specialty drugs no charge ü 20% ü T1 & 2: 40% ü
Emergency Room (ER) visit no charge ü 20% ü $250 for 2/$250 ~
Inpatient hospital stay no charge ü 20% ü T1: $250, T2: $500 ü
Option 1 Option 2 Option 3
Insurance company Consumers’ Choice Consumers’ Choice Coventry
Health plan name Bronze HDP 1 Bronze 10 Bronze $15 Copay Upstate
Plan type (HMO, PPO, POS, EPO, or other) EPO EPO POS
Monthly premium (after tax credit) $0 $13 $56
Deductible (in-network/out-of-network) $11,000 $12,600 T1: $10,000/T2: $12,500
OOP Maximum (in-network/out-of-network) $11,000 $13,200 $13,200
Other Considerations
Other Consideration: out-of-network coverage? û û ü
Other Consideration: Spanish speaking PCPs 19 (10 mi.) 26 (20 mi.) 19 (10 mi.) 26 (20 mi.) T1: 46, T2: 15 (10 mi.)
Scenario 2: the Green Family (family of 5)
99
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit no charge ü $40
Specialist visit no charge ü $150
Pres
crip
tions
Generic drugs no charge ü $20
Preferred brand name drugs no charge ü $80
Non-preferred brand name drugs no charge ü $150
Specialty drugs no charge ü 20% ü
Emergency Room (ER) visit no charge ü 20% ü
Inpatient hospital stay no charge ü 20% ü
Option 1 Option 2 Option 3
Insurance company Consumers’ Choice Consumers’ Choice
Health plan name Bronze HDP 1 Bronze 10
Plan type (HMO, PPO, POS, EPO, or other) EPO EPO
Monthly premium (after tax credit) $0 $13
Deductible (in-network/out-of-network) $11,000 $12,600
OOP Maximum (in-network/out-of-network) $11,000 $13,200
Other Considerations
Other Consideration: out-of-network coverage? û û
Other Consideration: Spanish speaking PCPs 19 (10 mi.) 26 (20 mi.) 19 (10 mi.) 26 (20 mi.)
Scenario 2: the Green Family (family of 5)
100
Copays/Coinsurance Amount Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit no charge ü $40 $10
Specialist visit no charge ü $150 20% ü
Pres
crip
tions
Generic drugs no charge ü $20 $10
Preferred brand name drugs no charge ü $80 20% ü
Non-preferred brand name drugs no charge ü $150 20% ü
Specialty drugs no charge ü 20% ü 20% ü
Emergency Room (ER) visit no charge ü 20% ü 20% ü
Inpatient hospital stay no charge ü 20% ü 20% ü
Option 1 Option 2 Option 3
Insurance company Consumers’ Choice Consumers’ Choice Consumers’ Choice
Health plan name Bronze HDP 1 Bronze 10 Silver 10
Plan type (HMO, PPO, POS, EPO, or other) EPO EPO EPO
Monthly premium (after tax credit) $0 $13 $167
Deductible (in-network/out-of-network) $11,000 $12,600 $1,000
OOP Maximum (in-network/out-of-network) $11,000 $13,200 $3,000
Other Considerations
Other Consideration: out-of-network coverage? û û û
Other Consideration: Spanish speaking PCPs 19 (10 mi.) 26 (20 mi.) 19 (10 mi.) 26 (20 mi.) 19 (10 mi.) 26 (20 mi.)
Scenario 2: the Green Family (family of 5)
101
Copays/Coinsurance Amount Amount Deductible applies? (check if yes) Deductible applies? (check if yes)
Primary Care Provider (PCP) visit no charge ü $10
Specialist visit no charge ü 20% ü
Pres
crip
tions
Generic drugs no charge ü $10
Preferred brand name drugs no charge ü 20% ü
Non-preferred brand name drugs no charge ü 20% ü
Specialty drugs no charge ü 20% ü
Emergency Room (ER) visit no charge ü 20% ü
Inpatient hospital stay no charge ü 20% ü
Option 1 Option 3
Insurance company Consumers’ Choice Consumers’ Choice
Health plan name Bronze HDP 1 Silver 10
Plan type (HMO, PPO, POS, EPO, or other) EPO EPO
Monthly premium (after tax credit) $0 $167
Deductible (in-network/out-of-network) $11,000 $1,000
OOP Maximum (in-network/out-of-network) $11,000 $3,000
Other Considerations
Other Consideration: out-of-network coverage? û û
Other Consideration: Spanish speaking PCPs 19 (10 mi.) 26 (20 mi.) 19 (10 mi.) 26 (20 mi.)
Scenario 2: the Green Family (family of 5)
$0 $2,004
Annual Cost Annual Cost
$6,400
$6,400
$40
$480
$4,124
$600
Health care needs: • PCP checkup every 3 months ($120/visit) • Four generic prescriptions per month ($40 retail) • Hospitalization ($4,000 bill)
$1,000
Identify the Green Family’s Priorities for Insurance
• Cheapest monthly payment? • Manageable deductible? • Low copays/coinsurance? • Having “first dollar” coverage? (i.e. some
services exempt from the deductible?) • Current doctor in network? • Size of network • Prescription drugs covered? • Out-of-network coverage? • Language spoken by providers? • Lowest overall annual cost (premiums +
anticipated cost-sharing)
102
Interactive Exercise
Assisting Consumers in Plan Selection
Assisting Consumers in Plan Selection 10
4
Scenario 1: Sasha (Tampa Bay Lightning Fan) 105
Sasha
Age 37
County Hillsborough County, FL
Zip Code 33601
Income $25,000
Federal Poverty Level 212%
Employer coverage? no
APTC $139.62/month
Cost-‐sharing ReducCons? Yes (Silver 73%)
Priorities • Very concerned about cost • Doesn’t have a specific doctor • Has one prescription medication (generic)
B1 B2
B3 B4
QHPs available to Sasha (Tampa, FL) - Bronze 106
QHPs available to Sasha (Tampa, FL) - Bronze 107
B5 B6
B7
S1 S2
S3 S4
QHPs available to Sasha (Tampa, FL) - Silver 108
S5 S5
S7
QHPs available to Sasha (Tampa, FL) - Silver 109
Scenario 2: Jillian and Michael (Chicago fans) 110
Jillian Michael
Age 55 55
County Cook County, IL
Zip Code 60609
Income $22,800 $7,200
Federal Poverty Level 188%
Employer coverage? no no
APTC $603.77/month
Cost-‐sharing ReducCons? Yes (Silver 87%)
Scenario 2: Jillian and Michael (Chicago fans) 111
Contact Info
Dave Chandra Senior Policy Analyst
202-408-1080 [email protected]
For more information and resources, please visit:
www.healthreformbeyondthebasics.org
a project of the Center on Budget and Policy PrioriRes, www.cbpp.org
112
113
New Training Resources
• Highly customized, Action-oriented • New suite of training services
• Goal-setting • Planning • Coaching • In-person training
• FOR MORE INFO – [email protected]