What is the ACA (“Obamacare”) ? The Patient Protection and Affordable Care Act (ACA) ACA reforms...
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Transcript of What is the ACA (“Obamacare”) ? The Patient Protection and Affordable Care Act (ACA) ACA reforms...
Affordable Care Act & You:What every consumer should know
What is the ACA (“Obamacare”)?
The Patient Protection and Affordable Care Act (ACA)
ACA reforms our complex health care system85% of working Americans receive healthcare as a
benefit of their full-time employment.Consumers can now purchase insurance from the
federal Marketplace.
ACA makes healthcare care more accessible and affordablePreventive careFamily planningRelated healthcare servicesNo discrimination due to pre-existing conditions or gender
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How the ACA WorksConsumers can enroll in a Qualified Health Plan (QHP)
through the MarketplaceThey can compare available plan options including monthly
premiums, co-pays, deductibles, service networks, etc.There is a single, streamlined application for private health
plans, Medicaid and/or CHIP options.
ACA requires you to have coverage.The 2014 Individual Responsibility Fee Penalty can be $95
per individual; $285 per family; or 1% family income.A number of exemptions are available.
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How the Marketplace Works
https://www.healthcare.gov/marketplace/individual
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Application Process
Submit application to
the Marketplace
Enroll in Medicaid or
CHIP
Eligibility determined and verified
Enroll in Qualified
Health Plan
Supported by Data Services
Hub
• Online• By Phone• In Person
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Eligibility determined for Qualified Health Plan, Medicaid or
CHIP
Ways to Apply
Online:www.HealthCare.gov
By Phone (24/7, 150 languages):
1-800-318-2596
In Person:Certified Application Counselors & NavigatorsVisit your nearest federally qualified health center or go to www.LocalHelp.HealthCare.gov.
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Eligibility
Eligibility:Live in the service areaUS citizen or
lawfully present non-citizen for the period of enrollment
Not incarcerated
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Affordable CoverageA refundable or Advanced Premium Tax Credit (APTC):
Can only be used to buy insurance from the MarketplaceYou can take it now and have it reduce your monthly premium.
Or, you can take it later and have it reduce your income tax liability.
Eligibility for the APTC is based on:Tax filing status and family sizeHousehold income of 100%-400% Federal Poverty LevelConsumer is ineligible for government or employer insurance
Additional Cost-Sharing Reductions are also availableHousehold income of 100%-250% of Federal Poverty Level
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Lawfully Present Non-CitizensLawfully present non-citizens are not eligible
for federal benefits until they have been residentsfor 5+ years.
However, if they are ineligible for Medicaid because of their immigration status, they can receive APTC even if their income is below 100% Federal Poverty Level.
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Federal Poverty Level Table
1. For households with more than 8 individuals, add $4060 for each.
2. Households earning less than 100% FPL will not be eligible for APTC.
3. Households earning more than 400% FPL will not be eligible for APTC.
4. Medicaid was not expanded in Florida.
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Types of PlansTypes of health plans
Platinum 90% of covered costs paid by plan Maximum services Lower deductible, higher premiums
Gold 80% of covered costs paid by plan
Silver 70% of covered costs paid by plan
Bronze 60% of covered costs paid by plan Minimum services Higher deductible, lower premiums
Catastrophic coverage is also available for adults under age 30 and/or those who obtain a hardship waiver.
Essential Health Benefits Each plan must include, at a minimum, 10 essential health benefits (below)
More expensive plans offer additional benefits
Ambulatory Patient Services Prescription Drugs
Emergency Services Rehabilitative Services and Devices
Hospitalization Laboratory Services
Maternity and Newborn Care Preventive & Wellness Services and Chronic Disease Management
Mental Health and Substance Use Disorder Services (to include behavioral health care)
Pediatric services, including oral & vision care (pediatric oral services may be provided by stand-alone plan)
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Enrollment
Open Enrollment is November 15, 2014 through February 15, 2015.
Health coverage is effective January 1, 2015if purchased by December 15, 2014.
For more information ….
In Person: [Insert Contact Info Here]
By Phone: Marketplace Call Center at 1 (800) 318-2596On-line: www.HealthCare.gov
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