What is The Affordable Care Act and how does it affect me?

Transcription

1 What is The Affordable Care Act and how does it affect me? November 2013

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3 Patient Protection and Affordable Care Act (PPACA) Overview The federal Patient Protection and Affordable Care Act signed by President Obama March 23, 2010, as amended by the Health Care and Education Reconciliation Act, signed March 31, 2010, is also referred to as the Affordable Care Act (ACA), or simply as federal health reform. Provisions included in the ACA are intended to expand access to insurance, increase consumer protections, emphasize prevention and wellness, improve quality and system performance, expand the health workforce, and curb rising health care costs. Requires most U.S. citizens and legal residents to have health insurance.

4 Patient Protection and Affordable Care Act (PPACA) Overview Created state-based American Health Benefit Exchanges through which individuals can purchase coverage and created separate Exchanges through which small businesses can purchase coverage. Provides coverage to young adults up to the age of 26. Prohibits plans from imposing lifetime and annual limits on the dollar value of benefits.

5 Health Insurance Marketplace Sometimes called Exchanges, the Marketplace is required by the ACA to be created by January 1, Marketplace offers small businesses and individuals the ability to select and enroll in a private health insurance plan. For those who are uninsured or who want to purchase private health insurance.

6 Essential Health Plan Benefits offered thru the Exchanges Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventative and wellness services and chronic disease management Pediatric services, including oral and vision care.

7 Marketplace Implementation Three models available State-Based Federal-State Partnership Federally-Facilitated U.S. Department of Health & Human Services to operate marketplaces for States that have not elected to do so.

8 Actuarial Value The ACA requires plans inside the Marketplace to meet particular actuarial value (AV) targets Bronze = 60% AV Silver = 70% AV Gold = 80% AV Platinum = 90% AV Metal Levels will enable consumers to compare plans with similar levels of coverage, promote competition on premiums, and allow plans flexibility to design cost sharing structures. Archdiocesan plans are comparable to the Platinum plans offered by the Marketplace.

9 Courtesy: Illinois Department of Insurance as of 9/30/13

10 Complying with the Affordable Care Act(ACA) What the Archdiocese has done so far: Extended dependent eligibility in our health benefit plans to age 26 regardless of whether or not the dependent is a student, financially dependent upon the employee or unmarried. Provided the Summary of Benefits and Coverage (posted on the HR website and Reference Library in MyEnroll) Reported the entire cost of health benefit coverage on the employee 2012 W-2 Forms. As a Church Plan, the Archdiocese is not required to comply with the provisions of the ACA that mandate women s preventative healthcare and other services that may not agree with Church teaching.

11 Health Insurance Marketplace Coverage Options and Tax credits Eligibility for Tax Credits: Employer does not offer a plan that meets the minimum standards required by the ACA. Cost of a plan offered by the employer for employee only coverage is more than 9.5% of household income for the year (qualifies for tax credit). Only available to eligible employees with household incomes between 100% and 400% of the FPL($45,960 for an individual and $94,200 for a family of 4), and who don t qualify for other health insurance coverage.

12 Health Insurance Marketplace Coverage Options and Tax credits Archdiocesan plans meet the minimum value standard set by ACA. Employee only cost under the Blue Advantage HMO meets the standard of affordability. Benefit eligible employees of the Archdiocese would not be eligible for the tax credit. The Archdiocese will not contribute toward any plans offered thru the Exchange.

13 Health Insurance Marketplace Coverage Options and Your Health Coverage Employees receive no Archdiocesan subsidy if they opt out of our plan and enroll in a plan on the Exchange. Employee contributions toward health plan coverage through an employer can be made on a pre-tax basis. Payment of premiums for a plan from the exchange is on an after tax basis.

14 Initial Open Enrollment Period for Government Sponsored Exchanges: October 1, 2013 March 31, 2014

15 Resources: Affordable Care Act websites Website chat 24/7 (English and Spanish) Affordable Care Act Phone Numbers: (English) (Spanish) Help in-person Navigators Other trained enrollment assisters Agents and brokers Health Insurance Marketplace Center for Consumer Information & Insurance Oversight website

16 How do the plans on the exchange compare to the Archdiocese plans? On the Marketplace, employees of the Archdiocese may find as many as 48 different options for coverage. The plans are categorized into four levels, enabling consumers to compare plans with similar levels of coverage. Archdiocesan plans provide benefit levels comparable to the Platinum plans, but with lower employee premiums than offered on the Marketplace. Costs and benefits comparisons should consider the following: Deductible the amount you pay before any insurance coverage begins. Co-payments and Co-Insurance the amount you pay for services after meeting the deductible. Out-of-pocket Maximum the amount you pay in total out of pocket, then the plan will pay 100% for any covered care thereafter. Monthly premium

17 How will the new health care law affect me? If you have health care insurance If you have insurance with the Archdiocese, you may not experience changes. You may enroll in a plan thru the Health Insurance Exchanges but you may not qualify for tax credits and other financial considerations available to those who are not eligible for coverage. If you don t have health care insurance The new health care law provides options for individuals and families to get coverage who have not had or could not get health insurance. Starting in 2014, you will be able to buy some form of health insurance if you are a U.S. citizen or a legal resident. There will be health plans that offer coverage to people with existing health problems. There will also be help to pay for health insurance premiums.

18 What is the Individual Mandate? The individual mandate requires most Americans to have health care insurance starting in 2014 or face a tax penalty if they don t do so. Tax Penalties for Failure to get Health Insurance Year Percentage of Income Flat Fee % of taxable income or $ % of taxable income or $ % of taxable income or $695 After 2016 The tax will increase each year following the cost-ofliving adjustment What happens if I don t get health care insurance? Those who can afford but do not buy health care insurance will face penalties of $95 a year or up to 1% of their yearly income, whichever is greater. By 2016, the penalties rise to $695 or 2.5% of their yearly income. For families, the penalty is up to $285 in 2014, but will rise to $2,085 or 2.5% of their yearly income in Penalties will be collected by the Internal Revenue Service via annual tax returns.

19 What If I cannot afford health care insurance? The new health care law may make health care insurance easier to afford. Tax credits may help people pay for premiums (monthly payments) when they buy coverage on the new health insurance exchange. Payment assistance may also be available for expenses that you pay when you receive medical treatment (such as deductibles, copays or coinsurance).

20 Summary of Illinois Qualified Health Plans Choice of Small Group and Individual Products in all Counties At least 48 Plans available in all Counties Gold, Silver, Bronze and Catastrophic Plans in all Counties Two Individual PPO Products available Statewide Three Small Group Products available Statewide Value Penguin (A Consumer Finance Website)

21 Questions?

22 Benefits Department Phone: (312) Fax: (312)