It s a new world! Health Care Changes and the ACA

Transcription

1 It s a new world! Health Care Changes and the ACA

2 Today s Agenda 2 MHC Who we are Understanding the Problem Understanding the Affordable Care Act Understanding Insurance Exchanges Moving Forward

3 Montana Health CO-OP: Who We Are

4 Who is MHC? 4 Member-operated health CO-OP Non-profit organization Home-grown (Helena-based) Funded via federal start-up loans CO-OPs currently approved in 24 states Offering products via the Health Insurance Exchange

5 Health Care: Understanding the Problem

6 Health Care Problems 6 Insurance Situation 50 million uninsured Americans 200,000 uninsured Montanans Premiums double in last 10 years 62% of all bankruptcies medically-related

7 Health Care Problems 7 Insurance Situation Coverage isn t comprehensive Affordability Emphasis on group/employer-provided insurance. Pre-existing condition clause Fear of losing coverage with job loss/change Insurance denied if no continuity of coverage

8 Health Insurance Exchanges & the ACA

9 Health Insurance Exchanges 9 Exchange = Marketplace Internet-based marketplaces to shop for and buy health insurance Compare apples to apples (tiers of coverage) Determine eligibility for premium subsidies Plans on the exchange must offer Essential Health Benefits 278,000 Montanans could get insurance via the Exchange Congress and their staff will get insurance from the Exchange

10 10 Health Insurance Exchanges

11 Health Insurance Exchanges 11 Platinum Gold Silver Bronze Metallic Plans

12 Solutions 12 Open Enrollment/Guaranteed Coverage Gold Silver Bronze $750 Deductible $2,000 Deductible $4,000 Deductible 80/20 70/30 60/40

13 ACA Subsidies 13 For qualifying individuals and families without employer-based insurance. Subsidies are not for those receiving Medicare. Starting in 2014 Subsidies (advanceable tax credits) to offset monthly premiums for those with income between % of the Federal Poverty Level (FPL). 65% of Montana families have incomes below 340% of the FPL.

14 2014: Subsidies At Work 14 Projected Income $34,516 (300% of poverty level) Unsubsidized annual health insurance premium (adjusted for age) $7,500 Maximum % of income the person/family must pay for premium (based on income % of poverty level) 9.50% Amount person/family pays $3,279 Government tax credit/subsidy $4,221 *Must purchase from the Exchange/Marketplace to receive subsidy.

15 2014: Subsidies At Work 15 Projected Income $16,107 (140% of poverty level) Unsubsidized annual health insurance premium (adjusted for age) $7,500 Maximum % of income the person/family must pay for premium (based on income % of poverty level) 3.41% Amount person/family pays $550 Government tax credit/subsidy $6,950 *Must purchase from the Exchange/Marketplace to receive subsidy.

16 Subsidies At Work Annual Guidelines Federal Poverty Level Family 100% 133% 150% 185% 200% 250% 300% 400% Size 1 $11,170 $14,856 $16,755 $20,664 $22,340 $27,925 $33,510 $44,680 2 $15,130 $20,122 $22,695 $27,990 $30,260 $37,825 $45,390 $60,520 3 $19,090 $25,389 $28,635 $35,316 $38,180 $47,725 $57,270 $76,360 4 $23,050 $30,656 $34,575 $42,642 $46,100 $57,625 $69,150 $92,200 5 $27,010 $35,923 $40,515 $49,968 $54,020 $67,525 $81,030 $108,040 6 $30,970 $41,190 $46,455 $57,294 $61,940 $77,425 $92, ,880

17 ACA Subsidies 17 Subsides will ensure qualifying households pay no more than a specific percentage of income on premiums: Percentage of household income is a sliding scale based on the Federal poverty level (FPL) of the family involved: Up to 133% FPL: 2% of income % FPL: 3.0% 4.0% of income % FPL: 4.0% 6.3% of income % FPL: 6.3% 8.05% of income % FPL: 8.05% 9.5% of income % FPL: Capped to 9.5% of income Source: (PPACA 1401, 10105; HCERA 1001; IRC 36B)

18 ACA Catch What is affordable? Employers: W-2, Box 1 9.5% of salary Employees: 1040, MAGI, 9.5% of income IRS: 8% of household income

19 Understanding the Affordable Care Act (ACA)

20 Affordable Care Act (ACA) 20 Signed into law March 2010 Expand Medicaid Encourage employers to offer health insurance. Provide premium subsidies Establish health insurance exchanges Strengthen consumer protections Impose protections to guard against unreasonable rate increases. Encourage primary and preventive care. Mandate insurance for everyone.

21 Affordable Care Act (ACA) 21 Insurance companies cannot: Put a lifetime cap on how much they will pay Cancel coverage by finding a paperwork error. Deny coverage based on pre-existing conditions Charge women more for coverage

22 Affordable Care Act (ACA) 22 Making Health Care Affordable Preventative services are free Cancer screenings: mammograms & colonoscopies Vaccinations: flu, mumps & measles Blood pressure and cholesterol screenings Tobacco cessation counseling Depression screening And more

23 Affordable Care Act (ACA) 23 Making Health Care Affordable The 80/20 Rule Before insurance companies spent as much as 40 cents of every premium dollar on overhead, marketing and salaries. Now they must spend 80 cents of your premium dollar on your health care or on improvements to care. If they don t, they must repay the money.

24 2014: Changes for Employers 24 Small employers offering health insurance with 25 or fewer full-time employees that have average wages under $50K are eligible for small business tax credit of 35 percent (increasing to 50% by 2014).

25 2014: Changes for Employers 25 Businesses with less than 50 full-time employees are exempt from having to offer health insurance to workers. 97% of Montana business have fewer than 50 fulltime employees. 80% of Montana employers have fewer than 10 workers.

26 2014: Changes for Employers 26 Penalties for large companies (50+ workers): Not offering minimum essential benefit coverage -- $2,000 per full-time worker (subtracts first 30 full-time workers) Not offering affordable coverage lesser of $3,000 per full-time employee receiving a subsidy or $2,000 per fulltime employee Excellent Summary: Summary of Provisions Affecting Employer-Sponsored Insurance

27 Penalties for the Uninsured : Insurers mail a Notice of Insurance (similar to W-2) for taxes. Income too low to file a federal tax return? Penalties are not meant for you $95 per adult and $47.50 per child, up to a family maximum of $285 or 1 percent of family income, whichever is greater

28 Moving Forward

29 29 Making the New Laws Work for Montana Stay informed: Medicaid expansion dead? Will other insurers participate on the exchange? Consider the paradigm shift from group coverage to individual coverage. Do we have ample primary care physicians? Expect a dramatic change in the health care market. Anticipate the possibility of an insurance shift (354,000 Montanans may see an insurance change). Know that there will be fine-tuning and clarification of the ACA. See:

30 Thank you! Karen Murphy