The Affordable Care Act, Cancer and Employment

Transcription

1 The Affordable Care Act, Cancer and Employment Eva LaManna Manager of Programs, Cancer and Careers Monica Bryant, Esq. COO, Triage Cancer This presentation is intended to provide general information on the topics presented. It is provided with the understanding that the author is not engaged in rendering any legal, medical, or professional services by its publication or distribution. Although this content was reviewed by a professional, it should not be used as a substitute for professional services. Copyright 2014 Cancer and Careers & Triage Cancer 1 1

2 Cancer and Careers Cancer and Careers empowers and educates people with cancer to thrive in their work environment by providing expert advice, interactive tools and educational events. CancerAndCareers.org Publications in English and Spanish Job Search Tools Accredited Trainings for Healthcare Professionals Career Coaching CancerAndCareers.org/espanol Ask The Experts Teleconferences Community Events National Conference Resume Review Service 2 2

3 Triage Cancer Triage Cancer provides education and resources on the entire continuum of cancer survivorship issues Speakers Bureau of experts & survivors Educational blog at TriageCancer.org/blog Resources & materials at TriageCancer.org Expert authors on cancer survivorship issues Seminars, teleconferences, webinars, & conferences Cancer survivorship event planning & support Triage Cancer partners with experts in the areas of medicine, mental health, nursing, social work, patient navigation, nutrition, oncofertility, law, employment, education, financial management, insurance, relationships, sexuality and intimacy, pain and palliative care, advocacy, and other areas of cancer survivorship. 3 3

4 Health Insurance Terms Cost to Have Health Insurance Premium each month Costs When You Use Your Health Insurance Deductible each year Co-Payment each time you get care Co-Insurance or Cost-Share each time you get care Out-of-Pocket Maximum = deductible + co-payments + co-insurance Pre-existing Conditions 4 4

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6 Why has it been hard to get health insurance? Pre-existing conditions Cost Confusion 6 6

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8 Patient Protection & Affordable Care Act (ACA) Signed into law on March 23,

9 New Benefits & Protections 1. No Rescissions (cancellations) 2. No Lifetime or Annual Limits 3. Free Preventative Care No co-pays, co-insurance, or deductibles Ex: immunizations, blood pressure, diabetes, cholesterol, cancer screenings 4. Young adults can stay on parent s plan until Copyright 2013 Triage Cancer

10 1. Premium Rating: Individual/family New Protections Geographic Location (CA has 19 regions) Age (64 year old can t be charged more than 3 times what a 21 year old can) Ex: if a plan costs a 21 year old $100, then that same plan cannot cost a 64 year old more than $ No Pre-Existing Condition Denials/Exclusions Insurance companies cannot look at: Pre-existing condition (physical or mental) Health status or health history Gender or Age 10 10

11 New Medicare Benefits 1. Free Wellness Visit 2. Free Preventative Care 3. Lowers the cost of prescription drugs 2014: Part D deductible = $310; Donut hole between $2,850 and $4,550 Year What you pay for brand name drugs in the coverage gap % 72% % 65% % 58% What you pay for generic drugs in the coverage gap 11 11

12 New Requirement to Have Health Insurance Most U.S. citizens & legal residents must have health ins. What coverage counts? Employer Plans COBRA/HIPAA Plans Medicare & Medicaid Individual Plans TRICARE/VA Health Plans MRMIP, and others How much is the penalty? 2014: $95/adult, $47.50/child, up to $285/family Or 1% of family income whichever is more Fine collected through IRS annual taxes 12 12

13 New Requirement to Have Health Insurance Can have one gap up to 3 months during the year Lines up with 90 day waiting period for employer health insurance CA = waiting periods can t be more than 60 days Who Doesn t Need Health Insurance? Financial hardship If cheapest plan costs more than 8% of household income Taxpayers with incomes below $9,750 (individual under ) Members of Indian tribes Members of health care sharing ministries Individuals who are undocumented or incarcerated 13 13

14 ACA s New Health Insurance Options 14 14

15 New Health Insurance Options Medicaid Expansion New category of eligibility: Adults with household income under 138% of the federal poverty level No asset/resource test Household 138% Size 1 $15, , , , , ,

16 Status: State Medicaid Expansion in 2014 Expanding 26 AR, AZ, CA, CO, CT, DC, DE, HI, IA, IL, KY, MA, MD, MI, MN, ND, NJ, NM, NV, NY, OH, OR, RI, VT, WA, WV Medicaid Waivers Pending for IN, PA Not Expanding 23 AK, AL, FL, GA, ID, KS, LA, ME, MO, MS, MT, NC, NE, NH,OK, SC, SD, TN, TX, UT, VA, WI, WY Updated: December 11, 2013 (Kaiser Family Foundation) Note: this information changes frequently, please check for updates 16 16

17 New Health Insurance Options State Health Insurance Marketplaces Exchanges An insurance shopping mall Eligibility: Live in U.S.; be a U.S. citizen or lawfully present; and not incarcerated 2014: individuals & small businesses (<50 FT employee equivalents) $ help to buy a plan: premium tax credits & cost-sharing subsidies 17 17

18 Helping You Buy Health Insurance Premium tax credits: Lowers your monthly premium Applies when you enroll Only applies to plans in the exchange! Cost-sharing subsidies: Lowers your deductible, co-pays, & co-insurance amounts Eligibility is based on income level & family size 18 18

19 Helping You Buy Health Insurance Cost-Sharing Subsidies* Household Size 100% 138% 200% 250% 400% 1 $11,490 $15,856 $22,980 $28,725 $45, ,510 21,404 31,020 38,774 62, ,530 26,951 39,060 48,825 78, ,550 32,499 47,100 58,875 94,200 Medicaid Premium Tax Credits *Cost-sharing subsidies from % only available in states w/o Medicaid expansion 19 19

20 Health Insurance Marketplace Plans 1. Standard cost-share: Catastrophic coverage (under 30 or $ hardship or cancelled plan) 2. Highest deductible*: $2,000 individual / $4,000 family 3. Highest OOP maximum*: $6,350 individual / $12,700 family *with some exceptions 20 20

21 What are the differences between plans? Networks of doctors and hospitals Check to make sure your doctors are covered by the plan you choose Co-payments Prescription drug coverage Which drugs are covered? Is there a separate drug deductible? 21 21

22 Other info to know... Cost-sharing subsidies only available for silver plans Enhanced Silver 70 plans Catastrophic plans have deductibles of $6,350 the same as the OOP maximum Can t get premium tax credits for catastrophic plans You project your income for 2014 If your income/family size changes during the year, tell Marketplace because you may pay less for coverage PCIP plans: can keep through 3/31/

23 Can an employee who is offered coverage from an employer buy a plan in the Marketplace? Yes! 23 23

24 Can an employee who is offered coverage from an employer buy a plan in the Marketplace AND still be eligible for $ Yes, if: help? Employer offers coverage that is not: Affordable Costs more than 9.5% of employees income Adequate Covers less than 60% of health care costs 24 24

25 State Health Insurance Marketplaces in 2014 State Marketplace CA, CO, CT, DC, HI, ID, KY, MA, MD, MN, NM, NV, NY, OR, RI, VT, WA Federal Marketplace AK, AL, AZ, FL, GA, IN, KS, LA, ME, MS, MO, MT, ND, NE, NJ, NC, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WY Partnership Marketplace AR, DE, IA, IL, MI, NH, WV 17 Approved for State Marketplace 27 Default to Federal Marketplace 7 Approved for Partnership Marketplace *Updated: May 23, 2013 (Kaiser Family Foundation)

26 State Run Health Insurance Marketplaces 26 26

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29 How to Enroll Enrollment: Website: HealthCare.gov Toll-free phone hotline: Paper application: mail or fax In-Person: places to get help enrolling Marketplace Assister Organizations

30 What You Need to Apply Social Security Numbers (or document # legal immigrants) Employer and income information for every member of your household who needs coverage (e.g., pay stubs or W-2 forms) Policy numbers for any current health insurance plans covering members of your household A completed Employer Coverage Tool 30 30

31 Employer Coverage Tool 31 31

32 When to Enroll? 2014 Open Enrollment Period October 1, 2013 to March 31, 2014 Latest date to enroll in Marketplace to avoid the individual mandate penalty = March 31, 2014 Medicaid applications accepted year round 32 32

33 Special Enrollment Period When you have a life changing event: Loss of minimum essential coverage, for ex: Change in full-time employment status Loss of employer-sponsored insurance Change in dependent status as a result of turning 26 Birth or adoption of a child Marriage, domestic partnership, divorce, legal separation Permanent move to a new state Gain eligible immigration status Release from incarceration Military returning from active duty Have 60 days to enroll in a Marketplace plan 33 33

34 6 Health Insurance Companies in Los Angeles County Regions 15 & 16 Region 15: North LA County Zip codes: ; ; Region 16: South LA County Zip codes: ; ; Anthem EPO, HMO Blue Shield PPO Health Net PPO, HMO Kaiser Permanente HMO L.A. Care Health Plan HMO Molina Healthcare PPO Anthem EPO, HMO Blue Shield PPO Health Net PPO, HMO Kaiser Permanente HMO L.A. Care Health Plan HMO Molina Healthcare PPO 34 34

35 South LA County: 40 Years Old 35 35

36 South LA County: 40 Years Old & Tax Credit Tax credit on bottom line; final monthly premium on top line 36 36

37 Summary: Health Insurance Coverage in 2014 Over 400% of FPL: Can buy a plan in Marketplace Between 400% and 100% of FPL: $ help to buy a plan in State Marketplace Employer Plans Individual Plans Medicare Medicaid Up to 138% of the FPL: Eligible for Medicaid (if your state expands) VA Health & Others 37 37

38 UPCOMING EVENTS & TELECONFERENCES National Conference on Work & Cancer New York, NY Scholarships available! Friday, June 13th, 2014 Ask The Experts: Legal and Career Advice Thursday, March 13th - 1:30pm ET, 10:30am PT Wednesday, May 7th - 6:30pm ET, 3:30pm PT Educational Series for Healthcare Professionals: Spring 2014 Thursday, March 27th - Session 1: Where to Start Thursday, April 17th - Session 2: Working Through Treatment Thursday, May 15th - Session 3: Returning to Work Job Search Calls: Tips, Tricks, and Tools Thursday, June 26th, pm ET/Noon PT For more information and to register:

39 ADDITIONAL RESOURCES Employment Rights: Equal Employment Opportunity Commission Job Accommodation Network U.S. Department of Labor (COBRA) U.S. Department of Labor (FMLA) Disability Insurance Options: Social Security Administration: Health Insurance Options: Legal Assistance: National Cancer Legal Services Network LawHelp

40 CONTACT INFORMATION Triage Cancer Monica Bryant, Esq. Facebook Blog Cancer and Careers Eva LaManna Facebook Newsletter /newsletter 40 40