AFFORDABLE CARE ACT (ACA) AMBASSADOR TRAINING PROGRAM Presented in conjunction with
Who We Are State s largest progressive advocacy coalition Convener of NJ for Health Care Coalition NJ For Health Care/NJ Citizen Action
Training Objectives Overview of ACA benefits & timelines Understanding how reform impacts New Jersey Explain the who, what, when & where of Eligibility & Enrollment Define the process & options for those with limited income Equip you with the knowledge you need to educate others & help drive enrollment
National Health Care Reform ACA signed into law March 23, 2010 What s already here? What comes next? What does it mean for New Jersey?
Implementation Timeline September 2010 Phase in of reforms begins October 1, 2013 Marketplace opens Enrollment begins January 1, 2014 ACA coverage begins
ACA Consumer Protections in Effect INSURANCE COMPANIES CAN NO LONGER: Put an annual or lifetime limit on your benefits Deny coverage for gender or pre-existing condition or rescind coverage if you get sick Charge a co-pay for preventive care like cancer screenings THEY MUST: Allow young adults to remain on their parents policy until age 26 Send rebate checks to members if they spend less than 80% of the members premiums on care.
System reforms: Incentives to Prevention No cost sharing on preventative services Increased Medicaid payments for primary care Risk assessments/behavior modification programs Grants for small employers that establish wellness programs
Provider side reforms Reduced rebates to issuers of Medicare Advantage plans Fees for hospitals for excessive readmissions New fees on pharmaceuticals Establishment of Accountable Care Organizations (ACO)
2012: Reform Moves Forward Supreme Ct. upholds ACA Medicaid expansion is up to the States Gov. Christie rejects State based Exchange
More changes in 2013 Consumers see first rebates from insurers NJ Governor Christie signs onto Medicaid expansion Nationwide 800# begins operation STILL TO COME Marketplace for enrollment will open October 1
Expanding Medicaid: What changes? It is no longer tied to General Assistance You can be working and still qualify Who will be eligible? Individuals under 65 who earn less than138% of federal poverty limit ($15,282 for individual/$31,322 family of four)
Adding to what exists NJ Family Care NJ Family Care Publicly funded/subsidized health insurance for children/low income families Covers children up to 350% of federal poverty limit Some parents/guardians with earned income up to 138% Legal immigrants (excluding children & pregnant women) must be legal residents for 5 years to be eligible
Not eligible for Medicaid? SHOP the Individuals or families with an annual income >138% up to 400% of Federal poverty limit WILL be eligible for financial assistance to help with health insurance costs Premiums will not exceed 9.5% of income
The Health Insurance Marketplace What is it? What will it look like? Who can use it? How will it work?
A New Way to Shop for Health Insurance 1-stop comparison shopping Provides information on Qualified Health Plan costs before you buy (premiums/deductibles/outof-pocket costs) Access to subsidies for consumers who qualify
What will it look like? The Marketplace is a WEBSITE that will look like others you may have used to comparison shop on the internet.
What Will Be Covered: Essential Health Benefits QHP coverage must include at least these 10 service categories Ambulatory Patient Services Emergency Services Hospitalization Maternity & newborn care Mental Health & Substance Use Disorder Services (including behavioral health treatment) Prescription Drugs Rehabilitative & Habilitative Service & Devices Lab services Preventative & wellness services Chronic disease management Pediatric services including Oral & vision
Who can use the Exchange? Individuals, families, and small businesses Citizens and Legal immigrants of five years or more Everyone enrolling in the exchange must verify legal status Members of Congress are required to use the Exchange
The Application & Enrollment Process The ACA establishes a NO WRONG DOOR POLICY One streamlined application to determine eligibility for Qualified Health Plan through the Marketplace New tax credits to lower premiums Reduced cost sharing (these are the out-of-pocket costs) Medicaid Children s Health Insurance Program (CHIP) (NJ Family Care) Center for Medicare & Medicaid Services (CMS) Application forms http://cciio.cms.gov/resources/other/index.html#hie
Enrolling in Coverage Apply by online, by phone, by mail, or in person. One application for all: Qualified Health Programs on the Marketplace Medicaid NJ Family Care (Children s Health Insurance program) Trained assistants called Navigators will be available to assist consumers Federal toll-free hotline & website
Understanding the Costs: Crunching the Numbers How much will plans in the Marketplace cover? What kind of subsidies are available to consumers? How will subsidies be calculated? How much financial assistance will consumers get?
Marketplace Exchange: Tier Levels of Coverage Level Plan pays* Enrollee pays* in addition to premium Bronze 60% 40% Silver 70% 30% Gold 80% 20% Platinum 90% 10% Catastrophic Young adults to age 30
Marketplace Subsidies Premium Tax Credits WHAT: Tax credit applied to premium cost up front WHO: Available to individuals & families with income between 100 400% of the Federal Poverty Limit HOW MUCH: For those receiving subsidies premiums will range between 2 9.5% of income
Qualifying for Marketplace subsidies Meet income eligibility: Individuals/families with income 100-400% of Federal Poverty Level Must be ineligible for health benefits through another source other than individual marketplace Individuals who can get insurance through an employer can get subsidized coverage through exchange if: Employer premiums are unaffordable (> 9.5% of HH income) Plan pays less than 60% of cost of covered benefits
Premium limits based on income Income Up to 133% of FPL Premium limit 2% of income 133 150% of FPL 3 4% of income 150 200% of FPL 4 6.3% of income 200 250% of FPL 6.3 8.05% of income 250 300% of FPL 8.05 9.5% of income 350 400% of FPL 9.5% of income
Additional Assistance: Cost Sharing Reductions WHAT: Limits out-of-pocket costs WHO: Those between 138-400% of Federal Poverty Limit (FPL) purchasing plans through the Marketplace ADDED BENEFIT: Individuals with income < 250% of FPL ($28,725 for individuals/$58,875 for family of four in 2013) Will qualify for reduced co-pays, deductibles
Out of Pocket Limits for Qualified Consumers on Marketplace Income Out of Pocket Limit * Individual Family 100-200% FPL 200-300% FPL 300 400% FPL Above 400% FPL 1/3 HSA limit $1983 $3966 1/2 HSA limit $2975 $5950 2/3 HSA limit $3966 $7932 100% HSA limit $5950 $11,900 *HSA Health Savings Account - Based on 2010 limits
Calculating financial assistance Federal Poverty guidelines will be used Household Size 100% 133% 150% 200% 300% 400% 1 $11,490 $15,282 $17,235 $22,980 $34,470 $45,960 2 15,510 20,628 23,265 31,020 46,530 62,040 3 19,530 25,975 29,295 39,060 58,590 78,120 4 23,550 31,322 35,325 47,100 70,650 94,200 5 27,570 36,668 41,355 55,140 82,710 110,280 6 31,590 42,015 47,385 63,180 94,770 126,360 7 35,610 47,361 53,415 71,220 106,830 142,440 8 39,630 52,708 59,445 79,260 118,890 158,520 For each additional person, add $4,020 $5,347 $6,030 $8,040 $12,060 $16,080
Help for Small Business Tax Credits available to Small Business Owners How do you know if a small business is eligible for a tax credit? Does the business have 25 or less employees? Employees average annual wage is $50,000 or less They contribute at least 50% toward their employee s health insurance costs YES to all 3 Business is eligible for Tax credit = up to 35% of the cost of health coverage
OUTREACH & ENROLLMENT New Jersey s Uninsured What we know and How we can reach them
A Profile of NJ Uninsured How many are there? More than 900 thousand in New Jersey Many have lost insurance through job loss or change in eligibility levels for public programs Most are employed They live in every region of the State Every ethnic and racial group is represented They don t have employer insurance options
An Employment Profile of NJ Uninsured Stats from NJ Policy Perspective
Worker categories most at risk
Understanding our Audience History Language/Culture Education/Experience Attitudes & Motivations
Gauging consumer knowledge Kaiser Health Foundation April 2013 What do consumers know about the current status of the Affordable Care?
Respondent s replies All Ages 18-29 Annual household income less than $30,000 Aware of ACA status (still law & being implemented) 59% 49% 42% Unaware of ACA status 42 51 59 Is no longer law Overturned by Supreme Ct. 7 8 14 Is no longer law Repealed by Congress 12 21 16 Don t know/refused 23 22 29 Note: Percentages may not add to 100% due to rounding.
Consumer Attitudes on ACA
BECOME AN ACA AMBASSADOR Join us in our outreach to potential enrollees. We ll equip you with what you need. Do presentations for local community groups Organize house parties in your area Disseminate literature blanket your community Libraries, town halls, community centers, houses of worship Postcard drive - Sign people up to stay informed Set up informational tables on ACA at community events Fairs/Festivals Sporting events Concerts Help or participate in a town hall meeting in your area Sign up for training to become a volunteer enrollment counselor
Additional Resources NJFAMILYCARE.ORG HOTLINE: 800-318-2596
Contact Us Maura Collinsgru Health Policy Advocate NJ Citizen Action 75 Raritan Avenue, Suite 200 Highland Park, NJ 08904 732-246-4772 maura@njcitizenaction.org www.njcitizenaction.org www.njforhealthcare.org