Your Guide to Health Care Reform April 20, 2015
Agenda Health care reform and you Top 5 must-know facts More peace of mind for you and your family Health Insurance Marketplaces Financial help from the government Terms you should know 1 1
Health care reform and you On March 23, 2010, the Affordable Care Act (ACA) became federal law. The ACA could affect you in a variety of ways, whether or not you are a Kaiser Permanente member. To find out how health care reform might affect you, read on. I m insured by my employer Many health care reform changes that affect your health plan may be in place. If there are additional changes that will affect your plan, you should get more details at your next enrollment period. I m insured on my own Some plans are updated to include certain protections health care reform requires. If you re a Kaiser Permanente member, we ll continue to keep you informed about your options or anything that affects your coverage. I m not insured As of January 2014, U.S. citizens and individuals lawfully present in the U.S. can no longer be denied coverage based on their health. Financial help may also be available if you qualify. Visit buykp.org to learn more. 2 2
Top 5 must-know facts 1. What is health care reform? The term health care reform refers to the Affordable Care Act and any state laws passed to put it in place. It s designed to help more people get affordable health insurance and receive better medical care. 2. Who has to buy health insurance? Most people are required to have a basic level of health coverage as of January 1, 2014. Some people don t have to buy insurance, based on their income or other status. Go to coveredca.com for details. 3. What if I don t buy health insurance? If you re required to have coverage, you ll be charged a tax penalty by the government if you go without insurance for 3 consecutive months or longer. You won t be charged the penalty if you are uninsured for less than 3 consecutive months. 3 3
Top 5 must-know facts 4. What if I can t afford to buy health insurance? You may get financial help to help pay for coverage, care, or both. The amount is based on your income, where you live, other coverage that may be available to you, and if you are a U.S. citizen or lawfully present in the U.S. 5. What services do new health plans cover? Most medically necessary services are covered. This includes preventive care and well-care visits for men, women, and children; immunizations; cancer screenings; prescriptions; laboratory and mental health services; as well as hospital and emergency care. 4 4
More peace of mind for you and your family If you currently have health insurance, you may be enjoying some of the added benefits from health care reform. For example, the following benefit changes are in effect for some plans.* Expanded, no-cost preventive care. This includes immunizations, diabetes and cancer screenings, counseling for smoking and alcohol abuse, and more. No annual or lifetime limits on essential health benefits. Your kids can stay on your plan until they turn 26 years old. Children with pre-existing health problems can be covered. *Some of these benefit changes do not apply to grandfathered health plans. Your employer and your insurer should let you know if your plan is grandfathered. 5 5
More peace of mind for you and your family About 2014 plans The added protections from health care reform are part of all new health plans being offered for 2014. If you need to buy coverage, or if you decide to change your health plan, these safeguards are already in place. This will help you compare plan benefits while you re shopping. 6 6
Health Insurance Marketplaces Marketplaces are federal or state-run markets where you can shop, compare, and buy health care coverage. They are sometimes called Exchanges. In California, it s called Covered California, and you can find it online at coveredca.com. Covered California offers Four levels of coverage Kaiser Permanente plans (Bronze, Silver, Gold, Platinum) offer a range of affordable options. A high-deductible plan option with a low monthly premium to help those who qualify. Additional help if you need it to help you find out if you re eligible for Medicare, Medicaid, or federal financial assistance (subsidies). 7 7
Health Insurance Marketplaces I m insured by my employer There are limited time periods during which you may be eligible to buy health care coverage at coveredca.com. Get more details about your coverage at your next enrollment period. I m insured on my own You may be able to keep your existing health plan. To change your plan, you can buy directly from us or through Covered California. I m not insured You can buy directly from us at any time or through Covered California during the enrollment period. To learn more, visit buykp.org. 8 8
Financial help from the government There are 2 types of financial help that may be available to you. One kind helps pay your monthly health insurance premium. The other helps with your out-ofpocket expenses for care. You may qualify for one or both, and the federal government can pay your health plan directly. How to apply Qualification is based on your income and family size, where you live, other coverage that is available to you, and if you are a U.S. citizen or lawfully present in the U.S. You can apply for financial help through Covered California at coveredca.com. You can only get financial help when you buy coverage through Covered California. 9 9
Financial help from the government I m insured by my employer Get more details about your coverage at your next enrollment period. In certain circumstances, you may be eligible for financial help, which you can apply for at Covered California. I m insured on my own You may qualify for financial help. Use the online calculator at coveredca.com to find out. I m not insured If you couldn t afford health coverage before, help may be on the way. Use the online calculator at coveredca.com to find out. 10 10
Terms you should know When choosing a health plan, it s important to know how health coverage works. Understand the basics with these terms. Coinsurance: The percentage of charges you pay when you receive a covered service. Your health plan coverage pays the rest. Coinsurance amounts vary depending on your plan and the service. Copayment: The fixed dollar amount you pay when you receive certain covered services or prescriptions. Your health plan coverage pays the rest. Copayments vary depending on your plan and the service. Deductible: A set amount you must pay in a plan (group) or policy (individual) year for certain health care services before your health plan coverage begins to pay. Grandfathered plan: A health plan that has been in existence since on or before March 23, 2010, and that meets certain requirements. Grandfathered plans are exempt from some of the changes required under the Affordable Care Act. 11 11
Terms you should know Health Insurance Marketplaces: Also known as Exchanges, Marketplaces are federal or state-run and regulated markets where you can shop, compare, and buy health care coverage. Out-of-pocket expenses: Includes copayments, coinsurance, and deductible payments for health care services you receive, in contrast to the premium you pay each month for your health plan coverage. Premium: The amount you and/or your employer pay (usually each month) for health care coverage. 12 12
13 OTN 43819 EMP National Nord PPT 2b