Affordable Care Act in Massachusetts Training

PFAC Webinar Series

Kate Bicego, Health Care For All

Health Care For All

oNon-profit advocacy and health information organization. Goal is quality and affordable health care.

oHelpLine: 800-272-4232oHealth Law Advocates: 617-338-5241oBlog: blog.hcfama.orgoWebsite: www.hcfama.org

Where are we right now?

“Thank you, Chapter 58!”

MassHealth (Medicaid)

o Health insurance coverage for long-term unemployed people, low-income parents & their children, some pregnant women, & some disabled people.

o Can sometimes help pay for work insurance that is unaffordable to families

Commonwealth Care

o Health insurance coverage for adults (19+) who are not eligible for MassHealth or insurance through a job

o Lower monthly premiums and co-pays

o Choice of health plansoNetwork Health, BMC HealthNet, NHP,

Celticare, or Fallon

Who qualifies right now?

oMassHealthoHousehold with children <19 living in home

o Single person +1 child, ~$20,000 /yearo Family of four, ~$31,000 /year

oPregnant women

o Single woman, ~$31,000 /yearo Family of four, ~$55,000 /year

Who qualifies right now?

o Commonwealth Careo Adults (19+)

o Single adult, ~$34,000 /yearo Family of four, ~$70,000 /year

Cannot have access to health insurance through a job

Cannot get unemployment benefits

Cannot qualify for school insurance (FTE students)

Other Health Care Options

oEmployer or private health insurance

oHealth Safety Net (free care)

oChildren’s Medical Security Plan

Opportunities for Improvements

oNo “wrong door” to insurance

oHigher income limits

oEasier application and enrollment

oOn-going coverage (fewer gaps)

Affordable Care Act

History being made on March 23rd, 2010!

Insurance Market Reforms No denials or charging more for pre-existing conditions

Insurance plans must provide an understandable Summary of Benefits and Coverage

No lifetime or annual limits on coverage

No cost sharing (co-pay, deductible, or coinsurance) for certain preventive services

Insurance must cover doctor’s visits, maternity services, ER care, and prescriptions

Insurance companies no longer cancel coverage*

Insurance Market Reforms

*Your insurance company can still cancel coverage if you:

Put false or incomplete information on your insurance application on purpose

or

You don’t pay your premiums on time.

ACA Impact in Massachusetts

How will the ACA help more people in Massachusetts to afford health insurance coverage?

Major ACA Improvements in Mass.

More people will qualify MassHealth! More help paying for health insurance from the Health Connector!

More Help Paying for Health Insurance!

oMassHealthoMost adults (including students) eligible up to

133% FPL

o Single adults: ~$15,000/year o Family of four: ~$31,000/year

oHelp paying for private insurance o Families eligible up to 400% FPL

o Single person: ~$46,000/yearo Family of four: ~$94,000/year

New Income Limits for Help Paying for Health Insurance

Household Size

MassHealth CarePlus 138% FPL

ConnectorCare 139% - 300% FPL

Help Paying for Qualified Health Plans From Health Connector

301%-400% FPL

1 $15,288 $34,472 $45,960

2 $20,640 $46,536 $62,040

3 $25,980 $58,596 $78,120

4 $31,332 $70,656 $94,200

5 $36,672 $82,716 $110,280

6 $42,024 $94,776 $126,360

The Health Connector is getting better!

oThe Health Connector is the one-stop shop for health insurance in the state.

oWhat gets better?o1 online application oHelp paying for health insurance up to

400% FPL

Other Health Coverage Options in Mass.

o Employer health insurance

o Parent’s health insurance

o Health Safety Net (free care)

o Children’s Medical Security Plan

Affordable Care Act Coverage Transitions

Who needs to reapply and reenroll for their new health insurance

coverage?

No one currently in MassHealth needs to reapply unless one of their household members needs to reapply.

Commonwealth Care members under 133% FPL do NOT need to reapply.

The “Pink Notice”

Commonwealth Care members over 133% FPL DO need to reapply NOW.

Reapply Notice

All Commonwealth Choice and Commonwealth Care members need to reapply and reenroll by March 24th, 2014.

Additional Reapply

All Medical Security Plan (MSP) members All documented immigrantsAnyone that has been denied

Commonwealth Care in the past that may now qualify

Anyone that has been denied MassHealth in the past that may now qualify

Over Age 65 & the Affordable Care Act

• No change in Medicare process

• No change in MassHealth

• If family has members <65 & >65, apply for entire family using both new application & paper application

ACA Changes in Massachusetts:Case Examples

Rosa is a 58 year old married woman that has been unemployed since she lost her job during the recent recession. Her household’s only income is $1,500 per month in Social Security benefits. How can Rosa get health insurance help because of the ACA?

ACA Changes in Massachusetts:Case Examples

Janet is an uninsured single mother with three children living in her home. She is self-employed and earns about $85,000 per year. How will the ACA help Janet get affordable health insurance?

Resources

o For more information about the Affordable Care Act: www.healthcare.gov

o Health Connector: www.mahealthconnector.org or 877-MA-ENROLL

o Health Care For All: www.hcfama.org or call our FREE health insurance HelpLine at 800-272-4232

Counselors are available to take calls in English, Spanish, and Portuguese.

Speaker Contact Info

Kate BicegoConsumer Assistance Program Manager

Health Care For All617-275-2912

kbicego@hcfama.org

Questions???

Future Webinars

Wednesday, January 8: 1:00-2:00pmTopic: PFACs Working to Improve Mental Health Care

Future webinars: The second Wednesday of every month (February 12, March 12, April 9, June 11, July 9, September 10, October 8, November 12, December 10).

Wednesday May 14: Second Annual Statewide PFAC Conference at the College of the Holy Cross