Affordable Care Act 101
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Transcript of Affordable Care Act 101
Affordable Care Act 101
Subsidies and Plans
Open Enrollment Rules and Deadlines
The Future of Healthcare
Why Marketplace Nebraska?
Clients Asking: Does the Affordable Care Act affect me? How do I get a tax subsidy? How do I enroll in the Marketplace? What are the Bronze, Silver, Gold, and
Platinum Plans? What are cost sharing reduction plans and
who qualifies for them?
The Patient Protection and Affordable care Act (PPACA) was signed into law on March 23, 2010.
Various portions of the law began being implemented in 2010 and will continue until 2018.
Federal and state governments are largely implementing these provisions.
◦ *PPACA does not affect those on Medicare, or covered under the VA, Tricare system
Covering the Uninsured & Underinsured population◦ Approximately 32 million more Americans
Improving the Transparency and Ease of Purchasing Health Insurance.◦ The Exchange System
Creating National Standards◦ Essential Health Benefits (EHBs)
Standardizing Benefit Packages◦ Summary of Benefits
Reducing medical and Insurance Costs
Guarantee Issued. Cannot be denied coverage
No Pre Existing Condition Limitations
Comprehensive coverage
Essential health benefits
Tax Subsidies to offset premium
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PPACA regulations as of today
Sec. 1302(b)(1)Services covered
include:
• Ambulatory patient services• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance use disorder services, including
behavioral health treatment• Prescription drugs• Rehabilitation and Rehabilitative services & devices• Laboratory services• Preventative and Wellness services and Chronic Disease
Management• Pediatric services, including oral & vision care
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Employer Impacts Description Small Group Fully Insured
Large Group Fully Insured
Self-Funded
Individual
1Essential Health Benefits (EHB) *
• Health Plans must provide Essential Health Benefits for individual and small group
Yes No No Yes
2OOP Max * • OOP limits must comply with OOP
limits for HSA plans
• All cost sharing (including copays) for EHB services must count toward OOPM
Yes Yes Yes Yes
3DeductibleLimits *
• Beginning 2014 plan design deductibles may not exceed a $2,000 (self-only) or $4,000 (other than self-only) annual limitation
Yes No No No
4
Metallic Levels • Four tiers of coverage for EHB packages: Bronze, Silver, Gold, and Platinum and catastrophic coverage (under 30-year-olds only)
• Requirement to meet actuarial value of one of four plans
• Requirement in and out of Exchange
Yes No No Yes
Pre-existing Condition Exclusion (All Ages)
• Beginning in 2014, pre-existing condition exclusions must be removed for all members, not just those under age 19
Yes Yes Yes Yes
For many 2014 provisions, we are awaiting further
guidance. Information will be updated.
* Not required for grandfathered plans
90% actuarial
value
80% actuarial
value 60% actuarial
value
70% actuarial
value
11
Platinum
Plan
Gold
Plan
Bronze
Plan
Silver
Plan
Proprietary Information of UnitedHealth Group.
Do not distribute or reproduce without express
permission of UnitedHealth Group. 12
Household Size 100% 133% 150% 200%250%
300% 400%
1 $11,670 $15,521 $17,505 $23,340
$29,175
$35,010 $46,680
2 15,730 20,921 23,595 31,460
39,325
47,190 62,920
3 19,790 26,321 29,685 39,580
49,475
59,370 79,160
4 23,850 31,721 35,775 47,700
59,625
71,550 95,400
5 27,910 37,120 41,865 55,820
69,775
83,730 111,640
6 31,970 42,520 47,955 63,940
79,925
95,910 127,880
7 36,030 47,920 54,045 72,060
90,075
108,090 144,120
8 40,090 53,320 60,135 80,180
100,225
120,270 160,360
Starts November 15th 2014
Ends February 15th 2015
If enrolled after the 15th, the effective date is not for the immediate month but for the nest month out
Overall, 30 percent of employers will definitely or probably stop offering ESI in the years after 2014.
Businesses with fewer than 50 full-time employees most impacted by potential to seek alternative insurance and compensation models
At least 30 percent of employers would gain economically from dropping coverage even if they completely compensated employees for the change through other benefit offerings or higher salaries.
Move toward a more informed and engaged approach to selecting and managing your health
CMS NEWS
FOR IMMEDIATE RELEASE Contact: CMS Media Relations GroupMay 2, 2014 (202) 690-6145 or [email protected]
Administration announces proposal to clarify availability of Health Insurance Marketplace coverage to workers eligible for
COBRA
WASHINGTON – The Obama administration today announced updates to model notices informing workers of their eligibility to continue health-care coverage through the Consolidated Omnibus Budget Reconciliation Act. The updates make it clear to workers that if they are eligible for COBRA continuation coverage when leaving a job, they may choose to instead purchase coverage through the Health Insurance Marketplace.
“In many cases, workers eligible for COBRA continuation coverage can save significant sums of money by instead purchasing health insurance through the Marketplace,” said Assistant Secretary of Labor for Employee Benefits Security Phyllis C. Borzi. “COBRA continues to play an important role in helping workers and families maintain coverage after a job loss, and it is important that workers know that in some cases there is a Marketplace option as well.”
Workers and their families who are eligible for employer-sponsored coverage generally must be informed of their right to COBRA continuation coverage at the start of employment. They must also be informed of their right to purchase COBRA coverage when separating from a job. The proposed changes to the model notices would offer information on more affordable options available through the Marketplace, where workers and families may be eligible for financial assistance that would not otherwise be available for COBRA continuation coverage. In most cases, workers and their families eligible for, but not enrolled in, COBRA continuation coverage would be able to enroll in Marketplace coverage outside of the normal open enrollment period.
“We are pleased that the Marketplace is providing affordable health insurance options to consumers,” said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. “With over eight million enrollees, we know that the Marketplace is working and is providing consumers with additional choices and control over their health care.”
The Departments of Labor, Health and Human Services, and Treasury are also publishing frequently asked questions related to the proposed changes to model notices. The FAQs are posted on the Department of Labor website at http://ww.dol.gov/ebsa/faqs/faq-aca19.html and the HHS website at http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs19.html. In addition, HHS is publishing a clarifying bulletin regarding a special enrollment period in the Marketplace for individuals already enrolled in COBRA continuation coverage. The bulletin is posted on the HHS website at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/SEP-and-hardship-FAQ-5-1-2014.pdf.The updated model notices are posted on the Department of Labor website at http://www.dol.gov/ebsa/modelgeneralnotice.doc and http://www.dol.gov/ebsa/modelelectionnotice.doc. A related notice of proposed rulemaking on the COBRA notice requirements will be published in the May 7 edition of the Federal Register. The notice of proposed rulemaking can also be viewed here at http://www.dol.gov/ebsa/pdf/cobranprm.pdf.
#
CMS NEWS
FOR IMMEDIATE RELEASE Contact: CMS Media Relations GroupMay 2, 2014 (202) 690-6145 or [email protected]
Administration announces proposal to clarify availability of Health Insurance Marketplace coverage to workers eligible for
COBRA
WASHINGTON – The Obama administration today announced updates to model notices informing workers of their eligibility to continue health-care coverage through the Consolidated Omnibus Budget Reconciliation Act. The updates make it clear to workers that if they are eligible for COBRA continuation coverage when leaving a job, they may choose to instead purchase coverage through the Health Insurance Marketplace.
“In many cases, workers eligible for COBRA continuation coverage can save significant sums of money by instead purchasing health insurance through the Marketplace,” said Assistant Secretary of Labor for Employee Benefits Security Phyllis C. Borzi. “COBRA continues to play an important role in helping workers and families maintain coverage after a job loss, and it is important that workers know that in some cases there is a Marketplace option as well.”
Workers and their families who are eligible for employer-sponsored coverage generally must be informed of their right to COBRA continuation coverage at the start of employment. They must also be informed of their right to purchase COBRA coverage when separating from a job. The proposed changes to the model notices would offer information on more affordable options available through the Marketplace, where workers and families may be eligible for financial assistance that would not otherwise be available for COBRA continuation coverage. In most cases, workers and their families eligible for, but not enrolled in, COBRA continuation coverage would be able to enroll in Marketplace coverage outside of the normal open enrollment period.
“We are pleased that the Marketplace is providing affordable health insurance options to consumers,” said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. “With over eight million enrollees, we know that the Marketplace is working and is providing consumers with additional choices and control over their health care.”
The Departments of Labor, Health and Human Services, and Treasury are also publishing frequently asked questions related to the proposed changes to model notices. The FAQs are posted on the Department of Labor website at http://ww.dol.gov/ebsa/faqs/faq-aca19.html and the HHS website at http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs19.html. In addition, HHS is publishing a clarifying bulletin regarding a special enrollment period in the Marketplace for individuals already enrolled in COBRA continuation coverage. The bulletin is posted on the HHS website at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/SEP-and-hardship-FAQ-5-1-2014.pdf.The updated model notices are posted on the Department of Labor website at http://www.dol.gov/ebsa/modelgeneralnotice.doc and http://www.dol.gov/ebsa/modelelectionnotice.doc. A related notice of proposed rulemaking on the COBRA notice requirements will be published in the May 7 edition of the Federal Register. The notice of proposed rulemaking can also be viewed here at http://www.dol.gov/ebsa/pdf/cobranprm.pdf.
#
CMS NEWS
FOR IMMEDIATE RELEASE Contact: CMS Media Relations Group
May 2, 2014 (202) 690-6145 or [email protected]
Administration announces proposal to clarify availability of Health Insurance Marketplace coverage to workers eligible for COBRA
WASHINGTON – The Obama administration today announced updates to model notices informing
workers of their eligibility to continue health-care coverage through the Consolidated Omnibus Budget Reconciliation Act. The updates make it clear to workers that if they are eligible for COBRA continuation coverage when leaving a job, they may choose to instead purchase coverage through the Health
Insurance Marketplace. “In many cases, workers eligible for COBRA continuation coverage can save significant sums of money by instead purchasing health insurance through the Marketplace,” said Assistant Secretary of Labor for Employee Benefits Security Phyllis C. Borzi. “COBRA continues to play an important role in helping workers and families maintain coverage after a job loss, and it is important that workers know that in some cases there is a Marketplace option as well.”
Workers and their families who are eligible for employer-sponsored coverage generally must be informed of their right to COBRA continuation coverage at the start of employment. They must also be informed of their right to purchase COBRA coverage when separating from a job. The proposed changes to the model notices would offer information on more affordable options available through the Marketplace, where workers and families may be eligible for financial assistance that would not otherwise be available for
COBRA continuation coverage. In most cases, workers and their families eligible for, but not enrolled in, COBRA continuation coverage would be able to enroll in Marketplace coverage outside of the normal open enrollment period. “We are pleased that the Marketplace is providing affordable health insurance options to consumers,” said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. “With over eight million
enrollees, we know that the Marketplace is working and is providing consumers with additional choices and control over their health care.”
The Departments of Labor, Health and Human Services, and Treasury are also publishing frequently asked questions related to the proposed changes to model notices. The FAQs are posted on the Department of Labor website at http://ww.dol.gov/ebsa/faqs/faq-aca19.html and the HHS website at
http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs19.html. In
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