Health Reform and Older Adults: Opportunities for Funders

Kim VanPeltSt. Luke’s Health Initiatives

October 18, 2013

Coverage Expansion

Employer-based coverage Medicaid

The “Exchange”

2

Insurance Coverage and the Pre-Medicare Population

• More likely to be covered than other demographic groups

• 12 percent uninsured among 50-59 year olds versus 28 percent uninsured among 18–28 year olds

• However, more likely to uninsured due to cost, more likely to be delaying care

Uninsured, Pre-Medicare Population

85364, YUMA

85706, TUCSON

85281, TEMPE

85705, TUCSON

85033, PHOENIX

85035, PHOENIX

85041, PHOENIX

85008, PHOENIX

85301, GLE

NDALE

85713, TUCSON

85204, MESA

85225, CHANDLE

R

85719, TUCSON

85037, PHOENIX

85009, PHOENIX

0

200

400

600

800

1,000

1,200

1,400

1,600

0%

5%

10%

15%

20%

25%

30%

Uninsured Pre-Medicare (Age 50-64) by Zip Code

Uninsured Pre-Medicare Uninsured Rate Pre-Medicare

Medicaid Expansion • Increases eligibility up to 138 percent of the federal poverty level

• Over 300,000 Arizonans will benefit

• Allows for coverage to childless adults, many of whom are older adults without children living at home

• SLHI supported polling, messaging and advocacy

• Approximately 60 percent of voters support expansion

• Eligibility screening began October 1, coverage begins on January 1, 2014

The Marketplace• Online site for individuals and small businesses to compare and purchase health

coverage

• Intended to simplify and structure health insurance choices for individuals, families and small businesses

• Exclusive mechanism for receiving federal subsidies and plans with cost-sharing limits

• Open enrollment began October 1

• Open enrollment will occur through the end of March

• 1.3 million Arizonans predicted to eventually receive coverage through the marketplace

Premium Subsidies

• Tax credit is advanceable or refundable

• Eligibility is based on – Projected household income and family size– 100 – 400% FPL ($23,550 -$94,200 for a family of four in 2013)– Obtaining qualified coverage through the marketplace– Ineligible for government-sponsored coverage, affordable-

sponsored insurance, or certain other minimum essential coverage

• Tax credits available to immigrants who are lawfully present

Cost Sharing Reduction

• Eligibility for reduced cost sharing is based on

– Incomes at or below 250% of FPL ($58,875 annually for a family of four in 2013)

– Receiving the new premium tax credit

– Enrolling in a marketplace silver-level plan

Cover Arizona

• More than 600 organizational members

• Focusing on awareness, outreach, enrollment assistance

• Varied strategies based on demographics, geography, special populations

Strategies for Older Adults

• Partnering with AARP, Area Agency on Aging on outreach activities

• Working with Area Agency on Aging, Corporation for National and Community Service and Retired and Senior Volunteer Program (RSVP) volunteers to develop an infrastructure for enrollment assistance

Need more information

www.healthcare.gov

www.marketplace.cms.gov

www.coveraz.org

www.slhi.org