Nebraska Appleseed Justice and Opportunity for All Nebraskans.
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Transcript of Nebraska Appleseed Justice and Opportunity for All Nebraskans.
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Nebraska AppleseedJustice and Opportunity for All Nebraskans
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Open for Business: Health Insurance Marketplace
October 4, 2013
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Health Insurance TodayCurrently, people get insurance through:
- Their employer- Medicaid and/or Medicare- The individual market
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Health Insurance Today Insurance companies do not have to sell to you,
and may deny you insurance on the basis of a pre-existing condition, or not cover certain services or treatments
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Health Care Reform• In 2010, President Obama signed into law the
Patient Protection and Affordable Care Act (ACA).
• The Supreme Court upheld the ACA on June 28, 2012, but ruled that the new Medicaid program was optional for states.
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Health Care Reform
The ACA focuses on four main areas:
•How to find and access insurance coverage• Health Insurance Marketplace• New Medicaid Program
•How to afford coverage
•How to ensure the insurance system is fair and that people get value for their premium dollar
•How to change our health care delivery system to control costs and focus on prevention
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Accessing Coverage
People will access coverage through:
•Employers
•Creation of Health Insurance Marketplaces• Nebraska has opted for a federally
facilitated Marketplace
•Expansion of Medicaid• Nebraska has not yet opted in to the new
Medicaid program
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Coverage with ValueCertain consumer protections are already
in effect:
• Ends denial of coverage for pre-existing conditions for children
• Bans co-pays and out-of-pocket expenses for preventive care and immunizations on new plans
• Prohibits lifetime benefit limits in all plans
• Extends dependent coverage to age 26 in all plans
• Insurers cannot drop you when you get sick
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Coverage With ValueInsurance Reforms and Consumer Protections
•Prohibits denial of coverage for pre-existing conditions for everyone by 2014
•Changes what insurers can look at when setting premiums:
• They can no longer set different rates based on your health status or gender
• Can only look at age (3:1), geographic area, family composition, and tobacco use (1.5:1)
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Coverage With ValueInsurance Reform and Consumer Protections
•Guaranteed issue and renewability in 2014– insurers can’t refuse to sell
•Prohibits annual limits for ten essential services
•Creates a standard benefit plan for all new policies (does not apply to existing individual and employer-sponsored plans)
•Eliminates waiting periods for coverage more than 90 days
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Essential Health Benefits
The ACA requires that all plans sold inside the new Health Insurance Marketplace, and most plans outside the Marketplace, to cover ten essential health benefits (EHBs)
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Accessing CoverageThe new Health Insurance Marketplace•The Health Insurance Marketplace is a one-stop shop for people for private coverage, Medicaid coverage, and accessing tax credits
•The Marketplace is accessible for individuals and small businesses with up to 50 employees
•Nebraska has chosen to have a federally facilitated Marketplace—one that will be run by the federal government in place of the state
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Accessing CoverageThe new Health Insurance Marketplace•Four insurance carriers offer plans
• Blue Cross/Blue Shield, CoOpportunity, Health Alliance, Coventry
•All plans must cover essential health benefits
•Four levels of plans will be available • Bronze, Silver, Gold, Platinum
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Accessing CoverageThe new Health Insurance Marketplace•Help paying for the cost of coverage (tax credits)
• Eligible incomes are between 100% and 400% of the federal poverty level (FPL) ($19,090 to $76,360 for a family of three)
• Individuals are not eligible for tax credits if they are offered coverage by their employer unless • The employer plan does not meet certain
minimum standards and the employee share of (individual) premiums is 9.5% of income
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Accessing CoverageThe new Health Insurance Marketplace•The process
• Start the process at healthcare.gov
• Series of screens/questions
• If eligible for tax credit, credit is applied
• Compare and select a plan
• Enroll
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Medicaid and the Marketplace• Medicaid was intended to be the foundation of
coverage for low income adults, because it is much cheaper to cover people under Medicaid than to subsidize their insurance
• Therefore, those who are making under 100% FPL can’t get tax credits through the Exchange, and will have no path to coverage, creating a large gap
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Outreach and Enrollment184,429 Nebraskans under 400% FPL are
uninsured Household of 4 making less than $94,200
12% of total population
Source: 2010 Small Area Health Insurance Estimates,
U.S. Census Bureau
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Timelines for Enrolling*October 1, 2013- March 31, 2014
Enrollment Date Effective Date of Coverage
Oct. 1, 2013-Dec. 15, 2013 January 1, 2014
Dec. 16, 2013-Jan. 15, 2014 February 1, 2014
Jan. 16, 2014-Feb. 15, 2014 March 1, 2014
Feb. 16, 2014-March 15, 2014 April 1, 2014
Mar. 16, 2014-March 31, 2014 May 1, 2014
You may be eligible for a Special Enrollment Period if you:•Move to a new state•Have certain changes in income•Change your family size•Belong to a federally recognized Tribe
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Consumer Assistance FrameworkEnrollment Assisters
Navigators CACs (Hospitals, doctors offices, libraries, etc.) Agents/Brokers Call-Center Representatives
Educators Partners & Stakeholders Local government branches & employees Connect community to www.healthcare.gov and
enrollment assisters.
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Consumer Assistance Framework
Assisters Help consumers fill out the
application
Help consumers compare plans & make an enrollment selection
Provide education about the application and plan compare process
May conduct local outreach to bring consumers to assistance.
Educators Create awareness of the
Marketplace
Drive consumers to Customer Service channels (www.healthcare.gov & assisters)
Conduct outreach events and activities
Provide basic information about the Marketplace and where to get help
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Enroll Nebraska Goal: To equip and connect assisters and
educators with resources to enroll Nebraska’s uninsured.
Visit www.enroll-ne.org for latest materials
Equip Connect
• Policy Updates• Sample Press Releases• FAQ’s• Sample Outreach Plans• Troubleshooting• Calendar of Events• Strategies for
community engagement
• Identifying and linking resources between organizations
• Referrals• Facilitating
collaboration
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How can you engage your community? Link with other organizations in your area to
organize education and enrollment events
Share tools and resources with Enroll Nebraska and other organizations
Questions to consider: What are you currently doing? What are the challenges? What resources already exist?
www.healthcare.gov www.canhelp.org www.enroll-ne.org
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Nebraska AppleseedJustice and Opportunity for All Nebraskans
Questions?