The Patient Protection and Affordable Care Act

The Promise of Health Care Reform

• Primary Goal: Health Insurance Coverage for approximately 26 million Americans – over 1 million Illinoisans

• Right Care, Right Time, Right Setting

• Better Health

What This Means for Illinois

• 2013: 1.7 million uninsured Illinoisans

• By 2015:– More than 400,000 will gain coverage in the

Health Insurance Marketplace– Nearly 350,000 will be covered under Medicaid

What Health Care Reform Does

• Establishes Health Insurance Marketplace

• Allows states to expand Medicaid effective January 1, 2014– Illinois opted in under Senate Bill 26 /

Public Act 98-104 – signed into law July 22

Options for Consumers• If you already have private insurance, Medicare, Medicaid or VA

coverage – Don’t do anything

• If you are a legal resident under age 65, earning less than $15,302 (individual) or $31,155 (family of 4) – Enroll in Medicaid

• If you earn more than the above limits, up to 400% of the federal poverty level [$45,960 (individual) or $94,200 (family of 4)] – Receive financial help (premium subsidies) and buy insurance in

the Health Insurance Marketplace

Health Coverage with Good Benefits

• Prescription drugs• Hospitalization• Doctor visits• Preventive care/wellness services• Mental health & substance abuse disorder

services• Pediatric services – incl. oral & vision care• NO denials for pre-existing conditions

When & How Do Consumers Sign Up

Health Insurance Marketplace:•ILLINOIS Marketplace to be launched by Oct. 1, 2013•Open enrollment starts Oct. 1, 2013 and ends March 31, 2014•Create your own account – enter information about you and your family, including income, household size•Review and compare health plans and premiums•Find out if you will receive financial help with premiums•Choose a plan•Coverage begins as soon as Jan. 1, 2014 if you enroll by Dec. 15, 2013

When & How Do Consumers Sign Up

New Illinois Medicaid Enrollment Website: ABE or Application for Benefits Eligibility

•URL: ABE.illinois.gov•Sign up starting Oct. 1, 2013•Sign up also available on walk-in basis at Dept. of Human Services offices•Coverage for newly eligible Medicaid population starts Jan. 1, 2014

BOTH Marketplace and Medicaid•Can sign up online, by phone, by mail or in-person with help of “Assister” or “Navigator”

Where Consumers Can Get Help

Community–based “Assisters”•In-Person Counselors – outreach, education and enrollment assistance•Navigators – outreach, education and enrollment assistance•Certified Application Counselors (includes hospitals)•All “Assisters” will help consumers apply for Insurance Marketplace coverage and Medicaid

Website Resources

• www.HealthCare.gov

• www.healthcarereform.illinois.gov

• www.EnrollAmerica.org

• www.GetCoveredAmerica.org