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THE AFFORDABLE CARE ACT

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Jocelyn Curtis

on 7 November 2014

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Transcript of THE AFFORDABLE CARE ACT

Penalty or Exemption
Gives people access to affordable health insurance through:
Introduction Video
Qualified Health Plans
No Insurance?
Advanced Premium Tax Credits
Cost-Sharing Reductions
Exemptions
Friday, November 7, 2014
States Decide
Medicaid Expansion
The Affordable Care Act  provides Americans with better health security by putting in place comprehensive health insurance reforms that will:

Expand coverage
Hold insurance companies accountable
Lower health care costs
Guarantee more choice
Enhance the quality of care for all Americans









What is the Affordable Care Act?
Source: http://www.medicaid.gov/AffordableCareAct/Affordable-Care-Act.html
Lower monthly premium based on yearly income and family size
Lower copayments, deductibles and coinsurance based on yearly income and family size
Essential Health Benefits
Plan Levels
Ambulatory Services
Emergency Services
Hospitalization
Maternity and Newborn Care
Mental and Behavioral Health Care
Prescription Drugs
Rehabilitative Services
Laboratory Services
Preventative Care and Chronic Disease Management
Pediatric Services (including dental and vision)

Catastrophic: lowest premium/highest deductible*†



*Catastrophic plans are not subject to APTC
† Catastrophic plans are only for those under 30 y.o. or under 100% FPL
**Silver plans are the ONLY plans subject to CSR

8% rule
Member of health care sharing ministry, recognized religious sect that objects health insurance, or federally recognized Indian tribe
Income below tax filing threshold
Uninsured for less than 3 months
Hardship (including Medicaid non-expansion)
Penalty
2014:
Greater of $95/adult or 1% of income

2015:
Greater of $325/adult or 2% of income

2016:
Greater of $695/adult or 2.5% of income

What Does This All Mean?
Source: http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/
Health insurance is more affordable
More people are going to have health insurance

Many people will have health insurance for the first time in their lives

People will take more responsibility for their health
Insurance Companies
Source: National Physicians Alliance, npalliance.org

What About Dental?
Contact Information
Jocelyn Eppich
660-988-3669
jeppich@nmhcinc.org
Essential Health Benefit: Pediatric dental
Must be offered in the Marketplace, but isn't required to be purchased.

Exceptions:
Required to be purchased in Washington, Nevada, Colorado and Kentucky
All embedded plans in Connecticut, DC, Vermont, and West Virginia
Non-marketplace plans must provide dental or be "reasonably sure" that the consumer has access elsewhere.
Out-of-pocket limit for stand-alone dental plans is $700 for one child or $1400 for multiple children in federal exchange.
source: www.ada.org
Adult dental
Insurance companies are prohibited from rescinding coverage
Insurance companies can't place annual or lifetime limits on insurance coverage
Insurance companies can't charge more for pre-existing conditions
Individual Shared Responsibility Provision
Minimum Essential Health Coverage
Penalty
Exemptions
Minimum Essential Health Coverage
Private Insurance
Employer Insurance (including Retiree and COBRA)
Medicaid
Medicare
TRICARE
VA Benefits
Qualified Health Plans
SHOP Marketplace
Plan to have your own practice?
Small Business Health Options Program
A more affordable way to offer health insurance to your employees
https://www.healthcare.gov/small-businesses/
https://www.healthcare.gov
https://www.healthcare.gov/find-premium-estimates/
1-800-318-2596
To apply or get more information:
To get a quote:
Sidenotes
Tobacco surcharge
up to 50% increase in premium
Employer Coverage
9.5% rule
Medicare
Can't have Medicare and Marketplace
Open Enrollment
November 15, 2014-February 15, 2015
Health Insurance Marketplace
Bronze: low premium/high deductible
Silver: mid premium/mid deductible**
Gold: high premium/low deductible
Platinum: highest premium/lowest deductible (not in MO)
http://kff.org/medicaid/state-indicator/dental-services/
Medicaid Expansion
Plans offered in Marketplace
Stay on your parents' plan until age 26
State-based vs. Federally-Facilitated Marketplace
THE AFFORDABLE CARE ACT
source: kff.org
Full transcript