Presented by Shirley B. Whitenack, Esq. SCHENCK, PRICE, SMITH & KING, LLP Florham Park, NJ – Paramus, NJ – Sparta, NJ

 Minimum Essential Coverage  Medicaid Expansion  Pre-Existing Condition Insurance Program (PCIP)  Health Insurance Exchanges SCHENCK, PRICE, SMITH & KING, LLP

 Beginning January 1, 2014 all nonexempt individuals must have minimum essential coverage or pay a penalty when they file their federal income tax return.

 Group health plan  Employer-sponsored retiree health plan  Public benefits plans such as Medicaid, Medicare, CHIP, Tricare  Private health insurance, including Marketplace plan  Self-funded student health plans, Medicare Advantage plans

 Limited-scope dental and vision  Flexible Spending Arrangements

 Prisoners  Undocumented immigrants  Native American tribal members  Certain religious sects  Individuals who cannot afford coverage  Individuals who live in states that opted out of Medicaid expansion  Individuals who have no plan options in state exchange  Hardship  Coverage gap of no more than 3 months

 Employers with 50 or more fulltime employees must offer health care insurance to all who work at least 30 hours per week or pay penalties  Reporting requirements  Employer mandate & reporting requirements now delayed until January, 2015

 States have the option, but are not required, to cover individuals: 1.Between ages 19 and 64, 2.Who have meet the citizenship requirement, 3.Are not entitled to Medicare, 4.Are not incarcerated, and 5.Have income below 133% of the federal poverty level.

 No asset or resource test for children (CHIP), pregnant women, families and the new “aged 19-64” target population  Uses the applicant’s modified adjusted gross income (MAGI) to determine whether below 133% of the federal poverty line.  Income eligibility includes a 5% income disregard

 Expansion states will use a single application, established by CMS, to determine eligibility for benefits under the children (CHIP), pregnant women, families and the new “aged 19-64” programs

 Effective until December 31, 2013  Thereafter, all insurance plans will be unable to refuse coverage based on a pre-existing condition  An individual is eligible for a PCIP if he or she is: ◦ Uninsured for at least six months, and ◦ Has a pre-existing condition or has been denied health coverage because of the health condition

 State administered PCIP ◦ Maine, Rhode Island, Connecticut, New Jersey, Maryland, Wisconsin, Montana, New Mexico and Oklahoma  Federally administered PCIP ◦ Pennsylvania and all other states

AgeMonthly Premium Cost PennsylvaniaNorth Carolina 00-18$241$ $241$ $241$ $241$ $241$575

Age Monthly Premium Cost Horizon BCBSNJ AmeriHealth Plan C + NJ Protect Rider 80%/70%, $2500/$5000 Plan C + NJ Protect Rider 100%/70%, $0/$7500 Plan C + NJ Protect Rider $30 90%/70% 00-25$245.18$ $ $274.51$ $ $324.35$ $ $348.50$ $ $357.94$ $ $369.90$ $ $418.84$ $ $479.03$ $ $566.55$ $ $659.40$ $629.20

 Competitive marketplace, also known as exchange, for individuals and small businesses to purchase affordable comprehensive health insurance  Individuals and families with incomes between 100% and 400% of the FPL may apply for income based subsidies to assist with affording coverage.

 States may elect to: 1. Establish an exchange on their own, 2. Establish an exchange in partnership with the federal government or 3. Participate in a federally-facilitated exchange (FFE) administered through the US Department of Health and Human Services.

 A child may be covered regardless of whether he or she: 1.Is married, 2.Living with the parents, 3.Attending school, 4.No longer financially dependent on the parents, or 5.Eligible to enroll in an employer’s plan. Note: Until January 1, 2014, grandfathered employer plans do not have to offer coverage until age 26 if the child is eligible for group coverage outside of the parents’ coverage.

 Medicare and Medigap policies are not part of Marketplace  More preventive services ◦ Mammograms, colonoscopies, annual wellness without Part B co-pay or deductible  50% discount for Part D brand-name prescription drugs for those in the donut hole  Medicare Trust fund extended to 2029

 Megan consults with you to establish an SNT and apply for MA for her son, Samuel.  Samuel is 20 years young and developmentally disabled. He attends a day program, which Megan intends to pay for as long as he can attend. Samuel requires cueing for personal hygiene but can attend to daily activities on his own.  Samuel will inherit $250,000 from the Estate of Grandma Gloria.

 Establish SNT and file for MA?  Seek health insurance coverage from Megan?  Apply for “Aged 19-64” benefits? Remember this is Pennsylvania we’re talking about... No Medicaid expansion!!  Wait until January to purchase an individual health insurance policy?  Move to NJ???

Thanks for your Attention!!