COBRA Coverage and the Marketplace An Overview Name Certified Navigator Phone Number Hello, my name is and I am a ? …. I work for Enroll Virginia and I thank you for having me. My goal today is to talk about Enroll’s Virginia’s role with the Marketplace.

ACA Basics

AFFORDABLE CARE ACT Protection, Prevention & Education On March 23, 2010; two existing laws combined together as ONE created the Affordable Care Act The Marketplace is a one-stop shop to find Affordable health care with subsidy and Essential Health Benefits! Ambulatory Patient Services Emergency Services Maternity & Newborn Care Hospitalization Mental Health & Substance Disorders Prescription Drugs Laboratory Services Pediatric Services (which includes oral & vision) Rehabilitative & Habilitative Services Free Preventative & Wellness Services We ALL Benefit: No more pre-existing conditions, annual limits or caps Children under age 26 can stay on parents plan No Co-pays for preventive care and screenings More affordable health insurance options This slide information gives an overview of how the ACA law was presented to congress for vote and the benefits that the law obtained for the consumer.  The second piece of information on this slide is the definition of health benefits that are in all insurance plans that are on the Health Insurance Exchange or Marketplace.

Free Preventive Services Well visits (1 per year) Blood pressure & cholesterol screening  Cancer screenings  Depression screening  Diabetes screening  Diet counseling for adults with chronic diseases HIV/STD screening and counseling Obesity screening and counseling Immunizations Alcohol/tobacco use screening and counseling Contraception

Eligibility for Marketplace Insurance To purchase insurance on the Marketplace Live in its service area Be a U.S. citizen or national, or be a non-citizen who is lawfully present in the U.S. Not be incarcerated To get financial assistance Not have access to other affordable and adequate insurance Have income between 100% and 400% of the federal poverty guidelines Not receiving or eligible for “minimum essential coverage”: Medicaid, FAMIS, Medicare “Affordable & Adequate ” job-based coverage Job-based coverage is not affordable/adequate if employee-only plan: cost to employee not ↑9.5% household income; or covers ↓60% healthcare costs & essential health benefits

Enrollment Periods When eligible individuals can enroll in a Qualified Health Plan (QHP) Marketplace will determine eligibility to enroll in a plan, determine eligibility for financial assistance and assess eligibility for Medicaid A person can only enroll in a QHP during Open Enrollment or during a Special Enrollment Period (SEP) Applies to QHPs on the Marketplace and those off the Marketplace

Special Enrollment Periods Life Change Eligibility (60 Days) this isn't a comprehensive list GETTING MARRIED*** PERMANENTLY MOVING OUTSIDE PLAN’S COVERAGE** BIRTH, ADOPTION & FOSTER CARE INDIAN TRIBE OR ALASKA NATIVE NEWLY ELIGIBLE/INELIGIBLE FOR APTC OR COST SHARES LEAVING INCARCERATION GAINING ELIGIBLE IMMIGRATION STATUS LOSING OTHER HEALTH COVERAGE (NON-VOLUNTARY)* This explains all the reasons a consumer may qualify for Special Enrollment Period Bronze – 60% AV - low overall coverage, lower premiums but higher out-of-pocket costs. Platinum - 90% AV - best coverage, highest premiums. Catastrophic coverage for people under age 30 with very high deductible * Pick a plan by the last day of the month and your coverage can start the first day of the next month. ** Important: You must prove you had qualifying health coverage for one or more days during the 60 days before your move. *** Propose to change .

Information Needed to Apply Household Size Based on tax filing principles Identity of Household Members Name and contact information Social Security Number Immigration status Estimated Yearly Income Modified Adjusted Gross Income (MAGI) Expected household income for the year you want coverage, NOT last year’s income For everyone in your household, even if they are not applying for coverage Availability of employer-based coverage

MAGI: Modified Adjusted Gross Income Count: Taxable wages/salary Profit from self-employment Social Security benefits (SSDI, retirement) Unemployment benefits Alimony received Most retirement benefits (including VA pensions) Interest (including tax-exempt interest) Rental income Do not count: Child support received Supplemental Security Income (SSI) Workers’ compensation payments Veteran’s benefits (service-related disability) Gifts/Inheritances Pre-tax deductions (IRAs, childcare, health) Alimony paid Social Security of dependents who aren’t required to file taxes

Financial Help: Premium Tax Credits & Cost-Sharing Reductions Cost Sharing Reductions reduce the amount of your deductibles and out of pocket costs. Available for those with income at or below 250% of FPL Only applies if Silver Plan is purchased Premium Tax Credits (PTCs) reduce the amount of your monthly insurance premium.

2017 Federal Poverty Level (FPL)

APTC & RECONCILITION If you had a Marketplace plan and used APTC to lower your monthly payment, you’ll have to “reconcile” when you file your federal taxes. This means you’ll compare 2 figures: The amount of premium tax credit you used in advance during the year. (This was paid directly to your health plan so your monthly payment was lower.) The premium tax credit you actually qualify for based on your final income for the year. You will need: 1095 A – sent by the Marketplace Form 8962 – IRS Form Federal Poverty Level Single Married Less than 200% $300 $600 200%- 300% $750 $1,500 300%- 400% $1,275 $2,550 Over 400% Return APTC

Don’t Pay A Penalty! Exemptions 2017: The Greater of Coverage is considered unaffordable A Short coverage gap (less than 3 consecutive months, can only be used once in the year B Citizen living abroad or certain non-citizens (undocumented immigrants) C Aggregate self-only coverage considered unaffordable (if it exceeds 8% of household income) G Resident of state that did not expand Medicaid and your income falls below 138% FPL Member of tax household born, adopted, or died H Income Below Filing Threshold - 2015 tax year, $10,300, single under 65 - 2015 tax year, $20,600, married under 65 - 2015 tax year, $13,250, head of household under 65 2017: The Greater of 2.5% of your yearly household income above the federal tax return filing threshold (capped at the national average for a bronze plan) or $695 per adult ($347.50 per child under 18; family maximum $2,085) For 2017 tax returns:  -   All laws about health coverage and tax penalties still apply. -   IRS may process returns without health coverage information, but penalties can be assessed later. Enroll Virginia Hotline: 434-336-7757 www.enrollva.org

COBRA v. THE MARKETPLACE When you lose job-based insurance, you may be offered COBRA continuation coverage by your former employer, however this is often very expensive. Losing job-based coverage qualifies you for a Special Enrollment Period (SEP) to enroll in Marketplace coverage. This means you have 60 days before and 60 days after you lose coverage to enroll in a health plan, even if it’s outside the annual Open Enrollment Period. You may be eligible for financial assistance to purchase insurance through the Marketplace, but cost is only one important factor to consider!

Comparing Plans What are the costs of each plan? Premiums Deductibles Co-payments and co-insurances Are your current doctors and hospitals covered? Are your current medications covered? Do you have any planned medical treatment? Do any of your current medications or planned procedures require prior authorization? How much have you already spent on healthcare this year? Have you met your deductible?

Other things to consider Other coverage options Spouses job-based plan Medicaid (applications accepted year-round) Medicare Once you opt out of COBRA, you will not have the opportunity to opt back into it. If you go without coverage you will have to pay a penalty when you file your taxes, unless you qualify for an exemption. Free assistance is available to help you complete a Marketplace application and compare plans!

When can I enroll in a Marketplace plan?

ADDITIONAL HEALTHCARE OPTIONS Sliding Scale Clinics Healthcare coverage is based on income and might have pharmacy help Health Care Centers (FQHC) Have primary care doctors plus more , operate on a sliding scale up to 200% FPL, and do not turn away insured patients. Free Clinics Offer free services for the uninsured with little to no income and have volunteer doctors Our education extends to various types of clinics due to not having Medicaid expansion. Private Family Practice This is a typical medical practice NOT a sliding scale or free clinic

Appointment Hotline: 888-392-5132 Who is ENROLL Virginia!? Appointment Hotline: 888-392-5132 Check out upcoming events & workshops! Check out where to get help! ENROLL Virginia! is a nonprofit, nonpartisan entity that assists individuals and small businesses to obtain health insurance including commercial health coverage through the federally facilitated health insurance marketplace, to qualify for applicable tax subsidies, and to comply with the U.S. Patient Protection and Affordable Care Act and avoid penalties for failure to do so. The program is paid for by a federal grant (FOA CA-NAV-15-001 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services)  and administered by the Virginia Poverty Law Center.  The contents provided here are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. Statewide Toll-Free:1-888-392-5132 Enroll Virginia Hotline: 434-336-7757 www.enrollva.org