The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable Health Care December 17, 2014

Agenda ACA and Marketplace Basics The Marketplace & COBRA Helping Employees Understand Their Options

Our Mission To advocate the right to quality, affordable health care for every man, woman and child in Maine.

About Consumers for Affordable Health Care Non-profit, non-partisan mission-driven research and advocacy organization based in Augusta (founded in 1988) o Consumer Assistance Program and HelpLine ( ) o Public Policy Research and Advocacy

Marketplace Basics

The Health Insurance Marketplace The Health Insurance Marketplace helps people without insurance find health coverage When you apply, you’ll learn if you qualify for: Lower costs on private insurance plans based on your household size and family income Other programs like MaineCare and the Children’s Health Insurance Program (CHIP) 6

1.Advanced premium tax credits (APTCs) 2.Cost sharing reductions (CSRs) Two kinds of financial help:

Marketplace Eligibility You may be able to get help with the cost of Marketplace plans if… o You do NOT have access to insurance at work, or insurance at work is unaffordable AND; o You do NOT have access to public insurance like Medicare or Medicaid AND; o Your household income is between:

Tax Credit Eligibility Plans 1 person: $11,490-$45,960 2 people: $15,510-$62,040 3 people: $19,530-$78,120 4 people: $23,550-$94, Plans 1 person: $11,670- $46,680 2 people: $15,730- $62,920 3 people: $19,790- $79,160 4 people: $23,850- $95,400

Financial help is on a sliding scale.

Who can go to the Marketplace? Anyone can purchase a Marketplace plan  Exceptions! Those who get Medicare Part A free (most people on Medicare) 11

These groups won’t usually use the Marketplace Medicare recipients Medicaid recipients Military/veterans If you have an employer plan (or dependent coverage through a spouse’s or parent’s plan) unless it’s “unaffordable” or “crappy”

Marketplace plans may be a good option for people who are eligible for COBRA Employees need help understanding their options, and when different options are available Marketplace and COBRA

Most people are only able to sign up for a plan on the Marketplace during Open Enrollment o For 2015: November 15, 2014 – February 15, 2015 Some people qualify for Special Enrollment Periods outside of Open Enrollment if they have certain life events happen to them o Losing another kind of coverage qualifies you for a SEP Timing Matters!

When someone loses their employer- based coverage, they can choose COBRA or the Marketplace COBRA or Marketplace?

If they choose COBRA: o They can’t switch to Marketplace until the next Open Enrollment period o They can switch during Open Enrollment o When COBRA expires, they can get a Special Enrollment Period and sign up on the Marketplace COBRA or Marketplace?

If they choose the Marketplace and forego COBRA: o They have 60 days from when coverage will end to enroll in a Marketplace plan through a Special Enrollment Period o Depending on income, they may be able to get financial help on the Marketplace COBRA or Marketplace?

Differences between plans, including: o Cost o Total out-of-pocket expenses o Provider networks Timing – when is each option available? Marketplace eligibility – can they get financial help? o Other coverage available o Projected income Helping Employees Understand Their Options

Local help is available to help people understand their options, and apply to the Marketplace Find local help: o Enroll207.com o Call our HelpLine at You Don’t Have to Do It Alone!

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