Health Reform: What It Means to Our Community

Health Reform: Key Provisions o Provides coverage to 32 million uninsured people by o Changes insurance rules to protect consumers. o Builds on existing employer- and government-sponsored insurance programs. o Tests ways to tie payment of hospitals and physicians to quality improvement.

10 Things to Know Health Reform: 10 Things to Know

1. No lifetime benefit limits and no annual limits on coverage. 2. Coverage cannot be denied coverage based on health status. 3. Dependent adult children can stay on parents’ health policy until age No insurance coverage exclusions for pre-existing conditions beginning in Mandates coverage of preventive care. Health Reform: The Top 10

6. Coverage cannot be cancelled when someone becomes sick. 7. Limits insurers’ ability to set premiums based on health status and other factors. 8. Creates a new marketplace called an insurance exchange to help people find insurance. 9. Provides subsidies to help people buy insurance through the exchanges. 10. Requires all Americans to have health insurance. Health Reform: The Top 10

Health Reform: A Deeper Look

What does reform mean for me? What Does Reform Mean for Me? Employer-sponsored or Buying coverage on your own

Most individuals with coverage through their employers should not see substantial changes. The bill includes incentives for your employer to offer insurance. Employer Coverage

Individuals who purchase their own insurance coverage may: o Be eligible for coverage through the exchanges. o Qualify for tax credits to help purchase coverage. Buying Coverage on Your Own

What Does Reform Mean for Me? Medicare Beneficiaries

Individuals with traditional Medicare coverage should not see substantial changes, but will receive some additional benefits. Additional benefits will include: o Free preventive screenings such as colonoscopies and mammograms. o A free annual physical or “wellness” visit. o Discounts for brand-name prescription drugs. o A 50% discount on brand-name drugs while in the “doughnut-hole” coverage gap. However, individuals with Medicare Advantage plans may see changes in their benefits depending on how their insurance company responds to reduced funding for this type of plan. Medicare

What does reform mean for me? What Does Reform Mean for Me? Individuals without Insurance

Beginning in 2014, all U.S. citizens and legal residents must have coverage or pay a penalty. o Uninsured individuals will have access to coverage through insurance exchanges. o Subsidies will be available to help low-income individuals buy private health insurance. Uninsured

o Eligibility for Medicaid is expanded to low-income individuals. o Starting in 2010, a high-risk insurance pool will be available to individuals with pre-existing conditions and early retirees -- those 55 or older but not yet eligible for Medicare. ◦ Every state must set up an exchange by ◦ The high-risk pool expires in 2014 when exchanges and rules to prevent insurers from excluding individuals with pre-existing conditions are in place. Uninsured

“Small companies and individuals who don’t have insurance through work will be able to purchase insurance through newly created marketplaces, known as insurance exchanges, created and regulated by states. … Think of it as an Orbitz or Travelocity for health care plans.” - USA Today Insurance Exchanges

What does reform mean for me? What Does Reform Mean for Me? Large Employers or Small Businesses Note: Employers are not required to provide coverage.

Large Employers Large employers – businesses with 50 or more employees – will be fined if their employees purchase health care coverage through the new exchanges and receive federal help to pay their premiums.

Small Employers Small businesses are eligible for subsidies to offer insurance and have access to the exchanges. o Employers with 10 or fewer employees who earn, on average, less than $25,000 a year can get a 50% tax credit for providing health insurance. o Employers with 25 or fewer employees who earn, on average, less than $50,000 can receive a partial tax credit.

Health Reform: What Happens Next? In 2010 Insurance reforms: o No lifetime benefit limits on coverage for all new plans. o Appeals process and patient protections for all new plans. o Dependent children up to age 26 can remain covered under their parents’ plans. o Children with pre-existing conditions cannot be denied coverage.

Health Reform: What Happens Next? In 2010 Insurance reforms (cont.): o New plans cannot cancel coverage for individuals if they get sick. o No discrimination based on salary for all group health plans. o Insurers will be required to spend at least 80% of all premiums payments on medical services.

Health Reform: What Happens Next? In 2010 Coverage: o Establishes a temporary national high-risk insurance pool for individuals with pre-existing conditions and early retirees – those 55 or older but not yet eligible for Medicare. Once the exchanges are in place, this provision will expire. Quality: o Establishes a national strategy to improve the delivery of health services and patient health outcomes. Reduction of health disparities is a major focus.

Health Reform: What Happens Next? In 2010 Medicare: o Provides a $250 rebate to Medicare beneficiaries who reach the prescription drug “doughnut-hole” coverage gap in Note: The gap is scheduled to be eliminated by 2020.

Health Reform: What Happens Next? In 2010 Employers: o Small businesses can receive tax credits to purchase insurance for employees.

Health Reform: What Happens Next? In 2011 Medicare: o Beneficiaries receive a 50% discount on brand-name drugs while in the “doughnut-hole” coverage gap. o Offers a comprehensive health risk assessment.

Health Reform: What Happens Next? In 2013 Families with an annual income above $250,000 will be required to: ◦ Pay an additional 3.8% tax on investment income. ◦ Contribute more to the Medicare program in payroll taxes.

Health Reform: What Happens Next? In 2014 Most Americans will be required to have insurance coverage or face a federal penalty: o Fine would start at $95 per person, up to $285 per family, or 1% of taxable household income, whichever is greater. Insurance reforms: Insurers will be prohibited from refusing to sell policies and there are new limits on their ability to set prices based on health status.

Health Reform: What Happens Next? In 2014 Employers: o Businesses with 50 or more employees must provide coverage or pay a penalty.

Health Reform: What Happens Next? In 2016 Penalties would grow to $695 for each family member, up to $2,085, or 2.5% of taxable income.

Resources Kaiser Family Foundation: Federal government: AARP: Robert Wood Johnson Foundation: Resources