ACA 101 Matt Jewett Associate Director of Grants Mountain Park Health Center

What is health insurance to you?

The “ACA” (The “Affordable Care Act” or “Obamacare”)

Coverage Expansion Where were Arizonans getting health insurance? US Census American Community Survey through statehealthfacts.org Uninsured 20.1% Employer 52.2% AHCCCS (Medicaid) 20.1% Direct from Insurer 4.9% Other Public 2.8%

▪No more denials because of pre-existing conditions ▪Young adults can stay on their parent’s health insurance plan until they are 26 years of age ▪Free preventative services ▪Ends lifetime and yearly dollar limits on coverage of essential health benefits What changes have happened as a result of the ACA?

▪Medicaid/AHCCCS ▪ Individual plans in the Marketplace with financial assistance and without financial assistance ▪ Employer-based coverage What are coverage options under the ACA?

AHCCCS Arizona Health Care Cost Containment System

What is AHCCCS?

Who could qualify for AHCCCS? AHCCCS Income limits Number In Household Income 133% of Federal Poverty Level 1$15,660 2$21,192 3$26,724 4$32,256 5$37,788 Each additional person, add $5,532

AHCCCS- Health-e-Arizona Plus AHCCCS = health insurance SNAP = Food Stamps TANF = Cash Assistance Clinic SFS = Sliding Fee Scale care

The Marketplace

Coverage Expansion The Health Insurance Marketplace

What is the Marketplace?

▪Must live in the United States ▪Must be a U.S. citizen/national or a lawfully present resident ▪Can't be currently incarcerated ▪Details at: healthcare.gov Who is eligible for the Marketplace?

What will a Marketplace health plan provide?

The buyer can choose from four levels of coverage What levels of coverage can I choose from? Bronze Silver Gold Platinum Cost of policy (“premium”) Percentage of a medical cost covered by insurance Percentage of a medical cost the insured must pay (“co-pay”) $ $$$$ 40% 30% 20%10% 90%80% 70% 60% Under a Silver level plan, the insured may be eligible for “cost-sharing” or help paying their share of medical costs $ $$$

▪Are my doctor and specialist on the health plan network? ▪Are my medications covered? ▪Can I get dental coverage? ▪Which plan fits my budget but still meets my needs? There are people available to help! What will guide a person in choosing a “Qualified Health Plan” (QHP)?

Financial Assistance for Insurance from the Marketplace

▪ Premium Tax Credits (PTC) ▪ Cost Sharing Reduction (CSR) What financial assistance is available in the Marketplace?

Who could qualify for f inancial a ssistance? Number In Household 250% Federal Poverty Level 1$29,175 2$39,325 3$49,475 4$59,625 5$69,775 Each additional person, add* $10,150 Marketplace Income limits

▪Depends on projected household income and household size ▪Cannot be eligible for public insurance or affordable employer-based insurance ▪Must be a citizen or legal resident Who qualifies for financial h elp paying monthly premiums?

When a person qualifies for a Premium Tax Credit… When should I take my PTC?

Is there more financial assistance available?

Eligibility for cost sharing is based on: Household income and family size Eligibility for the Premium Tax Credit Enrollment in a Marketplace silver-level plan Cost Sharing Reduction (CSR)

To calculate the Premium Tax Credit and Cost Sharing Reduction go to: How to find out how much assistance a person might q ualify f or

Catastrophic Coverage: A Limited Marketplace Option

Catastrophic Coverage

Workplace-based Insurance Coverage

What if I get insurance through my workplace?

I s the M arketplace available to employees with affordable workplace insurance? If the employee’s personal insurance premium is 9.5% or less of their income or “affordable” The family can elect coverage through the employee’s workplace OR apply for insurance through the Marketplace but will not qualify for the Premium Tax Credit.

When is the M arketplace available to employees with workplace insurance? If the employee’s personal insurance premium is over 9.5% of income or “unaffordable” The employee and family may qualify for insurance and financial assistance through the Marketplace

Enrolling in Coverage through the Marketplace

Where to Apply or Renew:

There are many ways to apply

When can people enroll in Marketplace coverage or make changes to coverage? Important dates for 2016 enrollment: November 1, 2015: Start of 2016 Open Enrollment period — first day you can enroll in a 2016 Marketplace plan January 1, 2016: First date 2016 coverage can start January 31, 2016: 2016 Open Enrollment ends AHCCCS (Medicaid): 365 days a year

What if someone needs to apply for coverage outside the Open Enrollment Period?

Health Insurance Expansion

2015: 11.7 million MP Nov – March Plus 12.2 million Medicaid 2014: 8 million MP ACA Results Nationally Results

Plan Enrollment

QUESTIONS?