Affordable Care Act Marketplace Implementation Briefing PA Breast Cancer Coalition Annual Conference October 5, 2015 H EALTH C ARE.GOV Joanne Corte Grossi, MIPP Regional Director U.S. Department of Health & Human Services, Region III Pennsylvania, Delaware, District of Columbia, Maryland, Virginia, West Virginia

Affordable Care Act Overview 17.6 million adults gained health insurance since the beginning of open enrollment 2013 through September 12, million adults gained health insurance since the beginning of open enrollment 2013 through September 12, million young adults gained coverage 5.4 million young adults gained coverage 12.3 million enrolled in Medicaid & CHIP 12.3 million enrolled in Medicaid & CHIP Uninsured rate dropped to 9.4% - lowest since they began keeping records Uninsured rate dropped to 9.4% - lowest since they began keeping records

Affordable Care Act Overview Provides coverage to young adults up to the age of 26 Provides coverage to young adults up to the age of 26 Strengthens Medicare benefits with lower prescription drug costs for those in the ‘donut hole,’ chronic care, and free preventive care Strengthens Medicare benefits with lower prescription drug costs for those in the ‘donut hole,’ chronic care, and free preventive care Prohibits plans from imposing lifetime and annual limits on the dollar value of benefits, and from rescinding coverage when you get sick Prohibits plans from imposing lifetime and annual limits on the dollar value of benefits, and from rescinding coverage when you get sick

Affordable Care Act Overview Rein in insurance premiums rates Rein in insurance premiums rates Prevent denials of coverage, including for pre-existing conditions Prevent denials of coverage, including for pre-existing conditions Make health insurance affordable for middle class families Make health insurance affordable for middle class families Make health insurance affordable for small businesses with tax cuts Make health insurance affordable for small businesses with tax cuts

Pennsylvania is a Federally Facilitated Marketplace Pennsylvania is a Federally Facilitated Marketplace 549,205 Pennsylvanians enrolled during 2014 open enrollment 549,205 Pennsylvanians enrolled during 2014 open enrollment 472,697 Pennsylvanians enrolled during the 2015 open enrollment 472,697 Pennsylvanians enrolled during the 2015 open enrollment 479,00 enrolled in Medicaid through Medicaid expansion 479,00 enrolled in Medicaid through Medicaid expansion Marketplace Implementation

15 insurance carriers offering 50 health plans 15 insurance carriers offering 50 health plans 80 percent of Pennsylvania consumers qualified for an average tax credit of $226 per month 80 percent of Pennsylvania consumers qualified for an average tax credit of $226 per month 51 percent obtained coverage for $100 or less 51 percent obtained coverage for $100 or less Marketplace Implementation

Actuarial Value The ACA requires plans inside the Marketplace to meet particular actuarial value (AV) targets The ACA requires plans inside the Marketplace to meet particular actuarial value (AV) targets Bronze = 60% AVBronze = 60% AV Silver = 70% AVSilver = 70% AV Gold = 80% AVGold = 80% AV Platinum = 90% AVPlatinum = 90% AV “Metal Levels” will enable consumers to compare plans with similar levels of coverage, promote competition on premiums, and allow plans flexibility to design cost sharing structures “Metal Levels” will enable consumers to compare plans with similar levels of coverage, promote competition on premiums, and allow plans flexibility to design cost sharing structures

Essential Health Benefits Essential Health Benefits Ambulatory patient servicesAmbulatory patient services Emergency servicesEmergency services HospitalizationHospitalization Maternity and newborn careMaternity and newborn care Mental health and substance use disorder services, including behavioral health treatmentMental health and substance use disorder services, including behavioral health treatment Prescription drugsPrescription drugs Rehabilitative and habilitative services/devicesRehabilitative and habilitative services/devices Laboratory servicesLaboratory services Preventive and wellness services and chronic disease managementPreventive and wellness services and chronic disease management Pediatric services, including oral and vision carePediatric services, including oral and vision care Quality Insurance

Open Enrollment Special Enrollment Period Special Enrollment Period Qualifying Life Events Qualifying Life Events Next Open Enrollment: Next Open Enrollment: November 1, 2015 – January 31, 2016November 1, 2015 – January 31, 2016

From Coverage to Care Understand your coverage – know what services are covered Understand your coverage – know what services are covered Find a provider – Check your plan’s list of providers Find a provider – Check your plan’s list of providers Know where to go for care – use ER’s only for life threatening situations Know where to go for care – use ER’s only for life threatening situations Stay healthy with screenings and manage chronic conditions Stay healthy with screenings and manage chronic conditions Make an appointment – make sure your plan is accepted by the provider & take your insurance card with you Make an appointment – make sure your plan is accepted by the provider & take your insurance card with you

Individual Mandate Penalty For 2016: For 2016: 2.5% of yearly household income or2.5% of yearly household income or The higher of $695 per person (up to 3 people or $2,085)The higher of $695 per person (up to 3 people or $2,085) Fee is paid on the federal income tax return you file for the year you don’t have coverage Fee is paid on the federal income tax return you file for the year you don’t have coverage

Medicaid Expansion 479,000 Pennsylvanians are newly covered since January 1, 2015 for health insurance with Medicaid expansion479,000 Pennsylvanians are newly covered since January 1, 2015 for health insurance with Medicaid expansion 100% federally funded for first three years ( )100% federally funded for first three years ( ) Federal funding gradually reduced to 90% in 2020Federal funding gradually reduced to 90% in 2020

Navigators/CACs in PA PA Navigators received $3.1 million from CMS PA Navigators received $3.1 million from CMS Consumer Health Coalition Consumer Health Coalition consumerhealthcoalition.org (412) consumerhealthcoalition.org (412) Penn Asian Senior Services Penn Asian Senior Services passi.us (215) passi.us (215) PA Association of Community Health Centers PA Association of Community Health Centers pachc.com (717) pachc.com (717) PA Mental Health Consumers’ Association PA Mental Health Consumers’ Association pmhca.org pmhca.org Public Health Management Corporation Public Health Management Corporation phmc.org (215) phmc.org (215) Young Women’s Christian Assn. of Pittsburgh Young Women’s Christian Assn. of Pittsburgh ywcapgh.org (412) ywcapgh.org (412)

Resources: Affordable Care Act website – Affordable Care Act website – Navigators/CACs - Navigators/CACs - localhelp.healthcare.gov localhelp.healthcare.gov Tax Tools – Tax Tools – Affordable Care Act Spanish website – Affordable Care Act Spanish website –

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