UNDERSTANDING THE AFFORDABLE CARE ACT & HOW IT CHANGED HEALTHCARE

HOW MANY NAMES CAN IT BE CALLED ?  Obamacare  The Affordable Care Act (ACA)  The Patient Protection and Affordable Care Act (PPACA)  Underage Health  Under 65  Health Care Reform  TAX care  FFM (Federally Facilitated Marketplace)  IFP (Individual & Family Plans) WAP has decided that we will call this product line UA 65

WHY DID ACA/OBAMACARE HAVE TO HAPPEN ? The United States had millions (approximately 32 million) of uninsured people, and people who did have insurance were paying more for coverage than in other comparable countries. The Affordable Care Act aims to fix these issues (in phases) by giving more Americans access to affordable, quality health insurance and to reduce the growth in US Health Care spending. The Affordable Care Act includes new benefits, rights and protections, rules for insurance companies, taxes, tax breaks, funding, spending, the creation of committees, education, creation of new jobs, and much more. After years of drama on Capitol Hill, a Supreme Court case and a Presidential election, President Obama finally signed it into law on March 23, 2010.

Top 10 “Need To Know” Provisions of the Act 1. It provides affordable coverage by reducing premium and out of pocket costs 2. It spreads risk equally and ends discrimination against gender or health status 3. It eliminates lifetime and unreasonable annual limits on benefits 4. You can no longer be dropped from coverage for any reason aside from fraud, and it has easier processes for filing a grievance. 5. It provides eligibility and assistance for those who are uninsured due to a pre-existing condition, and promotes wellness. 6. It requires carriers to provide preventative services and immunizations with no out-of-pocket costs and will provide better care for seniors, mental health and women's health services. These are known as “Essential Services”. 7. It extends dependent coverage up to age It enforces the 80/20 rule – insurance companies can’t spend more than 80% of premium dollars on NON-medical costs. If they do, you get a rebate. 9. It requires carriers to develop uniform coverage documents, so comparison is easier for the member. A broker can receive certification to assist members and will receive a commission for the sale. 10. All medical data is now collected on centralized databases, making coordinating care more effective in your service area.

Enrollment Timeframes Open Enrollment 2016 began on November 1, 2015 and ends January 31, 2016 You may also Qualify for a Special Enrollment (SEP) if you miss a deadline, have a change in status, lose your plan or have one of many hardships People on Medicaid and CHIP (Children’s Health Insurance Program) are entitled to open enrollment all year Open enrollment dates / plan year are subject to change annually, and may differ by insurance type. In 2014, the OEP (Open Enrollment Period) was 11/15/14-2/15/15. In 2016, the OEP is expected to be 10/1/16-12/15/16.

What Are Health Insurance Exchanges? The exchanges are state or federally run online marketplaces where customers can shop for affordable quality health insurance (exchange and marketplace mean the same thing). is a virtual space created to assist customers in locating and purchasing affordable health care. Customers each have the opportunity to purchase ON exchange or OFF exchange. The difference between an On Exchange and Off Exchange health plan is where the applicant performs his/her own enrollment. If the enrollment is performed within a government-run marketplace for insurance it is known as ON Exchange. (These are plans are eligible for financial assistance.) If the enrollment does not take place within the government run marketplace for insurance it is known as OFF Exchange. (These plans are not available for purchase through the marketplace/exchange.)

Both on and off exchange health plans in the individual and small group markets must satisfy “Essential Health Benefits” coverage requirements, and are required utilize one of the four “metal” plan designs for medical out-of-pocket costs. BRONZE - intended to have the lowest premium of the four categories, but charge the highest out-of-pocket costs - 60% paid by health plan and 40% by consumer. SILVER - lower out-of-pocket costs - 70% paid by health plan and 30% by consumer. GOLD - higher premium - 80% paid by health plan and 20% by consumer PLATNUM- highest premium, lowest out-of-pocket costs. 90% paid by health plan and 10 % by consumer. Premium and deductible amounts are set by the carrier, creating a competitive arena for plans.

CAN A MEMBER BE ELIGIBLE FOR COST ASSISTANCE ? Cost assistance can include premium assistance and out of pocket assistance depending on income and is ONLY available through the marketplace ON Exchange during open enrollment, unless you qualify for an SEP. The exception is Medicaid / CHIP which can be obtained at any time of year. These may be referred to as “subsidies”. There Are Three Types of Cost Assistance / Subsidies: 1.Premium Tax Credits – Tax Credits are paid to your insurer in advance to lower your monthly premium or are adjusted on your tax returns. – Based on income for people making between % of the Federal Poverty Level (FPL). 2.Cost Sharing Reduction - lower out-of-pocket costs / lower deductible / coinsurance / co-payment amounts for Silver Plans (only) purchased on the exchange. Based on income between 100%-250% FPL. 3.Medicaid / CHIP – (Children’s Health Insurance Program) – Obamacare Medicaid expansion is one of the biggest milestones in health care reform. In Arizona our state plan is referred to as AHCCCS. (Arizona Health Care Cost Containment System)

What Are the Negatives to the Affordable Care Act ? It imposes tax increases on high-earners and the healthcare industry. It requires consumers to pay the INDIVIDUAL MANDATE / PENALTY for those that can afford health insurance but have not obtained coverage. 2015=$325 per adult /$ per child/up to $975 per household 2016=$695 per adult /$ per child/up to $2,085 per household You many qualify for an exemption – however it makes filing your taxes very difficult. Examples: If you went less than 3 months without coverage or your income is below the tax filing threshold, coverage would cost more than 8% of household income per person. It can mean more complicated shopping for coverage as well as the risk of over or under purchasing coverage options. Insurance companies must now cover / claim those that would not qualify due to their severe co-morbidities, and this increases the cost of everyone’s insurance. It increased the cost of employee health benefits.

The Affordable Care Act does contain some negatives, but we need to ask ourselves this question: Do the costs outweigh the benefits? Did you know that Obamacare technically includes the biggest middle class tax cut for healthcare in American History? It actually saves low to middle income families and small businesses billions of dollars by providing reduced costs and premiums to millions of families through Marketplace cost assistance. Not everyone will get cheaper health insurance but those making less than 400% of the FPL will.