Affordable Care Act Red group Luke, Trevor, Noah, Sarah

Multi- State Plans Noah Multi-State Plans was a program created to provide additional coverage for travelers in the Health Insurance Marketplace. Used by people who travel often. Most states offer multi-state plans (by 2017 all states will). Not any more expensive than other plans.

Insurance market and rating rules Noah Everyone got the right to get a guaranteed issue on January 1, The only thing that could vary it is age. Tobacco use Family Size Geography Those are the things that could raise the insurance premiums.

Benefit Tiers Noah They offer four different types of benefit plans called metal plans, plus a special plan offered through the Exchange. All plans will provide minimum benefits and protections. Bronze Plan: Offers the lowest premiums of all the plans providing 60% of sharing costs. Covers 60% of out of pocket costs, you pay the other 40%. You will save more on a bronze plans premium then you will with any other program.

Benefit Tiers continued… Noah Silver plan: The Silver plan is the Marketplace standard, most people fall into this plan. It is the second lowest covering 70% of out of pocket costs, you pay 30%. if you make 100%-250% of the FPL you will more than likely want to pick the Silver plan. Gold Plan: This plan is for some of the lowest income people in the country where it covers 80% of your out of pocket costs. Which still means you pay 80%.

More Benefit Tiers Noah Platinum Plan: For this plan standard population will pay 90% of this plan's out of pocket dues. The platinum plan has the highest premium on average. Not all states offer the platinum plan depending on their minimum standards. If you have a low income and lots of medical services this is the best plan to have. Catastrophic Plan: This plan is offered for young adults under the age of 30. Low premiums, High deductibles, and high cost sharing amounts. They also won’t pay any out of pocket costs.

Basic Health Plan Sarah *Health Care Exchange: Free market of health insurance companies under federal regulation *FPL: Federal Poverty Level *ACA: Affordable Care Act

Basic Health Plan COntinued… Sarah *133%-200% FPL can receive Federal Aid on Premiums ~Only for essential health benefits ~Not Medicaid ~Not for Elite Plans with costs (Gold and Platinum)

Essential Benefits Package Sarah * Policies offered by the private insurance companies have to offer essential benefits ~Failure to complete this results in lack of certification ~Covers at least 60% of Costs ~Not more extensive than the normal employer plan

Essential Benefits Package Sarah *Have to include care within the following categories to become certified ~Ambulatory Patient Services ~Emergency Services ~Hospitalization ~Maternity/Newborn Care ~Mental Health/Substance Abuse Disorder Care

Essential Benefits Package Continued Sarah ~Pediatric Services(Including Oral and Vision Care) ~Preventative Wellness Services ~Chronic Disease Management ~Laboratory Services ~Prescription Drugs ~Rehabilitative and habilitative services and devices

Abortion Coverage Sarah *Can prohibit plans in exchange offering Abortion services ~ only require abortion in life of mother, rape, incest *Can’t raise rates for use ~Discrimination

Abortion Coverage Sarah *Coverage through the ACA is determined by actual cost and the cost of ¨Abortion Benefit.¨ ~Reduce subsidy to prevent coverage ~Minimum $1 per enrollee *Effective as of January 1, 2014

Abortion Coverage Sarah *Need estimates before coverage ~Costs up to $800 for the Abortion Pill Used up to 9 weeks Effective 97 times out of 100 ~Costs up to $1500 for the in-clinic abortion procedure Vacuum Aspiration used up to 16 weeks D&E used after 16 weeks

Concerns Sarah *Taxes for subsidies??? *Plan costs/timely matter? *Insurance Company Profit? *Abortion Controversy (Coverage)

Tax changes related to Health insurance luke ❖ A new Medicare tax of 0.9 percent was added on January 1, The 0.9 percent applies to wage,Railroad Retirement Act, and self-employment that exceeds a threshold anywhere from $125,ooo to $250,000

individual Tax changes luke ➢ If an employee has children under the age of 27 they normally are tax free for the employee. ➢ This change also include people that are self employed. ➢ Tax on insurers of employer based plans with high values.

changes related to financing health reforms New annual fees on pharmaceutical manufacturers New annual fees on the health insurance sector Non-profit insurers only half of net premiums are taken into account.

tax on medical devices Luke A 2.3 percent tax increase on taxable medical devices. Limit employee compensation Add 10 percent tax on the amount paid for indoor tanning beds

creation and structure of health insurance Luke Make state based health benefit exchanges Businesses with less than 100 employees can qualify

eligibility in the exchange Luke People who are legal U.S citizens are eligible to get insured.

Consumer Operated and Oriented Plan trevor Created in all 50 states and District of Columbia to offer qualified health plans. In order to be eligible to receive funds your organization must meet the requirements. Requirements: can’t be an existing health insurer, can’t be sponsored by state or local government, operate with a strong consumer focus, profits must be used to lower premiums.

Qualifications of participating health plans trevor Meet marketing requirements Use uniform enrollment form and standard format to present plan information

Qualifications of participating health plans Have adequate provider networks Be accredited with respect to performance on quality measures

Requirements of the exchanges trevor Exchanges must have a call center for customer service Must submit financial reports to the Secretary States can apply for state health subsidy programs online, in person, mailed, or by phone but requires them to develop a single form for applying Determine procedures to figure out eligibility for tax credits What the Exchanges look like

Luke skaw work cited "Affordable Care Act Tax Provisions." Affordable Care Act Tax Provisions. IRS, 11 Jan Web. 11 Jan "Washington Health Benefit Exchange." Washington Health Benefit Exchange. N.p., n.d. Web. 11 Jan

Noah Price Works Cited insurance-market-reforms/market-rating-reforms.html

Works Cited Sarah benefits