1. Goals  What is ACA?  The Law & Key Benefits  Options & Plans  What’s Covered  Need to Know  Penalties & Exceptions  Resources

2. What is ACA? On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms. The Affordable Care Act puts consumers back in charge of their health care. Under the law, a new “Patient’s Bill of Rights” gives the American people the stability and flexibility they need to make informed choices about their health.

3. The Law & Key Benefits... A You Can’t be Denied Coverage B Your Kids are Covered C No More Dollar Limits on your Care D Your Coverage is Protected On March 23, 2010 President Obama signed the Affordable Care Act

4. The Law & Key Benefits... E Your Guaranteed Benefits are Protected F More Preventive Care is Covered G Lower Prescription Drug Cost H Simple Language & Apples to Apples Comparisons. Lowering Medicare Part B, Improving Medicare Advantage.... And Many MORE...

5. Healthcare Options Available... Employer/Broker/Agent Medicaid Medicare Marketplace

6. New Open Enrollment November 1, 2015 – January 31, 2016 Note: Medicaid/FAMIS applications accepted & processed all year Currently there are several scenarios in which you can qualify for health insurance under a Special Enrollment.

7. SPECIAL ENROLLMENT EXCEPTIONS I got married or divorced I moved to a new State I welcomed a child I lost eligibility for Medicaid or CHIP (Child Health Insurance Plan) My disability status changed My immigration status changed Misconduct by a non- Exchange My income has changed I adopted or foster parent Error by Representative Indians & Alaska Natives I lost my existing health plan because  A family member died  I turned 26  I changed jobs  I was terminated from my job  My COBRA, CHIP, Medicaid benefits expired

8. Basic Eligibility for Marketplace Insurance with Premium Tax Credits Income between 100%-400% federal poverty line  Some legal immigrant under 100% FPL can get tax credits IF not eligible for current Medicaid because of immigration status.  Most under 100% FPL will fall into Virginia’s Medicaid GAP until expansion. Family Size 100% FPL400% FPL 1$11,670$46,680 2$15,730$62,920 3$19,790$79,160 4$23,850$95,400

9. Income.... What Counts? Medicaid Market Place Taxable Wages/SalaryWages/Salary Self Employment including Depreciation Self Employment NET Income Social Security Benefits Social Security Payments (Not Supplemental Security) Unemployment BenefitsTips Alimony ReceivedAlimony Most Retirement Benefits (include VA Pension) Cash Support but NOT GIFTS Interest (include tax exempt interest) Interest Rental Income Retirement, Investment, Pension, and Rental Income Child Support Paid Taxable, prizes, awards & gambling, winnings Veterans Disability & WC is NOT included

10. Qualified Health Plans QHP/4 TIERS of COVERAGE Essential Health Benefits (Standardize Coverage) Bronze = 60% Ambulatory Patient Services Emergency Services Gold = 70% Hospitalization Maternity & Newborn Care Silver = 80% Mental health & Substance disorders Prescription Drugs Platinum = 90% Rehabilitative & habilitative Services Laboratory Services Catastrophic (available for <30) Preventive & Wellness Services Pediatric Services includes Oral & Vision

11. Important Healthcare Terms Co-Pay Coinsurance Monthly Premium Out-of-Pocket maximum

12. Compare Plans Carefully

13. Requirement to Have Health Coverage Key Points Key Types of Minimum Essential Coverage Everyone is required to have minimum essential coverage (MEC) in 2015 Those without MEC will pay a shared responsibility payment, unless exempt  Taxpayer is responsible for dependents Coverage requirement, penalties, and most exemptions apply on a monthly basis One day rule:  A person has coverage for the month if they have coverage for at least one day in the month  A person is eligible for an exemption for the month if they are exempt for at least one day in the month. Private Insurance  Nearly all employer-sponsored insurance  Regardless of minimum value or affordability Most plans sold in the insurance market (inside or outside the Marketplace) Not short-term coverage or “excepted benefits”, like stand-alone vision or dental insurance Government Sponsored Coverage  Medicare  Most types of Medicaid  Most veterans and military coverage  CHIP $325 per person and $162.50 per child, per year (family max $975) | or 2% of your household income that is above the tax return filing threshold for your filing status (whichever is greater) Exemptions & Penalty

14. Granted by Marketplace Hardship, including: Life circumstances Insurance is unaffordable State failure to expand Medicaid Eligible for Indian Health services Plan cancellation Member of certain religious sects Granted at Tax Filing Income below filing threshold Insurance is unaffordable Certain noncitizens Short coverage gap (<3 months) Gap before effective date of Marketplace coverage purchased during open enrollment Granted by the Marketplace or at Tax Filing Indian tribe membership Incarceration Health care sharing ministry Exemptions from the Penalty

15. Need to Know.... List of Prescriptions Social Security Numbers Penalty Fee List of Doctors Income www.healthcare.gov Study the Plans Policy #s for current Policy Red Flags

17. Healthcare Resources Market Place MedicaidMedicare Enroll Virginia Enrollment Dates Nov 1 – Jan 31 Lifestyle Changes are year round Year Round Plan Change: 90 days after initial enrollment or renewal 65 th Birth Date Plan Change: Oct 15 – Dec 7 All YEAR Consultation Websites www.healthcare. gov www.common help. virginia.gov www.medicare. gov www.enroll- virginia.com Phone Number 800-318-2596 855-242- 8282 800-633- 4227 888-392- 5132