1. EVERYONE HAS A STORY… I’M COMING HOME, NOW WHAT? Name I’M COMING HOME, NOW WHAT? Name Position/Enroll Virginia Phone Number/Work Address Affordable Healthcare Options for You!

2. AFFORDABLE CARE ACT On March 23, 2010; two existing laws combined together as ONE, creating the Affordable Care Act We ALL Benefit: Protection & Prevention  No More High Administrative Fees  Caps on Medical Coverage  Low Prescription Drug Cost  Increasing Access to more Clinics & Funding  Increasing Access to Medicaid (State Option – Virginia GAP) Ambulatory Patient Services Hospitalization Mental Health & Substance Disorders Rehabilitative Services Preventative & Wellness Services Emergency Services Maternity & Newborn Care Prescription Drugs Laboratory Services Pediatric Services (which includes oral & vision) 10 Essential Health Benefits Now Covered in Insurance Plans Under the ACA:

3. What is Minimum Essential Coverage? Minimum Essential Coverage Includes: Medicare, parts A & C, Medicare Advantage Medicaid Chip Employer plan or Cobra Any Marketplace plan Certain individual plans bought outside the marketplace Tricare Most Veterans Healthcare programs Peace Corps Volunteer Self-funded health coverage offered to Students by universities for plans/policy years that begin on or before December 31, 2014 What does NOT count as minimum essential coverage? Coverage for only vision/dental Workers’ Compensation Coverage only for specific disease or condition Plans that only offer discounts on medical service Plan First or GAP

4. IT’S THE LAW… Everyone must have: Minimum Essential Coverage or Qualify for an Exemption or Pay an Individual Shared Responsibility Fee

5. For purposes of the Marketplace, “incarcerated” means serving a term in prison or jail. Incarceration doesn’t mean living at home or in a residential facility under supervision of the criminal justice system, or living there voluntarily. In other words, incarceration doesn’t include being on probation, parole, or home confinement. You’re not considered incarcerated if you’re in jail or prison pending disposition of charges—in other words, being held but not convicted of a crime. If you’re incarcerated, you can’t use the Marketplace to buy a private insurance plan. After you’re released, you can. INCARCERATION AND THE MARKETPLACE

6. Newly Released: Avoid Penalty Marketplace Exemption (must be filled out prior to your tax return) Marketplace Exemption (must be filled out prior to your tax return) – If you are NEWLY RELEASED, you can fill out a form with the marketplace, prior to doing your taxes, to receive an exemption certificate number to use on your tax returns. If you are a resident of a state that did not expand Medicaid and your income is project to fall below 138% FPL, you can complete an application to receive an exemption certificate number to use on your taxes. IRS Exemption IRS Exemption – If you were incarcerated, and do not have an exemption code, you may use Code F on your tax return to avoid the fee. If you are a Resident of a state that did not expand Medicaid and your income falls below 138% FPL, Code G can be used on your tax return to avoid the fee. Mail Marketplace Exemption to: Health Insurance Marketplace – Exemptions Processing 465 Industrial Blvd. London, KY 40741 WHEN YOU FILL OUT A MARKETPLACE EXEMPTION, YOU WILL RECEIVE A MARKETPLACE EXEMPTION CERTIFICATE NUMBER, WHICH YOU WILL NEED TO FILE WITH YOUR TAXES.

7. Marketplace Exemption Form

8. Tax Time: Claiming an Exemption You will need to attach form 8965 to your tax return form (1040, 1040A, or 1040EZ) Part I of form 8965 deals with the Marketplace-Granted Coverage Exemptions for Individuals If you have a Marketplace- Granted Coverage exemption, you will need the Exemption Certificate Number you received when you applied for the Marketplace exemption

9. What Are My Marketplace Options?

10. Newly Released: Am I Eligible? You are NOW RELEASED Eligibility Notice So, Let’s Apply Today! You are NOW RELEASED– To avoid future disappointments – our “best practice” is to create an account and receive an Eligibility Notice from the Marketplace. So, Let’s Apply Today! This will allow us to enter a “LIFE CHANGE” and apply for Healthcare if your new employer does not make this option available. Without an Account you will need to qualify for a Special Enrollment which must occur within 60 days of an event. If you’re incarcerated you can use the Marketplace to apply for Medicaid coverage in your state. Medicaid won’t pay for your medical care while you’re in prison or jail. But if you enroll in Medicaid while you’re incarcerated you may be able to get needed care more quickly after you’re released.

11. Special Enrollment Scenarios Judge decides on Friday to charge you and you are jailed, released on Monday = Eligible In jail over the weekend? Not convicted on Monday? Charges dismissed = Not Eligible Charged for drunk driving, you are jailed every weekend for 6 months, released from charge = Eligible Charged for drunk driving, you are jailed every weekend for 6 months, decide to enroll before release date = Not Eligible

12. Eligibility For Financial Assistance Premium tax credits reduce the amount you pay for your premium. Cost sharing reductions lower your deductibles, co- pays and out of pocket costs.

13. 2015 Federal Poverty Level (FPL) Family Size Annual Family Income 100% FPL133% FPL 138% FPL 200% FPL 250% FPL 400% FPL 1$11,770$15,654$16,243$23,540$29,425$63,720 2$15,930$21,187$21,938$31,860$39,825$63,720 3$20,090$26,720$27,724$40,180$50,225$80,360 4$24,250$32,253$33,465$48,500$60,625$97,000 5$28,410$37,785$39206$56,820$771,025$113,640 Source: 2014 Federal Poverty Guidelines, U.S. Dept. of Health and Human Services

14. Premium Tax Credit Example Mario is a 34-year old single male Annual Income of$17,200/year (150% FPL) Maximum Contribution 4% Income = $688/ yr Cost of 2 nd lowest Silver Plan$4,000 ($333.33/mo.) Subtract Max. Contribution- $688 Premium Tax Credit $3,312 ($276/mo) Full cost of plan 333.33/mo Subtract Tax Credit -276.00/mo Mario pays $57.33/mo

15. Using the Tax Credit Tax credit can be used for all plans except catastrophic Tax credit can be received as a refund when you file your taxes at the end of the year Or it can be paid in advance directly to the insurance plan to help pay monthly premiums Must report changes in income/family size during the year to ensure an accurate tax credit amount “Reconciliation” will occur when taxes are filed

16. Choosing Your Plan Monthly Premium is only one factor. Also Consider: Deductible Cost sharing – Co-insurance – Co-payments Provider Network - Specialists Drug Formulary Review service descriptions and exclusions or limits on coverage

17. How to Apply: Multiple “doors” Online: Marketplace Online: www.healthcare.govwww.healthcare.gov Medicaid/FAMIS: www.coverva.orgwww.coverva.org By Phone: Marketplace – 1-800-318-2596 Cover VA – 1-855-242-8282 Local assistance: Enroll Virginia – 1-888-392-5132

18. CONTACT A CERTIFIED MARKETPLACE REPRESENTATIVE

19. Information Needed to Apply Availability of Employer-based Coverage Identity of applicants Names and contact info Social Security Numbers Immigration Status and Documents Household Size Using tax code principles to determine household size Tax dependents are in the tax filers household Countable Income (MAGI) Using tax code principles & expected 2015 income Databases will verify most information Paper documents used for discrepancies

20. Remember, Remember, after you’re released, you have a 60-day Special Enrollment Period to sign up for private health coverage. During this time, you can enroll in private health insurance even if it’s outside the Marketplace open enrollment period. After this 60-day Special Enrollment Period, you can’t buy private health insurance until the next Marketplace open enrollment period (unless you qualify for another Special Enrollment Period). So, Apply NOW

21. Special Programs Virginia AIDS Drug Assistance Program (ADAP) The Virginia (VA) AIDS Drug Assistance Program provides access to life-saving medications for the treatment of HIV and related illnesses for low-income clients through the provision of medications or through assistance with insurance premiums and medication copayments. The program is primarily supported with federal Ryan White (RW) Treatment Extension Act Part B grant funding, which is distributed by a formula based on living HIV and AIDS cases to all states and territories in the United States. VA ADAP provides insurance cost support or directly purchased medications through four service options: Direct ADAP, the Medicare Part D Assistance Program (MPAP), the Insurance Continuation Assistance Program (ICAP) and the Health Insurance Marketplace Assistance Program (HIMAP). PLEASE CALL 855-362-0658 Limited Healthy Virginia: Governor Access Plan (GAP) GAP is a new Medicaid plan that will provide limited medical and behavioral healthcare coverage for mental health and substance use disorder services, medical doctor visits, medications, access to a 24-hour crisis line, recovery navigation services, and case management. This program is targeted to people who need mental health services but fall in the Medicaid Gap. You can find more information at http://www.dmas.virginia.gov/Content_pgs/gap.aspx  Please make sure that you visit your County’s Community Service Board for GAP eligibility and guidance or The Department of Corrections (DOC) staff may contact VDH staff for ADAP enrollment at 855-362-0658. ​ VISIT: WWW.COVERVA.ORG

22. QUESTIONS? Phone Number email@enroll-virginia.com www.enroll-virginia.com Facebook-www.facebook.com/enrollva Twitter-@EnrollVirginia

23. Thank you! ENROLL Virginia! is a nonprofit, nonpartisan entity that assists individuals and small businesses to obtain health insurance including commercial health coverage through the federally facilitated health insurance marketplace, to qualify for applicable tax subsidies, and to comply with the U.S. Patient Protection and Affordable Care Act and avoid penalties for failure to do so. The program is paid for by a federal grant (Funding Opportunity Number CA-NAV-13-001 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services) and administered by the Virginia Poverty Law Center. The contents provided here are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.