1. The Affordable Care Act [your name], Certified [NAV, IPA, CAC] [your organization name] [your email and phone]

2. What changed with the ACA? Insurance companies MUST: Allow children to stay on their parents’ plans until age 26 (2010) Give justification for rate increases over 10% (2011) Put $.80 of every $1.00 you spend on premiums toward actual healthcare (i.e. not on overhead; 2011) Submit a “summary of benefits and coverage” on each plan, so there’s no fine print (2012)

3. What changed with the ACA? (cntd) Insurance companies CAN’T: Put lifetime “caps” on coverage (2010) Deny people with pre-existing conditions (2014) Charge women more than men (2014) Put a limit on what they’ll pay for in a year (2010) Arbitrarily cancel your coverage (2010)

4. What’s NEW with the ACA? “Individual Shared Responsibility” (or “mandate”) – most people are required to have health insurance, or pay a penalty on their taxes Health Insurance Marketplace – a new, affordable way to shop for health insurance

5. The Health Insurance Marketplace “No wrong door” to apply! Online Over the phone Paper In-person (recommended!) Offerings are from private insurance companies, called qualified health plans At the same time that you apply for insurance, you can apply for financial help to pay for it

6. The Health Insurance Marketplace (cntd) Individuals/Families Individuals/Families Enroll on the “Individual Marketplace” Can only sign up during open enrollment (Novemoveber 1, 2015 thru January 31, 2016) or if special circumstances arise Have to enroll by December 15 for coverage to start on January 1 Small Businesses Small Businesses Enroll on the Small Business Health Options Program (“SHOP”) Marketplace Can sign up at any time! Get a small business tax credit

7. Eligibility for the Marketplace 1. Must be legally present in the US 2. Can’t be incarcerated 3. Must be a Virginia resident to sign up in Virginia …that’s it!!

8. What’s available on the Marketplace? Plans are structured in four “metal tiers:”* Bronze Bronze Silver** Silver** Gold Gold Platinum*** Platinum*** Catastrophic plans Catastrophic plans (outside the four tiers) are also available for those who meet certain criteria All of these have to cover 10 essential health benefits: 1. Ambulatory care 2. Emergency services 3. Hospitalization 4. Maternity/newborn care 5. Mental health and substance abuse services 6. Prescription drugs**** 7. Rehab services 8. Labs 9. Age-appropriate preventive services 10. Pediatric services

9. Eligibility for $$ help on the Marketplace Assistance with paying premiums (every month) Premium tax credit (“APTC”) Must file taxes (if married, must file jointly*) Can’t have other options for full, affordable coverage (i.e. through a job or a spouse’s job)** Must have income between 100-400% of the Federal Poverty Level*** Assistance with deductibles and copays (when you use services) Must purchase a silver- level plan Must have income between 100-250% of the Federal Poverty Level

10. What to consider when you’re shopping Costs Premium must be paid every month to stay covered (if you miss it, you risk losing your coverage) High premium means lower prescription costs; low premium means higher prescription costs Benefits What prescription drugs do you/your family take? How often will you/your family need to visit a doctor? Do you want to keep your current doctor?

11. Shopping for a plan Prescriptions drugs Make sure you know which drugs you/your family take before you begin shopping Drugs are “tiered” on most plans Tier 1: Preferred generic, low cost Tier 2: Non-preferred generic, slightly higher cost Tier 3: Brand-name, higher cost Tier 4: Specialty, highest cost Doctors doctor If you have a doctor you want to keep seeing, make sure you check with an insurance company to see that they are in-network before you enroll

12. Shopping for a plan (cntd) Hospitals Tier 1 If you have a preferred hospital, make sure it is listed as “Tier 1” on a plan before enrolling Note: emergency care is covered Specialists specialist care If you think you may have a health condition that requires special treatment, make sure you check out a plan’s copay for specialist care before enrolling

13. Help with your application You can get free, in-person help with a trained professional near you “Certified Application Counselor” (“CAC”) “Navigator” “In-Person Assister” (“IPA”) You’ll need to bring these things with you when you come to your application appointment: Social security numbers Employment & income information Information about other coverage available to you (even if you’re not enrolled in it) …for ALL members of your household, even if they aren’t looking to buy insurance

14. When can I enroll? Open enrollment Open enrollment begins again on November 1 and goes through January 31, 2016 Anyone can enroll (or renew) in a plan during this time Special enrollment periods Special enrollment periods can be granted for certain circumstances, like getting married, having a baby, or losing other health insurance 60 days after qualifying event

15. Questions?