1. Prepared by the American Association of Colleges of Nursing Updated October 2016

3. Key Dates for 2017 Open Enrollment November 1, 2016: Open enrollment period for 2017 plans begins December 15, 2016: Last day to enroll in or change plans for coverage to start January 1, 2017 January 1,2017: First date 2017 coverage can start January 31, 2017 Open Enrollment Ends If your patient has not enrolled in coverage by then, they generally cannot enroll in 2017 coverage until the next open enrollment period. The exceptions are life events such as having a child. If your patient does not have health insurance coverage in 2017, he or she may have to pay a penalty. Healthcare.gov. (2016). 2017 Open Enrollment. Retrieved from https://www.healthcare.gov/quick-guide/dates-and-deadlines/ During open enrollment, if your patient enrolls Between the 1st and 15th days of the month, their coverage starts the first day of the next month. Between the 16th and the last day of the month, their coverage starts the first day of the second following month. So if they enroll on March 16, your coverage starts on May 1.

4. What is the Health Insurance Marketplace?  The Health Insurance Marketplace was created through the Patient Protection and Affordable Care Act or ACA [Public Law 111-148] specifically in relation to Subtitle D—Available Coverage Choices for All Americans. [Public Law 111-148]  The core components of the ACA are the Individual Mandate and the State Exchanges. Individual Mandate requires most individuals to obtain health insurance or pay a penalty in the form of a tax. In order to incentivize health insurance acquisition, the ACA provides cost assistance subsidies to individuals who qualify. State Exchanges allow for each state to decide if they will create their own exchange, partner with the federal government, or have a federally- facilitated exchange for individuals to gain coverage. Kaiser Family Foundation (2014). State Decisions For Creating Health Insurance Marketplaces, 2014 Retrieved from http://kff.org/health-reform/state-indicator/health-insurance-exchanges/http://kff.org/health-reform/state-indicator/health-insurance-exchanges/

5. Who Is Eligible?  For an individual to be eligible for coverage through the Marketplace, they must meet the following criteria: Live in the United States Be a U.S. citizen, national, or live lawfully in the United States Cannot be incarcerated If you have Medicare coverage, you’re not eligible to use the Marketplace to buy a health or dental plan Healthcare.gov. (2016) Am I eligible for coverage in the Marketplace, Retrieved from https://www.healthcare.gov/am-i-eligible-for-coverage-in-the-marketplace/ https://www.healthcare.gov/am-i-eligible-for-coverage-in-the-marketplace/

6. What is Required to Enroll?  Information about your household  Social Security Numbers (or document numbers for legal immigrants)  Information about the professional helping you apply (if you’re getting help)  Information on how you file your taxes  Employer and income information for every member of your household who needs coverage (for example, from pay stubs or W-2forms—Wage and Tax Statements)  Policy numbers for any current health insurance plans covering members of your household  A completed Employer Coverage Tool for every job- based plan for which you or someone in your household is eligible  2016 income estimate  Notices from your current plan that include your plan ID, if you had health coverage in 2015 Healthcare.gov. (2015) Marketplace Application Checklist, Retrieved from https://marketplace.cms.gov/outreach-and-education/marketplace-application- checklist.pdf https://marketplace.cms.gov/outreach-and-education/marketplace-application- checklist.pdf

7. Understanding the Individual Mandate  The individual mandate requires that everyone have health insurance coverage or else they will pay a tax penalty.  In 2017, the penalty will be the greater of $695 for each adult and $347.40 for each child, up to $2,085 per family, or 2.5% of family income that is above the federal tax return filing threshold for your filing statusfiling status The penalty amount is capped at the cost of the national average for a bronze level health plan available through the Marketplace in 2017. HealthCare.gov (2016). The fee you pay if you don’t have health coverage. Retrieved from https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/ https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/

8. Understanding Cost Assistance Subsidies  There are three types of cost assistance subsidies Premium tax credits which lower your premiums Cost sharing reduction subsidies for lower out of pocket costs Medicaid/Children’s Health Insurance Program (CHIP)  As of 2016: 83% of Marketplace consumers received financial assistance to pay their premiums The average monthly premium for an individual after the advanced premium tax credit was applied was $113 7 in 10 consumers had the option to select a health plan with a net premium of less than $75 a month after the advanced premium tax credit Health and Human Services (2016). Health Insurance Marketplace 2016: Average premiums after advance premium tax credits in the38 States using the healthcare.gov platform. Retrieved from https://aspe.hhs.gov/sites/default/files/pdf/172176/2016HealthInsurance.pdf https://aspe.hhs.gov/sites/default/files/pdf/172176/2016HealthInsurance.pdf

9. Understanding the State Exchanges  There are four categories of state Marketplaces/Exchanges.  Types of State Exchanges State-based Marketplace ○ States are responsible for performing all Marketplace functions. Consumers in these states apply for and enroll in coverage through Marketplace websites established and maintained by states. Federally-supported State-based Marketplace ○ States are responsible for performing all Marketplace functions, except that they will rely on the Federally-Facilitated Marketplace IT platform. Consumers in these states apply for and enroll in coverage through healthcare.gov. State-Partnership Marketplace ○ States may administer in-person consumer assistance functions and HHS will perform the remaining Marketplace functions. Consumers apply for and enroll in coverage through healthcare.gov. Federally-Facilitated Marketplace ○ HHS performs all marketplace functions. Consumers apply for and enroll in coverage through healthcare.gov. Kaiser Family Foundation (2016). State Health Insurance Marketplace Types, 2016 Retrieved from http://kff.org/health-reform/state-indicator/state-health-insurance-marketplace- types/#note-3http://kff.org/health-reform/state-indicator/state-health-insurance-marketplace- types/#note-3

10. State Structure for Health Insurance Marketplace/Exchanges State breakdown of Health Insurance Marketplace, 2017 Kaiser Family Foundation (2016). State Health Insurance Marketplace Types, 2017 Retrieved from http://kff.org/health-reform/state-indicator/state-health-insurance-marketplace- types/#maphttp://kff.org/health-reform/state-indicator/state-health-insurance-marketplace- types/#map

11. Learn About the State Marketplace Plans There are five categories of plans that individuals can access through the Marketplace.  Bronze Your health plan pays 60% on average and you pay about 40%.  Sliver Your health plan pays 70% on average. You pay about 30%.  Gold Your health plan pays about 80% on average. You pay about 20%.  Platinum Your Health plan pays about 90% on average. You pay about 10%.  Catastrophic This plan pays less than 60% of the total average cost of care. They’re only available to people under 30 or have a hardship exemption. Healthcare.gov (2016). Marketplace Insurance Categories. Retrieved from https://www.healthcare.gov/choose-a-plan/plans-categories/https://www.healthcare.gov/choose-a-plan/plans-categories/

12. Comparing & Selecting A Plan  In considering the various plan options, consumers should: Compare total costs ○ monthly premium + out-of-pocket cost sharing Consider cost sharing reduction Silver plans if eligible Consider the various network types ○ HMO/EPO vs. PPO/POS Check if your provider is in network Utilize the plan comparison tools Review the summary of benefits and coverage

13. What Are The Essential Health Benefits?  Essential Health Benefits: A set of health care service categories that must be covered by certain plans, starting in 2014.  Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace. States expanding their Medicaid programs must provide these benefits to people newly eligible for Medicaid. Healthcare.gov. (2014) Glossary: Essential Health Benefits, Retrieved from https://www.healthcare.gov/glossary/essential-health-benefits/ https://www.healthcare.gov/glossary/essential-health-benefits/

14. What Are The Essential Health Benefits? (continued)  Services and devices that assist in recovery if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.  Preventive services including counseling, screenings, vaccines, and care for managing a chronic disease.  Pediatric services: This includes dental care and vision care for kids Specific health care benefits may vary by state. Even within the same state, there can be small differences between health insurance plans. When you fill out your application and compare plans, you’ll see the specific health care benefits each plan offers. 1 These essential health benefits include at least the following items and services:  Outpatient care  Emergency room visits  Inpatient hospital treatment  Prenatal and postnatal care  Mental health and substance use disorder services: behavioral health treatment, counseling, and psychotherapy  Prescription drugs  Lab tests Healthcare.gov. (2014) Glossary: Essential Health Benefits, Retrieved from https://www.healthcare.gov/glossary/essential-health-benefits/ https://www.healthcare.gov/glossary/essential-health-benefits/

15. What Are No Cost Sharing Services?  All Marketplace plans and many other plans must cover the following list of preventative services without charging you a copayment or coinsurance. Abdominal Aortic Aneurysm one time screening Alcohol misuse screening and counseling Aspirin use Blood pressure screening Cholesterol screening Colorectal cancer screening Depression screening Diabetes (type 2) screening Diet counseling Hepatitis B & C screening HIV Screening Immunization vaccines Lung cancer screening Obesity screening and counseling STI prevention counseling Syphilis screening Tobacco use screening Healthcare.gov (2015). Preventive Health Service for Adults. Retrieved from https://www.healthcare.gov/preventive-care-benefits/ https://www.healthcare.gov/preventive-care-benefits/

17. Understanding the Medicaid Expansion  Marketplace cost subsidies only cover individuals and families that earn incomes between 100-400% of the federal poverty line (FPL). As of April 2015, the median Medicaid eligibility limit for states was 44% of the FPL. This leaves individuals who earn between 45-99% of FPL unable to take advantage of cost subsidies and ineligible for Medicaid  The Medicaid “Coverage Gap” is a term used to describe the gap between state Medicaid eligibility and Marketplace subsidy eligibility in state’s that don’t expand  To alleviate the Coverage Gap, the ACA provides states with additional funding to expand their Medicaid program to cover adults under 65 with income up to 133% of the federal poverty level  The Medicaid expansion was intended to be national, however, in June 2012 the Supreme Court made it optional for states  Currently, 19 states are not moving forward with Medicaid expansion HealthCare.gov (2016). Medicaid expansions & what it means for you. Retrieved from https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/

18. Kaiser Family Foundation (2016). Current Status of State Medicaid Expansion Decisions. Retrieved from http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/ Current Status of State Medicaid Expansion Decisions Adopted (32 States including DC) Not Adopting At This Time (19 States)

20. Where Can I Direct My Patients Who Have Questions I Cannot Answer? Online Representatives are available to assist individuals via online chat: https://www.healthcare. gov /. https://www.healthcare. gov / By Phone Individuals and Families A hotline is available 24 hours per day, seven days per week to assist individuals who have questions about enrollment. 1-800-318-2596 TTY: 1-855-889-4325 In Person Find people and organizations in your community who can help you apply, enroll, and answer your questions. Visit https://www.healthcare. gov/contact-us/ and enter your zip code to be connected. https://www.healthcare. gov/contact-us/