1. [Introduce yourself]
[Thank attendees for coming.]

2. Let’s jump into today’s topic by first answering the questions that we hear every day from consumers:
What is health care reform?
And why should I care?

3. Health care reform is known by many names: the Affordable Care Act (ACA), PPACA (the Patient Protection and Affordable Care Act) and more commonly as “Obamacare”. No matter what we call it, it is the law of the land! Surveys of the average American reflect that almost half of us think that health reform was repealed, will be repealed or is not law.
Health reform impacts every American, some more than others. Many of us won’t feel its effects too much in 2014, but many of us will.

4. The core mission under the ACA is to get everyone covered under an insurance policy. Why? Without coverage individuals cannot access health care services that they need when they need them. Preventive care or chronic care management is skipped and more costly conditions develop over time.

5. Simply said, health reform is about getting coverage for all of us
Simply said, health reform is about getting coverage for all of us. No matter who you are – your age, your income, your health status…. For all of us.

6. The problem is that approximately 1
The problem is that approximately 1.2 million individuals in Michigan do not have coverage today.
Many of them have gone without coverage because they can’t find it (due to a health condition) or it’s just too expensive.
Reform seeks to change that.
Unfortunately, a recent study by the Urban Institute and Kaiser Family Foundation showed 45% of the uninsured individuals will choose to stay uninsured even after reform is implemented.
Which is why we have our work cut out for us. We need to share simple messages in a relevant way to take care of our communities and get Michigan covered. Health care costs should go down over time if all of us are covered.

7. There are three simple topics…
Do I need coverage?
What coverage fits me?
Where do I go to get coverage?
That’s it … let’s cover each one.

8. First, do I need coverage?
If I don’t have health insurance today… should I buy it in 2014?

9. The answer is YES! You should for four reasons.

10. Health insurance coverage is your ticket into the doctor’s office
Health insurance coverage is your ticket into the doctor’s office. Without this ticket, individuals seek routine services from the Emergency Room… for example, go to the ER for the ear infection, headache or UTI versus seeking treatment in a more cost effective and efficient method – the physician’s office.
Additionally, we believe that physicians are the key component in managing care – individuals with chronic conditions such as diabetes, asthma or heart disease need interactions with their physicians to manage their condition and prevent health deterioration.

11. Preventive care is free with coverage.
Immunizations, mammograms, well-child visits, annual physicals, colonoscopies … All free no matter which health insurance plan you have. This is required under the ACA.
Preventive care is invaluable for early detection of health problems and leads to greater understanding of patient health.

12. Health insurance coverage brings peace of mind
Health insurance coverage brings peace of mind. We’ve all heard the stories of a visit to the ER turning into a $140,000 medical bill. Without insurance the full cost of the treatment sits on the shoulders of the individuals.
Coverage brings peace of mind.

13. Finally, health reform introduces penalties for individuals choosing to not buy coverage. There are some very limited exceptions to this (related to severe financial hardship and religious beliefs).

14. The penalties are calculated annually for each month that coverage isn’t purchased and are collected when income taxes are filed.
In the first year, the penalty is the greater of $95 per person or 1% of household income. The amount goes up each year as you can see on this slide.

15. For example, in the first year an individual making $22,000 will pay a penalty of $220 for not having coverage. In 2016, this person would pay $695.
Remember that paying the penalty may seem attractive at first blush, but you are getting NOTHING for this money. It’s not going toward the cost of coverage, free preventive care or peace of mind!

16. The second question we’ll answer is: What coverage fits me?
But we need to look at how individual get their coverage today before we can answer this.

17. Roughly 46% of us in Michigan get coverage through our employer as a benefit of being an employee.
How will our coverage be impacted? Well, our employers will need to make changes to our benefits in order to comply with reform. Large employers have to make small changes and small employers need to choose a new insurance plan design.
We are used to these changes being made annually – and this shouldn’t come as a surprise.
The other note I’ll make here is that we are not expecting many employers to stop offering coverage to employees. Some smaller employers may drop coverage, as they have been doing in prior years. But most employer are not planning to drop coverage.

18. 17% of us in Michigan are covered under a Medicare plan – those of us 65 or order or disabled.
Rest assured that this program is staying in-tact. There aren’t any changes required under reform to Medicare for Some of positive changes have already been implemented for the Medicare population – reducing the Part D donut hole and free preventive care.

19. Another 17% of us are enrolled in Medicaid today.
Good news: the current program will stay in tact! There may be some small changes to the plan designs based on the Medicaid expansion that has been approved by our state Legislature.
The current Medicaid program has fairly stringent eligibility criteria today – for example, a pregnant mom may be on Medicaid pre-delivery, but is no longer eligible once the baby is born.

20. This issue of the pregnant mom losing coverage is addressed by reform
This issue of the pregnant mom losing coverage is addressed by reform. The ACA introduces a new Medicaid program – under this Medicaid Expansion program 500,000 in Michigan will be eligible for coverage.
This program was designed to help the working poor and eligibility for the program is entirely based on household income. Individuals making less than $15,000 annually will be now have coverage and families of four making less than $33,000 will now have coverage.
It will offer great benefits with low cost share.

21. For example, a newly married couple just starting out may have an annual household income of $21,400 – these individuals will be eligible for the new Medicaid expansion coverage!

22. A single mom, working with three kids and making $32,500 annually will also be eligible.

23. Okay – so we’ve talked about three buckets of coverage:
Employer sponsored coverage – rest assured, small benefit changes there
Medicare – don’t worry, no changes under reform
Medicaid – current program will stay in tact and NEW program offers coverage to more
What about the rest of us? What about those of us that purchase our own coverage today through an individual policy? Or those of us that don’t receive coverage as a benefit from our employer? Or what if our annual incomes are too high for Medicaid?

24. The good news is that reform introduces new options
The good news is that reform introduces new options. You can get coverage, great coverage.

25. Reform mandates that all plans must cover 10 types of services
Reform mandates that all plans must cover 10 types of services. For example, you don’t have to worry that maternity will be excluded from your plan.
Also, prescription drugs will always be covered.
So, buying health insurance on your own is confusing, right? You can know now that all plans have to cover these services.
You may still pay for a portion of the health service. For example, you may have to pay $10 to fill a prescription at the pharmacy.

26. How do you understand what you’ll pay when you go to the doctor, hospital or get a prescription filled?
There are two types of costs related to purchasing health insurance:
The Premium – is the amount you pay to purchase your health insurance. You’ll see this expense as a monthly bill from your insurance company.
Out-of-pocket costs include things like deductibles, copays and coinsurance. These are the costs that you share with your insurance company. For example, you might have a $10 copay for a prescription with your insurance paying the rest.
Reform requires that health insurance companies use terms that you can understand.
All health insurance plans will be assigned to a metal category. Platinum plans will require that you pay LESS for services because it is a more valuable plan. So, you may only pay $15 for an office visit. Bronze on the other hand is the least costly plan and so you will pay more when you get services, so you may pay $40 for an office visit.

27. So, all plans will cover the same types of services and it will be easier to understand the value of the plan you are buying.
But, will you be able to afford coverage?
Yes, help is available. The federal government will help you pay for your coverage. More help is available for those with lower incomes.
Health reform limits how much of your income you’ll pay for coverage. It’s like a discount on the cost. Those with lower incomes could get a 60% discount and those with higher incomes will get no discount at all.

28. Let’s walk through an example.
Roger is single and working at a job where he makes $22,000 annually. Under health reform Roger will pay no more than about 6% of his income to pay for health insurance premium. The federal government will help pay the rest of the cost.
So, Roger will pay roughly $120 per month for great coverage.
Said another way, for about $4 per day Roger gets a ticket to the doctors office, free preventive care, peace of mind and avoids the $220 penalty.

29. One more example,
Annette, is married with two children. She is a stay-at-home mom and her husband’s annual income is $46,000. Her family will pay no more than 6% of their household income for coverage. Which means they will get great coverage for $250 per month.
Great value for her family – free immunizations and well child checks, management of her husband’s high cholesterol (including coverage of medication) and peace of mind as her kids are actively involved in sports.

30. So, we’ve talked about
Do I need coverage
we also discussed what coverage is best for me.
Now let’s wrap up with Where do I go to get coverage?

31. Priority Health is here to be a trusted source of information on reform. We believe it’s the right thing to do. We need to get Michigan covered – it’s about the health of our communities.
Individuals can come to our website and get information about whether help is available, Medicaid eligibility, etc. We can even help them enroll in a plan and help them get those premium discounts from the federal government.
Also, the federal government has established a new Health Insurance Marketplace (otherwise known as the exchange) where individuals can shop for coverage and understand their options.
Consumers can still solicit help from a trusted agent partner, who can help navigate through their options.

32. The open enrollment period for January coverage starts this October.
It is running longer for the first year in order to allow consumers time to figure this out and make their choices.
If enroll from Effective date
October 1 to December 15, 2013 January 1, 2014
Dec. 16, 2013 through Jan. 15, 2014 February 1, 2014
Jan. 16, 2014 through Feb. 15, 2014 March 1, 2014
February 16 through March 15, 2014 April 1, 2014
March 16 through March 31, 2014 May 1, 2014