1. Affordable Care Act in Illinois
Oct 2013
CCU Training
John Spears
IL Dept of Healthcare & Family Services

2. The Affordable Care Act (ACA) Principal Goal
Everyone Gets Health Coverage
(it’s the law)
Everyone Can Get the Healthcare Services They Need When They Need Them
(preventing poor health)
Illinois is a Healthier State
(people live better and longer)
The Affordable Care Act (ACA) Principal Goal

3. The Affordable Care Act (ACA)
Establishes Health Insurance Marketplace - A place to compare and pick a private health insurance plan with financial help available to help make coverage more affordable.
Encourages States to expand Medicaid
Encourages States to create better, more convenient systems for signing up - Illinois’ ABE (Application for Benefits Eligibility)
The Affordable Care Act (ACA)

4. If you have Medicare or Medicaid, you are covered!
You do not need to do anything.
(Nor can you get a better deal by applying.)
Existing Coverage

5. How to Apply ABE or Marketplace Navigators & Assistors
Certified Application Counselors
Telephone application
Paper application
In-Person application for Medicaid
How to Apply

6. State or Federal – No Wrong Door
Marketplace Eligible
Medicaid Eligible
State Intake Eligibility System
Federal Marketplace
State or Federal – No Wrong Door

7. The Health Insurance Marketplace

8. Illinois Health Insurance Marketplace How Does It Work?
Create an account online: Starting 10/1/ enter information about you & your family, including your income, household size, and more.
Pick a plan: Next you’ll see all the plans and programs you’re eligible for and can compare them side-by-side. You’ll also see if you get financial help with premiums and out-of-pocket costs.
Enroll: Choose a plan that meets your needs and enroll!
First open Enrollment is 10/1/13 - 3/31/14.
Coverage starts on 1/1/2014 if you enroll by 12/15/2013.
Illinois Health Insurance Marketplace How Does It Work?

9. Illinois Health Insurance Marketplace What Benefits Do You Get?
Every Plan must cover:
doctor visits
emergency services
hospitalization,
maternity and newborn care,
mental health and substance use disorder services,
prescription drugs,
rehabilitative services and devices,
laboratory services,
preventive and wellness services and chronic disease management, and
pediatric services, including oral and vision care.
Illinois Health Insurance Marketplace What Benefits Do You Get?

10. Consumer Premium Payment as a Percent of Income
A sliding scale that increases the taxpayer’s own contribution towards the premium cost as household income as a percentage of the FPL increases
Advance payments are paid directly to the insurer on your behalf and reconciled at tax time
Income Level
Consumer Premium Payment as a Percent of Income
% FPL
2% of income
% FPL
3 – 4% of income
% FPL
4 – 6.3% of income
% FPL
6.3 – 8.05% of income
% FPL
8.05 – 9.5% of income
% FPL
9.5% of income
Premium Tax Credits

13. Medicaid Coverage

14. Medicaid Eligibility Changes for 2014
New ACA Eligible Adults
Adults, age 19-64, not receiving Medicare
Individuals under 138% will be eligible in a new Medicaid group ($1,321 per month or about $15,850 annual for 1)
Former Foster Care - children under 26 who were on Medicaid when they aged-out of foster care.
Medicaid Eligibility Changes for 2014

15. Monthly Income Standards
Program
1 person
2 in family
Family Care
$1,321
$1,784
Aged, Blind or Disabled*
$958
$1,293
Health Benefits for Workers with Disabilities**
$3,351
$4,524
Medicare Savings Program***
$1,292
$1,744
ACA Adults
Marketplace Insurance Subsidy
$3,832
$5,172
*$2,000 resource test for 1, $3,000 for 2
**$25,0000 resource test, retirement accts exempt
***$7,080 resource test for 1, $10,620 for 2
Monthly Income Standards
11/22/2018

17. Resources Check out these websites:
Illinois’ Health Care Reform site
Federal Health Care Reform sites (Health Insurance Marketplace info)
Marketplace.cms.gov/help-us/cac.html (to begin federal process of signing up to be a Certified Application Counselor (CAC))
Marketplace.cms.gov/training/get-training.html (to access federal computer based training even if not registering to be a CAC)