1. Affordable Care Act & You: What every consumer should know

2. What is the ACA (“Obamacare”)?
The Patient Protection and Affordable Care Act (ACA)
ACA reforms our complex health care system
85% of working Americans receive healthcare as a benefit of their full-time employment.
Consumers can now purchase insurance from the federal Marketplace.
ACA makes healthcare care more accessible and affordable
Preventive care
Family planning
Related healthcare services
No discrimination due to pre-existing conditions or gender

3. How the ACA Works
Consumers can enroll in a Qualified Health Plan (QHP) through the Marketplace
They can compare available plan options including monthly premiums, co-pays, deductibles, service networks, etc.
There is a single, streamlined application for private health plans, Medicaid and/or CHIP options.
ACA requires you to have coverage.
The 2014 Individual Responsibility Fee Penalty can be $95 per individual; $285 per family; or 1% family income.
A number of exemptions are available.

4. How the Marketplace Works

5. Application Process Enroll in Qualified Health Plan
Submit application to the Marketplace
Eligibility determined and verified
Eligibility determined for Qualified Health Plan, Medicaid or CHIP
Enroll in Medicaid or CHIP
Online
By Phone
In Person
Supported by Data Services Hub

6. Ways to Apply Online: In Person: By Phone (24/7, 150 languages):
By Phone (24/7, 150 languages):
In Person:
Certified Application Counselors & Navigators
Visit your nearest federally qualified health center or
go to

7. Eligibility Eligibility: Live in the service area
US citizen or lawfully present non-citizen for the period of enrollment
Not incarcerated

8. Affordable Coverage
A refundable or Advanced Premium Tax Credit (APTC):
Can only be used to buy insurance from the Marketplace
You can take it now and have it reduce your monthly premium.
Or, you can take it later and have it reduce your income tax liability.
Eligibility for the APTC is based on:
Tax filing status and family size
Household income of 100%-400% Federal Poverty Level
Consumer is ineligible for government or employer insurance
Additional Cost-Sharing Reductions are also available
Household income of 100%-250% of Federal Poverty Level

9. Lawfully Present Non-Citizens
Lawfully present non-citizens are not eligible for federal benefits until they have been residents for 5+ years.
However, if they are ineligible for Medicaid because of their immigration status, they can receive APTC even if their income is below 100% Federal Poverty Level.

10. Federal Poverty Level Table
For households with more than 8 individuals, add $4060 for each.
Households earning less than 100% FPL will not be eligible for APTC.
Households earning more than 400% FPL will not be eligible for APTC.
Medicaid was not expanded in Florida.

11. Types of Plans Types of health plans
Platinum
90% of covered costs paid by plan
Maximum services
Lower deductible, higher premiums
Gold
80% of covered costs paid by plan
Silver
70% of covered costs paid by plan
Bronze
60% of covered costs paid by plan
Minimum services
Higher deductible, lower premiums
Catastrophic coverage is also available for adults under
age 30 and/or those who obtain a hardship waiver.

12. Essential Health Benefits
Each plan must include, at a minimum, 10 essential health benefits (below)
More expensive plans offer additional benefits
Ambulatory Patient Services
Prescription Drugs
Emergency Services
Rehabilitative Services and Devices
Hospitalization
Laboratory Services
Maternity and Newborn Care
Preventive & Wellness Services and Chronic Disease Management
Mental Health and Substance Use Disorder Services (to include behavioral health care)
Pediatric services, including oral & vision care (pediatric oral services may be provided by stand-alone plan)

13. Enrollment
Open Enrollment is November 15, through February 15, 2015.
Health coverage is effective January 1, 2015 if purchased by December 15, 2014.

14. For more information …. In Person:
[Insert Contact Info Here]
By Phone:
Marketplace Call Center at 1 (800)
On-line: