1. What Athletic Trainers Need to Know about the Health Care Law National Athletic Trainers’ Association December 9, 2013, 3:00 pm EST

2. Affordable Care Act  Affordable Care Act was passed by Congress in March 2010.  The law extends insurance coverage and provides additional protections for all consumers. -Subsidies available to help individuals afford coverage in health insurance exchanges.  Greater focus on prevention of disease.  The law has been incrementally implemented since 2010. 2

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4. Upcoming Changes  A number of major provisions are set to be implemented in fall 2013 and 2014. -Health insurance marketplace/state exchanges -Medicaid expansion  As providers, you have an important role in ensuring that patients receive accurate information about the changes taking place.  As consumers of health care, you need to ensure you receive accurate, timely information in order to make the choices that best fit your needs. 4

5. If Already Insured…  Benefit from a number of new consumer protections under the ACA. -Insurance companies cannot drop coverage if you get sick or if your health care costs become too expensive. -Cannot be denied insurance coverage because of a pre-existing condition. -No more annual or lifetime coverage limits. -Coverage for more preventive care services. -Extends coverage for young adults up to age 26. 5

6. If Already Insured…  All employers were required to send their employees notices related to the ACA and the availability of coverage through the exchanges.  Contact your employer to see what, if any, changes can be expected for the next year.  If your health insurance premiums are too high compared to your income, you may be eligible for additional cost- sharing if you purchase a health plan on the exchange. 6

7. If you are an employer …  Beginning January 2015, large employers (more than 50 FTEs) will be required to provide health insurance to their employees or face a penalty. -“No Coverage” Penalty ($2,000/FTE/year) -“Insufficient Coverage” Penalty ($3,000/FTE/year)  Small businesses with less than 25 FTEs making an average of $50,000 or less may qualify for tax credits. 7

8. If Already a Medicare Beneficiary…  You do not need to purchase health insurance through the exchanges.  Medicare will now cover additional preventive care services and an annual wellness examination.  Medicare out-of-pocket prescription drug costs will be lower.  More focus on quality care -Accountable Care Organization (ACOs) 8

9. If Not Insured…  The ACA creates new health insurance exchanges (marketplaces) where health insurance coverage can be purchased. -Depending on income, may qualify for additional cost-sharing.  People with low incomes may qualify for Medicaid. 9

10. Health Insurance Exchanges  New health insurance exchanges (marketplaces) for individuals and small businesses to shop for health care coverage. -Offered in every state.  Plan choices and premiums will vary by state.  There are different levels of coverage.  Must sign up between October 1, 2013-March 31, 2014. 10

11. All plans offered in the Exchanges must cover 10 Essential Health Benefits  Doctor visits  Emergency services  Hospital care  Maternity and newborn care  Mental health and substance use disorder services, including behavioral health treatment  Prescription drugs  Rehabilitative services and habilitative services and devices  Laboratory services  Preventive and wellness services, and chronic disease management  Pediatric services, including oral and vision care 11

12. Coverage Levels Levels of CoverageAverage Plan ContributionAverage Individual Contribution* Bronze60 percent40 percent Silver70 percent30 percent Gold80 percent20 percent Platinum90 percent10 percent *In addition to the monthly plan premium. 12

13. Coverage Levels: Example  4 person household -Two 44 year olds, 16 year old, 12 year old  Annual household income of $60,000 13 How does their coverage differ between the different state marketplaces?

14. Coverage Levels: Side-by-Side Comparison 14 OregonWashington, DC

15. Help Paying for Insurance  Starting in 2014, depending on income, patients may be eligible for a subsidy to help lower out-of-pocket costs for health insurance purchased through the Exchanges Up to $45,960 Up to $62,040 Up to $78,120 Up to $94,200 Up to $110,280 15

16. Medicaid Expansion  States can choose to expand Medicaid (joint state-federal program) to cover individuals up to 133% of the federal poverty level ($15,282 for an individual and $31,322 for a family of 4). -Feds pick up 100% of the cost of the new population, phased down to 90% by 2020.  If states choose not to expand, they can keep their existing Medicaid program.  States have the option to change their minds. 16

17. Medicaid Expansion 17

18. Example  Harold, 30, has a bare-bones health insurance policy through his employer, and he has limited income. He cares for his mom Betty, an uninsured 60 year old with a mild hypertension. -Harold should contact his employer to see what, if any, changes his employer may make for next year. -Harold may want to see what plans are available in the health insurance exchange in his state. -Harold also may want to explore whether he qualifies for any tax credits or subsidies to help him afford his premiums. -Betty should explore her options for more affordable health insurance options through their state exchange. To learn more about the plans available on the exchanges Harold and Betty can go to healthcare.gov or call 1-800-318-2596. 18

19. When Signing Up, Consider…  What are the deductible (the amount paid out-of-pocket before benefits kick in) and maximum out-of-pocket costs?  Who is in the network? Does the plan cover preferred doctor(s) and/or hospital and sites of care?  Does the plan cover necessary prescription drugs? Is the coverage of those drugs an affordable amount? 19

20. To Sign Up for a Plan, You Will Need …  Social security numbers for every member of the household who needs coverage -Or document numbers for legal immigrants  Employer and income information for every member of the household who needs coverage -Pay stubs or W-2 forms  Policy numbers for any current health insurance plans covering members of the household  Information on employer coverage for every job-based plan a household member is eligible for 20

21. Where to Go for Information on the Exchanges  Official Exchange websites: www.healthcare.gov and www.cuidadodesalud.govwww.healthcare.gov www.cuidadodesalud.gov  24-hour toll-free call center: (800) 318-2596 (855-889-4325 TTY/TDD) 21

22. HealthCare.gov – Four Steps to Obtaining Insurance 22 Set up an account.Fill out the online application.Compare your options.Enroll!

23. Where to Go for Information on Medicaid  For state-by-state information: http://www.medicaid.gov/ medicaid-chip-program- information/by-state/by- state.html http://www.medicaid.gov/ medicaid-chip-program- information/by-state/by- state.html 23

24. Where to Go for Local Assistance  In-person assistance locators: https://localhelp.healthcare.gov and https://ayudalocal.cuidadodesalud.gov https://localhelp.healthcare.gov https://ayudalocal.cuidadodesalud.gov 24

25. Important Dates  October 1, 2013: Exchanges officially open, consumers can begin applying and enrolling for coverage.  January 1, 2014: Coverage begins as early as this date; Medicaid expansion begins in many states.  March 31, 2014: Exchange open enrollment period ends. 25

26. Protection from Scams  Keep insurance cards, Social Security cards, and other personal documentation private and in a safe place.  Know what the new exchanges involve. -The government will not be calling, sending e-mails, or knocking on doors to sign people up. -There is no application fee or charge for enrollment and there are no limited time offers. -People with Medicare or insurance through their employer do not need additional coverage.  Use trusted sources.  Report anything suspicious.  Trust your instincts! 26

27. Questions? Please submit questions using the chat box on your webinar screen. 27

28. Additional questions? Please e-mail any additional questions to: Parie Thorpe pariet@nata.org We will compile all questions and will release a Q&A document a few weeks after this webinar. 28