1. Health Insurance Coverage: What you need to know. Joao dos Santos Faustino Coordinator of Member Services Hudson River HealthCare October 15, 2015

2. Affordable Care Act The Law & Market

3. ✚ The Affordable Care Act also affords numerous consumer protections in most health insurance plans: ▪ Pre-existing conditions are covered ▪ A standardized summary of benefits must be provided ▪ Insurance companies are held accountable for rate increases ▪ Coverage as dependent is available on a parent’s policy up to age of 29 in New York ▪ Preventive care is free, e.g. immunizations, pap smears, well-woman visits, annual physicals, etc. ▪ There are no lifetime and annual benefit limits The ACA: the Benefits

4. ✚ Since January 2014, everyone must have insurance ▪Insurance must meet a minimum standard of quality ▪Medicaid, Child Health Plus, Qualified Health Plans, Essential Health Plans meet this standard and are all available through the marketplace. ✚ There are some exemptions for applying for insurance. ▪Financial hardship, undocumented immigrant, religion, incarcerated, member of Indian tribe. ✚ Penalties ▪2016 Penalty: greater of $695 or 2.5% family income/max $2,085 family The ACA: for Consumers

5. ✚ NYOSH is the official health plan marketplace for New York State ▪ Provides one-stop shopping for subsidized and unsubsidized coverage ▪ Easily compare health plan options ▪ The only place to check eligibility and apply for financial assistance ▪ Enroll in qualified health plans ✚ NYOSH enrollment periods ▪ Open Enrollment for Qualified Health Plans November 1st - January 31st ▪ Year round enrollment for Medicaid, Child Health Plus and Essential Health Plan ▪ Special Enrollment Periods The New York State of Health www.nystateofhealth.ny.gov

6. ✚ All plans through the marketplace must provide Ten Essential Health Benefits: ▪ Ambulatory patient services (Doctor’s Office Services) ▪ Emergency room services ▪ Hospitalization ▪ Maternity and newborn care ▪ Mental Health and substance abuse disorders ▪ Prescription drugs ▪ Rehabilitation and habilitation services and devices ▪ Laboratory Services ▪ Preventative and Wellness services and chronic disease management ▪ Pediatric services, including oral and vision NYSOH: Plan Benefits

7. The Marketplace The Plan Options

8. ✚ Medicaid income limits have increased. Those newly eligible will have the full Medicaid benefit package except institutional long term care. New Medicaid income limits are 138% of federal poverty guidelines (FPL): ▪ Individuals making less than $16,243 per year ▪ Family of 2 making less than $21,984 per year ▪ Family of 3 making less than $27,725 per year ▪ Family of 4 making less than $33,465 per year Medicaid Expansion

9. ✚ Any child under the age of 19 living in New York State is eligible for insurance ▪ Immigration status does not matter. ▪ Multiple managed care options that offer oral and vision health. Child Health Plus

10. Qualified Health Plans ✚ Financial aid is available to help pay for coverage purchased in the Marketplace ▪Premium subsidies provide money to help cut cost of health insurance is available for those with income up to 400% of the Federal Poverty Levels: ▪ Individuals making up to $47,080 per year ▪ Family of 2 making up to $63,720 per year ▪ Family of 3 making up to $80,360 per year ▪ Family of 4 making up to $97,000 per year ✚ The premium subsidies are available to people who do not have employer coverage that pays a minimum of 60% of covered medical expenses and/or has an employee share of the premium that is more than 9.5% of income.

11. ✚ APTC are Federal Tax Credits applied in advance against premiums for Qualified Health Plans ▪ Cost Sharing assistance also available in silver plans for those making less than 250% of the federal poverty level. ▪ Applicants must file taxes in the year the credit is received. ✚ QHPs offer “metal” levels of coverage with varying premiums ▪ Bronze - plan pays 60% of cost ▪ Silver - plan pays 70% of cost with possible CSR ▪ Gold - Plan pays 80% of cost ▪ Platinum - plan pays 90% of cost ▪ Each QHP must offer one silver and one gold plan Advanced Premium Tax Credits

12. ✚ A new health plan for New Yorkers that costs much less than QHPS and offers same essential benefits. ▪ EHPs are free for some, cost $20 monthly premiums for others. ▪ There is no deductible for these plans. ✚ Lower income people who do not qualify for Medicaid or Child Health Plus can purchase EHPs. ▪ Individuals making up to $23,540 per year ▪ Family of 2 making up to $31,860 per year ▪ Family of 3 making up to $40,180 per year ▪ Family of 4 making up to $48,500 per year Essential Health Plan

13. Joao dos Santos Faustino Coordinator of Member Services Hudson River HealthCare, Inc. 55 S Broadway Tarrytown, NY 10591 T (914) 524-4107 x 62008 F (914) 524-4108 jfaustino@hrhcare.org THANK YOU!