1. Health Insurance Changes By: Jenna, Lexi, Bethany, Kendra, Evie

2. Tax Changes Related to Health Insurance Lexi Individuals are reimbursed through an HRA and it excludes the costs for over-the-counter drugs, not prescribed by a doctor. Effective January 1, 2011.

3. Tax Changes Related to Health Insurance Lexi A new Medicare tax of 0.9 percent was added on January 1, 2013. The 0.9 percent applies to wage, Railroad Retirement Act, and self-employment that exceeds a threshold anywhere from $125,000 to $250,000.

4. Tax Changes Related to Health Insurance Lexi ● Raises the Medicare Part A tax rate from 1.45% to 2.35% on married couples filing jointly whose income is greater than $250,000.

5. Tax Changes Related to Health Insurance Lexi ● Raises the Medicare Part A tax rate from 1.45% to 2.35% on individual taxpayers who make over $200,000 a year.

6. Tax Changes Related to Financing Health Reform For non-profit insurers, only 50% of net premiums are taken into account in calculating the fee. different laws include: impose tax of 10% on the amt. paid for indoor tanning services (starts July 1, 2010) impose a tax of 2.3% on the sale of any taxable medical device (starts for sales after December 31, 2012) Exclude improcessed fuels from the definition of biofuel for purposes of applying the biofuel producer credit (starts January 1, 2010) BY: Bethany

7. Tax Changes Related to Financing Health Reform New annual fees on the pharmaceutical end of the sector, according to the following schedule: $2.8 billion in 2012-2013 $3.0 billion in 2014-2015 $4.0 billion in 2017 $4.1 billion in 2018 $2.8 billion in 2019 and later Bethany

8. Tax Changes Related to Financing Health Reform Impose an annual fee on the health insurance sector, according to the following schedule: $8 billion in 2014 $11.3 billion in 2015-2016 $13.9 billion in 2017 $14.3 billion in 2018 For many years, the fee shall be the amt. from the previous year increased by the rate of premium growth. Bethany

9. Tax Changes Related to Health Insurance ● It is clarify application of the economic substance doctrine and increase penalties for underpayments attributable to a transaction lacking economic substance ○ effective upon enactment

10. Creation & Structure of Health insurance exchanges ●Key component of the Affordable Care Act (ACA) ● Individuals and small businesses will be able to shop for coverage ●States can build a fully state-based marketplace, enter into a state-federal partnership marketplace, or default to a federally-facilitated marketplace ●States planning to operate a state-based marketplace were required to submit an Exchange Blueprint to the federal Department of Health and Human Services (HHS) Kendra

11. Eligibility to purchase in the exchanges Must live in the United States Must be a U.S. citizen or national ( or a lawfully present) Can't be incarcerated Kendra

12. Multi-State plans ● One must be non-profit ● Another must not provide coverage for abortions beyond those permitted by federal law. ● Both must be licensed in each state & also meet the qualification of a qualified health plan ● If the state has a lower age than 3:1 the may require plans to meet the more protective age rating rules ● They will be offered separately from the Federal Employees Health Benefit Program the then they will have a separate risk pool Kendra

13. Consumer Operated and Oriented Plan ● It’s an organization to foster the creation of non-profit, member-run health insurance company in all 5o states ○ Provide consumer Choice ○ Greater control ○ Greater plan accountability ○ Promote better models of care Kendra

14. Healthcare Benefit Plans Bronze Plan Minimum creditable coverage Provides essential health benefits Covers 60% of benefit costs Out-of-pocket limit equal to Health Savings Account Silver Plan Provides essential health benefits Covers 70% benefit costs HSA out-of-pocket limits Jenna

15. Healthcare Benefit Plans Platinum Plan Provides essential health benefits Covers 90% of benefit costs. HSA out-of-pocket plan Catastrophic Plan Available up to age 30 OR to ones that are exempt from the mandate to purchase coverages Only available in the individual coverage Jenna

16. Qualifications of Participating Health Plans Require qualified health plans meeting marketing requirements: have adequate provider networks contract with community providers & navigators to conduct enrollment assistance use enrollment form and standard format to present plan information Provide information on: payment policies, number of claims denied, cost-sharing requirements, enrollee rights in plain language Jenna

17. Insurance Market & Rating Rules Everyone gets accepted with guaranteed issue allowing rating variations based only on age. premium rating area family composition tobacco use Took effect on January 1, 2014 Jenna

18. Health Insurance Exchanges Health insurance exchanges are where you go to sign up during open enrollment. If your state doesn’t have one you have to sign up under the federal exchange. They are the ones that process your application and decide what subsidies and plans you are eligible for. Evie

19. Basic Health Plan The states can create a basic plan for people who are just above the poverty level (133-200% of the federal poverty level), but the coverage can’t exceed the amount that they would get under Obamacare. States would then receive funds that would equal 95% of the funds that would have been paid as federal cost-sharing subsidies. Evie

20. Abortion Coverage The states can prohibit abortion coverage. If they allow the coverage of abortions then no federal subsidies can be used to pay for that part of the insurance that covers more than the federal funds are normally permitted. They also can’t require abortion coverage in the basic health plans. Evie

21. Essential Benefits Package Essential benefits are considered to be necessary for the prevention and treatment of sickness. In order to be able to sell insurance on the Health Insurance Marketplace, each plan must include coverage in at least 10 areas. Evie

22. Works Cited The Healthline Editorial Team. "Health Insurance Exchanges: The Affordable Care Act Explained." Healthline. N.p., 24 Nov. 2015. Web. 07 Jan. 2016. "Summary of the Affordable Care Act." Summary of the Affordable Care Act. N.p., 25 Apr. 2013. Web. 07 Jan. 2016. "Establishing Health Insurance Marketplaces: An Overview of State Efforts."Establishing Health Insurance Marketplaces: An Overview of State Efforts. N.p., n.d. Web. 08 Jan. 2016. "Essential Health Benefits." HealthCare.gov. N.p., n.d. Web. 11 Jan. 2016.