oregon affordable care act_mckenzie river chamber presentation
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USA Benefits Group“The State of Health Insurance”
• Patient Protection and Affordable Care Actaka: Obama Care
Tom Koanui541-914-8441
Shonna Butler541-870-0815
Tom Koanui541-914-8441
Shonna Butler541-870-0815
Cover Oregon Health Care Insurance Exchange
The Health Insurance Exchange is an online Market Place for people to shop and purchase PPACA plans. PPACA plans will be available through a public exchange, private exchanges, and off-exchanges in Oregon. The State of Oregon was granted a $182 million grant to develop what we now know as Cover Oregon. Cover Oregon is the only public exchange in the state of Oregon and will be the only means to acquiring a tax or cost share subsidy. Oregon is one of 3 states that have a fully functioning public exchange in operation today and Oregon leads the nation in health care benchmarks.
Patient Protection Affordable Care Act
• Adopted on March 23, 2010• Prior to March 23, 2010 plans are grandfathered • Most Americans are required to purchase• Exempt: certain religious groups, Native American Tribe, undocumented immigrants, prisoners, low income• 2 types of subsidies to help offset health care costs• Important dates to remember:
- Open enrollment: Oct. 1, 2013 to Dec. 31, 2013- Extended enrollment: thru March 31, 2014- Plan effective date: Jan. 1, 2014
• Creation of the health insurance exchange
Tom Koanui541-914-8441
Shonna Butler541-870-0815
Patient Protection Affordable Care Act
Highlights for January 01, 2014• All individuals MUST have E.H.B. (Essential Health Benefits)• Guaranteed acceptance• No pre-existing condition exemptions• Maximum waiting periods of 90 days• NO RATING for health, gender, build & industry• 100% coverage for wellness visits • Metallic Levels: Bronze- Silver- Gold- Platinum• Insurance companies are required to spend 80 cents of each premium dollar on the cost of care
Tom Koanui541-914-8441
Shonna Butler541-870-0815
Patient Protection Affordable Care Act
Essential Health Benefits (EHB):1. Ambulatory patient services2. Emergency services3. Maternity and newborn care 4. Pediatric services, including dental and vision care5. Rehabilitative/habilitative services and devices6. Mental health and substance use disorder services,
including behavioral health treatment7. Preventive and wellness services and chronic disease management8. Hospitalization9. Prescription drugs10. Laboratory services
Tom Koanui541-914-8441
Shonna Butler541-870-0815
Tom Koanui541-914-8441
How will Health Reform affect me?
Shonna Butler541-870-0815
Individual: - Required to purchase- Penalty= 1% of taxable income or $95- May be eligible for tax subsidy - May be eligible for cost share subsidy- Estimated “taxable income” from previous year- Must purchase on exchange for subsidy- Non-medicare eligible may purchase- Need a knowledgable agent
Tax Subsidy:- Federal Poverty Level: $11,490-133% to 400% FPL- Single: $15,282 to $45,960- Couple: $20,928 to $62,040- Family: $31,322 to $94,200
Cost Share Subsidy:-100-150% FPL= 94%- 150-200% FPL= 87%- 200-250% FPL= 73%- 250-400% FPL= 70%
NOTE: Based on Silver Plan Actuarial Values
Tom Koanui541-914-8441
How will Health Reform affect my business?
Shonna Butler541-870-0815
Small Business: - < 50 FTE not required to offer coverage- Penalty= 0- May be eligible for premium tax credit - May be eligible for full premium tax credit- May purchase on the exchange- Oregon zip code to purchase on exchange- Need a knowledgable agent
Premium Tax Credit:- If elect to offer coverage-Pay min. 50% of FTE only- < 25 FTE- Average income of $50K
Full Premium Tax Credit:- Up to 35% of FTE only premium- < 10 FTE- Average income of $35K
Tom Koanui541-914-8441
How will Health Reform affect my business?
Shonna Butler541-870-0815
Large Business: - > 50 FTE required to offer coverage- Penalty= the lesser of $2,000 /FTE or $3,000 for each employee that receives subsidy, minus 30.- May be eligible for premium tax credit - May be eligible for full premium tax credit- Required to notify employees of PPACA and your choice- May purchase on the exchange- Oregon zip code to purchase on exchange- Realize increased cost of materials and supplies- Must consider price increases on products and services to cover additional expenses- Need a knowledgable agent
Tom Koanui541-914-8441
PPACA Plan Design
Shonna Butler541-870-0815
Tom Koanui541-914-8441
Employer Program Requirements
Shonna Butler541-870-0815
Oregon Exchange Plan Design
Tom Koanui541-914-8441
Shonna Butler541-870-0815
Tom Koanui541-914-8441
Shonna Butler541-870-0815
Exchange Prescription Drug Plan
Tom Koanui541-914-8441
Shonna Butler541-870-0815
Tom Koanui541-914-8441
Proposed Rates and Subsidies
Shonna Butler541-870-0815
Tom Koanui541-914-8441
IndividualProposed Rates for Standardized Plans
(Based on age 40 Non-Tobacco) Bronze 60% Silver 70% Gold 80%
Moda (ODS): $169 $225 $276
LifeWise: $195 $252 $303
Pacific Source: $195 $257 $323
Regence: $237 $280 NA
Kaiser: $229 $291 $344
Trillium: $401 $486 $563
Shonna Butler541-870-0815
Tom Koanui541-914-8441
Subsidies
Individual:
Silver Plan $368
Income:$20 K $283$26K $212$32K $131$38K $67$42K $36
Family of 4:
Silver Plan $1,102
Income:$42K $916$50K $822$60K $693$70K $553$80K $469
Shonna Butler541-870-0815
Tom Koanui541-914-8441
Small BusinessProposed Rates for Standardized Plans
(Based on age 40 Non-Tobacco) Bronze 60% Silver 70% Gold 80%
Moda (ODS): $209 $309 $375
LifeWise: $220 $292 NA
Pacific Source: $271 $358 $448
Regence: $268 $316 NA
Kaiser: $222 $299 $354
OR Co-Op: $284 $338 $403
Shonna Butler541-870-0815
Tom Koanui541-914-8441
Please consider scheduling a time to meet with us to discuss PPACA privately or with
a group of friends or family.
Questions?If you would like to receive updates regarding
PPACA, please give us your email address
Shonna Butler541-870-0815
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