Nebraska AppleseedJustice and Opportunity for All Nebraskans

Open for Business: Health Insurance Marketplace

October 4, 2013

Health Insurance TodayCurrently, people get insurance through:

- Their employer- Medicaid and/or Medicare- The individual market

Health Insurance Today Insurance companies do not have to sell to you,

and may deny you insurance on the basis of a pre-existing condition, or not cover certain services or treatments

Health Care Reform• In 2010, President Obama signed into law the

Patient Protection and Affordable Care Act (ACA).

• The Supreme Court upheld the ACA on June 28, 2012, but ruled that the new Medicaid program was optional for states.

Health Care Reform

The ACA focuses on four main areas:

•How to find and access insurance coverage• Health Insurance Marketplace• New Medicaid Program

•How to afford coverage

•How to ensure the insurance system is fair and that people get value for their premium dollar

•How to change our health care delivery system to control costs and focus on prevention

Accessing Coverage

People will access coverage through:

•Employers

•Creation of Health Insurance Marketplaces• Nebraska has opted for a federally

facilitated Marketplace

•Expansion of Medicaid• Nebraska has not yet opted in to the new

Medicaid program

Coverage with ValueCertain consumer protections are already

in effect:

• Ends denial of coverage for pre-existing conditions for children

• Bans co-pays and out-of-pocket expenses for preventive care and immunizations on new plans

• Prohibits lifetime benefit limits in all plans

• Extends dependent coverage to age 26 in all plans

• Insurers cannot drop you when you get sick

Coverage With ValueInsurance Reforms and Consumer Protections

•Prohibits denial of coverage for pre-existing conditions for everyone by 2014

•Changes what insurers can look at when setting premiums:

• They can no longer set different rates based on your health status or gender

• Can only look at age (3:1), geographic area, family composition, and tobacco use (1.5:1)

Coverage With ValueInsurance Reform and Consumer Protections

•Guaranteed issue and renewability in 2014– insurers can’t refuse to sell

•Prohibits annual limits for ten essential services

•Creates a standard benefit plan for all new policies (does not apply to existing individual and employer-sponsored plans)

•Eliminates waiting periods for coverage more than 90 days

Essential Health Benefits

The ACA requires that all plans sold inside the new Health Insurance Marketplace, and most plans outside the Marketplace, to cover ten essential health benefits (EHBs)

Accessing CoverageThe new Health Insurance Marketplace•The Health Insurance Marketplace is a one-stop shop for people for private coverage, Medicaid coverage, and accessing tax credits

•The Marketplace is accessible for individuals and small businesses with up to 50 employees

•Nebraska has chosen to have a federally facilitated Marketplace—one that will be run by the federal government in place of the state

Accessing CoverageThe new Health Insurance Marketplace•Four insurance carriers offer plans

• Blue Cross/Blue Shield, CoOpportunity, Health Alliance, Coventry

•All plans must cover essential health benefits

•Four levels of plans will be available • Bronze, Silver, Gold, Platinum

Accessing CoverageThe new Health Insurance Marketplace•Help paying for the cost of coverage (tax credits)

• Eligible incomes are between 100% and 400% of the federal poverty level (FPL) ($19,090 to $76,360 for a family of three)

• Individuals are not eligible for tax credits if they are offered coverage by their employer unless • The employer plan does not meet certain

minimum standards and the employee share of (individual) premiums is 9.5% of income

Accessing CoverageThe new Health Insurance Marketplace•The process

• Start the process at healthcare.gov

• Series of screens/questions

• If eligible for tax credit, credit is applied

• Compare and select a plan

• Enroll

Medicaid and the Marketplace• Medicaid was intended to be the foundation of

coverage for low income adults, because it is much cheaper to cover people under Medicaid than to subsidize their insurance

• Therefore, those who are making under 100% FPL can’t get tax credits through the Exchange, and will have no path to coverage, creating a large gap

Outreach and Enrollment184,429 Nebraskans under 400% FPL are

uninsured Household of 4 making less than $94,200

12% of total population

Source: 2010 Small Area Health Insurance Estimates,

U.S. Census Bureau

Timelines for Enrolling*October 1, 2013- March 31, 2014

Enrollment Date Effective Date of Coverage

Oct. 1, 2013-Dec. 15, 2013 January 1, 2014

Dec. 16, 2013-Jan. 15, 2014 February 1, 2014

Jan. 16, 2014-Feb. 15, 2014 March 1, 2014

Feb. 16, 2014-March 15, 2014 April 1, 2014

Mar. 16, 2014-March 31, 2014 May 1, 2014

You may be eligible for a Special Enrollment Period if you:•Move to a new state•Have certain changes in income•Change your family size•Belong to a federally recognized Tribe

Consumer Assistance FrameworkEnrollment Assisters

Navigators CACs (Hospitals, doctors offices, libraries, etc.) Agents/Brokers Call-Center Representatives

Educators Partners & Stakeholders Local government branches & employees Connect community to www.healthcare.gov and

enrollment assisters.

Consumer Assistance Framework

Assisters Help consumers fill out the

application

Help consumers compare plans & make an enrollment selection

Provide education about the application and plan compare process

May conduct local outreach to bring consumers to assistance.

Educators Create awareness of the

Marketplace

Drive consumers to Customer Service channels (www.healthcare.gov & assisters)

Conduct outreach events and activities

Provide basic information about the Marketplace and where to get help

Enroll Nebraska Goal: To equip and connect assisters and

educators with resources to enroll Nebraska’s uninsured.

Visit www.enroll-ne.org for latest materials

Equip Connect

• Policy Updates• Sample Press Releases• FAQ’s• Sample Outreach Plans• Troubleshooting• Calendar of Events• Strategies for

community engagement

• Identifying and linking resources between organizations

• Referrals• Facilitating

collaboration

How can you engage your community? Link with other organizations in your area to

organize education and enrollment events

Share tools and resources with Enroll Nebraska and other organizations

Questions to consider: What are you currently doing? What are the challenges? What resources already exist?

www.healthcare.gov www.canhelp.org www.enroll-ne.org

Nebraska AppleseedJustice and Opportunity for All Nebraskans

Questions?