The Marketplace Health Insurance Open Enrollment and

How it Impacts Libraries, Plus tips on how to assist patrons.

AcronymsCHIP – Children’s Health Insurance ProgramFTEs – Full-time Equivalent EmployeesHIX – Health Insurance ExchangeSHOP – Small Business Health Options ProgramQHP – Qualified Health Plan

CHIP – Children’s Health Insurance Program

Provides health coverage to more than 43 million children, including half of all low-income children in the United States.The ACA extends eligibility for this health coverage and Medicaid and is expected to provide numerous improvements to these programs.

FTEs – Full-time Equivalent Employees

What is a FTE?Monthly hours of all part-time employees (up to 120 hours) are totaled and divided by 120 (month)PlusFull-time employees working 30 hours per week (or more) are totaled and divided by 130 hours (month)

Example: 30 Part-time employees working 25 hours/week (3000 hours (month)/120 (hours) = 25 FTEsPlus, 20 Full-time employees = 45 FTEs (small employer)

HIX – Health Insurance Exchange

Effective January 1, 2014 Each State may set up a HIX. Michigan does not have its own HIX so the Federal Government will administer the exchange. www.healthcare.gov

All Employers must provide written notice to each current employee, and new hire, of the existence of the HIX.

– Give to current employees prior to October 1, 2013– Give to new employees on hire date after October 1, 2013

HIX (continued)

• Model Notice to Employees:Many provisions of the Affordable Care Act become effective on January 1, 2014. This letter is to serve as notification to you that the Health Insurance Marketplace will be open on October 1, 2013.

This Marketplace will allow individuals access to information regarding affordable health insurance coverage. You can visit the Marketplace at heathcare.gov

For the first year of this program, Open Enrollment will be October 1, 2013 – March 31, 2014. Annual Open Enroll periods after that will start on October 15 and end on December 7.Please see the attached notice for further information. (Workshop

attendees, the notice is attached in the back of the packet)

SHOP – Small Business Health Options Program• Simplifies the process of buying health insurance for your

small business• SHOP Marketplace is open to employers with 50 or fewer

full-time-equivalent employees (FTEs)• Some employers may be eligible for a small business

health care tax credit.To qualify for tax credit:- Must purchase coverage through SHOP-Fewer than 25 FTEs-FTEs making less than $50,000./yr.

• Small group tax credits are only allowed for two years.• Only apply to the smallest, lowest income employers

SHOP (continued)

• If you are a small business, you do not have to purchase health insurance from the SHOP, you can continue purchasing your insurance through your Broker, or other provider.

• The incentive of purchasing through SHOP is the possible tax credits.

• You can continue to use your current licensed agent or broker to buy health insurance in the SHOP.

QHP - Qualified Health Plan

• Under the Affordable Care Act. Starting in 2014, to be considered a Qualified Health Plan an insurance plan must provide:

• Provide essential health benefits• Follow established limits on cost-sharing (such as

deductibles, copayments, and out-of-pocket maximum amounts) and meet other requirements.

A qualified health plan will have a certification by each Marketplace in which it is sold.

The MarketplaceInsurance Marketplace websitewww.Healthcare.gov

• If you reside in Michigan this is the website you use to apply for coverage, compare plans, and enroll.

• Effective October 1, 2013 this website will be launched.• For the first year of this program Open Enrollment will

be October 1, 2013 – March 31, 2014.• Subsequent years Open Enrollment will be October 15,

through December 7.• Special enrollment periods available in certain

circumstances during the year.

Insurance Benefit Levels

• Four levels of health insurance coverage– Platinum– Gold– Silver– Bronze

• Each level of coverage covers a cores set of benefits called Core Benefits. They include:

-Outpatient Care -Emergency Room -Inpatient care in a hospital -Care before and after your baby is born -Mental Health and substance use disorder services: Includes behavioral health treatment, counseling, psychotherapy -Prescription drugs -Services and devices that help in recovery if you are injured, or have a disability or chronic condition -Lab tests -Preventive services including counseling, screening, and vaccines to keep you healthy and care for chronic conditions -Pediatric services : This includes dental care and vision care for kids

Application Process

• There are four (4) ways individuals may apply:1. By mail, using a paper form2. Online at www.Healthcare.gov3. By toll-free telephone at 1-800-318-2596 or4. In person using the services of a certified Navigator • Enrollment begins October 1, 2013

• One Application, one time, and applicants will see all the programs they qualify for.

• New Healthcare law offers some added protection to individuals and their families

1. Can not be turn down for insurance due to a chronic condition or due to a previous condition.

2. Insurers can not charge more for coverage of women than men.3. Bans lifetime limits on coverage.

Navigator Program

Each State is assigned Navigators to provide people with clear directions and information to help them get where they need to go.Navigators are groups of people who are specially trained to provide assistance to individuals and families with the information necessary to determine which health insurance option best fits their needs, and then help them enroll in the plan of their choice.

Navigators (continued)• Navigators must be certified– Take the initial web-based training– Take required on-going training– Recertified annually– Not accept direct or indirect compensation from issuers

related to enrollment of a Quality Health Plan, or non Quality Health Plans or receive any financial benefit, direct or indirect, from enrolling consumers in health plans.

Navigators are funded through grants provided by Government Exchange funds.

Navigators (continued)

• A Navigators Responsibilities include:– Conducting public education on available health plans– Distributing fair and impartial information on enrollment

and premium tax credits– Facilitating the enrollment process– Referring all grievances, complaints or questions regarding

health plans and coverage to an office of the health insurance consumer assistance or ombudsman, or any other appropriate state agency

– Provide culturally and linguistically appropriate information to meet the needs of the population

Navigators (continued)Navigators in Michigan are:• Community Bridges Management Inc. Linden (586) 741-8360

• Arab Community Center for Economic & Social Services (ACCESS)

Dearborn (313) 945-8367

• American Indian Health & Family Services of SE Michigan, INC.

Detroit (313) 846-3718• Michigan Consumers for Healthcare

http://consumersforhealthcare.org

How to Protect Yourself From Fraud

Be informed• Visit HealthCare.gov (https://www.healthcare.gov), the official

Marketplace website.• Compare insurance plans carefully before making your decision• Look for official government seals, logos or web addresses• Know the Marketplace Open Enrollment Dates

– October 1 , 2013 – March 31, 2014– No one can enroll you in a health plan in the Marketplace until Open

Enrollment begins or after it ends unless you have a special circumstances

Examples: moving to a new state, certain changes in your income, changes in your family size ( if you marry, divorce, have a baby, adopt).

Protect from Fraud (continued)

• Protect your private health care and financial information– No one should be asking you for your personal health

information. Don’t give it to anyone.– Keep personal and account numbers private. Don’t give

your social security number or credit card or banking information to companies you did not contact or in response to unsolicited advertisements.

– Never give your personal health or financial information to someone who calls or who comes to your home uninvited, even if they say they are from the Marketplace.

Protect from Fraud (continued)

• Ask questions and verify the answers– The Marketplace has trained assisters in every

state to help you at no cost. You should never be asked to pay for services or help.

– Ask questions if any information is unclear– Double check information that is confusing or

sounds fishy. Visit www.HealthCare.gov or call them at 1-800-318-2596

– Don’t sign anything you don’t understand

Protection from Fraud (continued)

• If you suspect fraud, report it– Call the Health Insurance Marketplace consumer

call center at 1-800-318-2596Or contact your local, state, or federal law enforcement agencies or your state department of insurance.

How the Marketplace Impacts Libraries

Approximately 7 Million people are expected to sign up for coverage in the new Marketplace.-It is predicted that libraries will be especially impacted in states where little effort has been done to promote the ACA.

Take a Breath

FIVE Keys to Avoid Conflict

KEY ONEPolicy & Practice

• Review library policy for patron privacy and confidentiality

• Past Practice – How did and/or does your library assist patrons requesting help:A. Completing applications for unemploymentB. Filing income taxes onlineC. Frozen on a page containing personal information

KEY TWOBasic Information Required to Complete Application

Required for Individual Applicant• Social Security Number (Document number if legal immigrant)• Employer and Income information (W-2 or paystub)• A completed Employer Coverage Tool

Required for Family Applicant• Social Security Numbers (Document numbers for legal immigrants)• Employer and Income Information for each family member• Policy Numbers for any current health insurance• Information about job-related health insurance available to the family• A completed Employer Coverage Tool for each eligible family member

KEY THREEUseful Websites - Government

www.HealthCare.govwww.michigan.gov/difswww.michigan.gov/libraryofmichigan

KEY THREE (cont.)Useful Websites – Association, Foundation and Provider

• www.ala.org/tools/affordable-care-act• www.webjunction.org• www.kff.org/health-reform• www.familiesusa.org/health-reform-cent

ral/• www.healthreformgps./• www.HealthCareReformBasics.com

KEY FOURIdentify the NAVIGATORS

Michigan ACA NavigatorsCommunity Bridges Management Inc.

(586) 741-8360

Arab Community Center for Economic & Social Services(313) 945-8367

American Indian Health & Family Services of SE MI, Inc.(313) 846-3718

Michigan Consumers for Healthcarehttp://consumersforhealthcare.org

KEY FIVEPrepare a ACA Glossary – A Sampling

The following links are not endorsed by The Library Network. They are examples of provider prepared common ACA terms which may be useful to public library patrons.

http://kff.org/glossary/health-reform-glossary/http://healthreform.kaiserpermanente.org/en/glossaryhttp://www.nwitimes.com/business/healthcare/affordable-care-act/glossaryhttp://www.uhc.com/united_for_reform_center/uniform_glosary_health

QUESTIONS