Affordable Care Act & You:What every consumer should know

What is the ACA (“Obamacare”)?

The Patient Protection and Affordable Care Act (ACA)

ACA reforms our complex health care system85% of working Americans receive healthcare as a

benefit of their full-time employment.Consumers can now purchase insurance from the

federal Marketplace.

ACA makes healthcare care more accessible and affordablePreventive careFamily planningRelated healthcare servicesNo discrimination due to pre-existing conditions or gender

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How the ACA WorksConsumers can enroll in a Qualified Health Plan (QHP)

through the MarketplaceThey can compare available plan options including monthly

premiums, co-pays, deductibles, service networks, etc.There is a single, streamlined application for private health

plans, Medicaid and/or CHIP options.

ACA requires you to have coverage.The 2014 Individual Responsibility Fee Penalty can be $95

per individual; $285 per family; or 1% family income.A number of exemptions are available.

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How the Marketplace Works

https://www.healthcare.gov/marketplace/individual

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Application Process

Submit application to

the Marketplace

Enroll in Medicaid or

CHIP

Eligibility determined and verified

Enroll in Qualified

Health Plan

Supported by Data Services

Hub

• Online• By Phone• In Person

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Eligibility determined for Qualified Health Plan, Medicaid or

CHIP

Ways to Apply

Online:www.HealthCare.gov

By Phone (24/7, 150 languages):

1-800-318-2596

In Person:Certified Application Counselors & NavigatorsVisit your nearest federally qualified health center or go to www.LocalHelp.HealthCare.gov.

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Eligibility

Eligibility:Live in the service areaUS citizen or

lawfully present non-citizen for the period of enrollment

Not incarcerated

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Affordable CoverageA refundable or Advanced Premium Tax Credit (APTC):

Can only be used to buy insurance from the MarketplaceYou can take it now and have it reduce your monthly premium.

Or, you can take it later and have it reduce your income tax liability.

Eligibility for the APTC is based on:Tax filing status and family sizeHousehold income of 100%-400% Federal Poverty LevelConsumer is ineligible for government or employer insurance

Additional Cost-Sharing Reductions are also availableHousehold income of 100%-250% of Federal Poverty Level

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Lawfully Present Non-CitizensLawfully present non-citizens are not eligible

for federal benefits until they have been residentsfor 5+ years.

However, if they are ineligible for Medicaid because of their immigration status, they can receive APTC even if their income is below 100% Federal Poverty Level.

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Federal Poverty Level Table

1. For households with more than 8 individuals, add $4060 for each.

2. Households earning less than 100% FPL will not be eligible for APTC.

3. Households earning more than 400% FPL will not be eligible for APTC.

4. Medicaid was not expanded in Florida.

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Types of PlansTypes of health plans

Platinum 90% of covered costs paid by plan Maximum services Lower deductible, higher premiums

Gold 80% of covered costs paid by plan

Silver 70% of covered costs paid by plan

Bronze 60% of covered costs paid by plan Minimum services Higher deductible, lower premiums

Catastrophic coverage is also available for adults under age 30 and/or those who obtain a hardship waiver.

Essential Health Benefits Each plan must include, at a minimum, 10 essential health benefits (below)

More expensive plans offer additional benefits

Ambulatory Patient Services Prescription Drugs

Emergency Services Rehabilitative Services and Devices

Hospitalization Laboratory Services

Maternity and Newborn Care Preventive & Wellness Services and Chronic Disease Management

Mental Health and Substance Use Disorder Services (to include behavioral health care)

Pediatric services, including oral & vision care (pediatric oral services may be provided by stand-alone plan)

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Enrollment

Open Enrollment is November 15, 2014 through February 15, 2015.

Health coverage is effective January 1, 2015if purchased by December 15, 2014.

For more information ….

In Person: [Insert Contact Info Here]

By Phone: Marketplace Call Center at 1 (800) 318-2596On-line: www.HealthCare.gov

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