University of Georgia MEACA Project

Guide to the Marketplace

What is the Affordable Care Act?• The Patient Protection and Affordable Care

Act (PPACA),commonly called the Affordable Care Act (ACA) or Obamacare,is a United States federal statute signed into law by President Barack Obama on March 23, 2010.

• The ACA aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of healthcare for individuals and the government.

Affordable Care Act Basics

The Affordable Care Act increases access to health coverage for consumers through:• Access to certain free preventative

services• Health coverage for pre-existing conditions • Access to health coverage through the

Marketplace• Health coverage for young adults up to

age 26 on their parents’ health plan

Affordable Care Act Basics

The Affordable Care Act protects consumers by changing requirements for health insurance companies. Health insurance companies must:• Help consumers understand their

coverage Summary of BenefitsGlossary of Terms

• Refrain from canceling health coverage after they’ve already agreed to cover consumers

(continued)

Affordable Care Act Basics

Health insurance companies must: (continued)• Offer certified health plans

– Qualified Health Plans (QHPs)• Offer a guaranteed set of benefits

– Essential Health Benefits (EHBs)• Prohibit lifetime limits on coverage• Adhere to deductible and out-of-pocket

limits

Affordable Care Act Basics

Medicaid Expansion• Medicaid provides health coverage for some low-

income people, families and children, pregnant women, the elderly, and people with disabilities.

• Medicaid programs must follow federal guidelines, but they vary somewhat from state to state.

• The Affordable Care Act gives states the option to expand Medicaid, the health coverage program for some groups of low- income consumers.

• Georgia has not chosen to expand its Medicaid program at this time.

Affordable Care Act BasicsT

Medicaid Expansion• Consumers between the

ages of 19 and 65 who have incomes up to 138% of the federal poverty level (FPL) may now qualify for Medicaid.

• Even though Georgia did not participate consumers may still be eligible for subsidies to help lower their costs through the marketplace.

Affordable Care Act Basics

The Health Insurance MarketplaceWhat is the Health Insurance Marketplace?• The Health Insurance Marketplace or

“Exchange” is an online system that provides consumers with an easy way to shop for health coverage shows if applicants are eligible for

programs to help lower their cost using a single, streamlined application

allows for apples to apples comparison for qualified health plans (QHPs)

Enrollment and Coverage Dates• Open enrollment for health coverage

through the Marketplace begins October 1, 2013 and ends March 31, 2014.

• Coverage will begin on January 1, 2014, for consumers who enroll before December 15, 2013, and make their first premium payment.

•

The Health Insurance Marketplace

Coverage Options• Health plans in the Marketplace are

separated into four health plan categories: Bronze Silver Gold Platinum

• Health plan categories are based on the plans actuarial value (AV). AV is the percentage of total average cost for

covered benefits that a plan will cover.

Marketplace Health Insurance Plans

Coverage Options (continued)•Bronze – 60% actuarial value (AV) – the Qualified Health Plan (QHP) issuer pays, on average, 60% of the cost of Essential Health Benefits (EHB) coverage.

•Silver – 70% actuarial value (AV) – the QHP issuer pays, on average, 70% of cost of EHB coverage.

Marketplace Health Insurance Plans

** Health plan categories do not reflect the quality or amount of care the plans provide.

60% 70% 80% 90%

Lower monthly premium Higher monthly premium Higher out of pocket Lower out of pocket

Coverage Options (continued)• Gold – 80% actuarial value (AV) – the

QHP issuer pays, approx., 80% of the cost of EHB coverage

• Platinum – 90% actuarial value (AV) - the QHP issuer pays, on average, 90% of the EHB coverage

Marketplace Health Insurance Plans

** Health plan categories do not reflect the quality or amount of care the plans provide.

60% 70% 80% 90%

Lower monthly premium Higher monthly premium Higher out of pocket Lower out of pocket

When consumers get health coverage through the Marketplace, depending on income and family size, they may be able to save money. Types of cost savings include:• Advanced Premium Tax Credits• Cost-Sharing Reduction• Medicaid• PeachCare for Kids

Marketplace Cost Savings

Advanced Premium Tax Credits• Some consumers may be able to lower the

cost of their monthly premiums through advanced premium tax credits.

• To qualify, consumers must apply and enroll in coverage through the Marketplace.

• If they meet income requirements, consumers will immediately see the amount of savings for which their eligible reflected in the premium cost shown for available QHPs.

• Consumers must reconcile tax credit payments on their federal income tax returns.

Marketplace Cost Savings

Marketplace Cost SavingsWho is Eligible for Premium Tax Credits • The amount the consumers’ eligible to save

through premium tax credit depends on the consumer’s income and family size. The lower consumer’s income, the higher

his or her savings will be.• Premium tax credits are available to

consumers who make between 100% -400% FPL, which is:$11,490 to $45,960 for individuals$15,510 to $62,040 for a family of two$23,550 to $94,200 for a family four

Cost-Sharing ReductionsCost-sharing reductions lower how much consumers pay for deductibles, copayments, and coinsurance. To be eligible for cost-sharing reductions, a consumer must:• Apply and enroll in health coverage through the

Marketplace• Have a household income less than or equal to

250% FPL• Receive the premium tax credit• Enroll in at least a silver level plan through the

Marketplace – a plan that pays 70% of the average overall cost of providing essential health benefits to members

Marketplace Cost Savings

Responsibility Payment

IRS Exemptions• Lack of affordable coverage• Lawful presence• Short coverage gap• Indian status• Hardship (limited categories)

Exemptions Available

Exemptions through the Marketplace• Health care sharing ministry• Incarceration status• Indian status• Religious conscience• Hardship

Exemptions Available

Contacts

For More Information: 706-542-6117

•

To Sign Up:

www.HealthCare.gov

For Assistance:www.MEACAProject.org

Thank You!www.MEACAProject.org