Affordable Care Act & You:What every consumer should know

What is the ACA (“Obamacare”)?

The Patient Protection and Affordable Care Act (ACA)

ACA will reform our complex health care systemIf you are not insured, or want to purchase insurance, a new

Florida-based system will help you get coverage

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

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

through the “Marketplace”The Marketplace helps consumers choose the plan that best suits

their needs by allowing them to compare available plan options including monthly premiums, co-pays, deductibles, service networks, etc.

There is a single, streamlined application for health plan, Medicaid and CHIP options.

ACA requires most people to have coverage by January 2014Penalty in 2014 is $95 per individual; $285 per family; or 1 percent of

family income, whichever is higher.A number of exemptions are also 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 ApplyOnline:

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 orcall 1-800-318-2596 to be connected.

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Eligibility

Eligibility:Live in the service areaUS citizen or

lawfully residing non-citizen for the period of enrollment

Not incarcerated

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Affordable Coverage

A refundable or Advanced Premium Tax Credit (APTC):Can only be used to buy insurance from the MarketplacePaid directly to insurer on your behalfCan reduce your monthly premium, depending on income level

Eligibility for the APTC is based on:Family size and household incomeHousehold income between 100%-400% Federal Poverty LevelIf consumer is ineligible for other coverage such as

government or employer insurance

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Federal Poverty Level TableHousehold

Size 100% 133% 150% 200% 300% 400%

1 $11,490 $15,282 $17,235 $22,980 $34,470 $45,960

2 15,510 20,628 23,265 31,020 46,530 62,040

3 19,530 25,975 29,295 39,060 58,590 78,120

4 23,550 31,322 35,325 47,100 70,650 94,200

5 27,570 36,668 41,355 55,140 82,710 110,280

6 31,590 42,015 47,385 63,180 94,770 126,360

7 35,610 47,361 53,415 71,220 106,830 142,440

8 39,630 52,708 59,445 79,260 118,890 158,520

For each additional

person, add$4,020 $5,347 $6,030 $8,040 $12,060 $16,080

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

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

3. Medicaid was not expanded in Florida.

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Types of Plans

Types 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 through the Marketplace is October 1, 2013 through March 31, 2014.

Health coverage is effective January 1, 2014if purchased by December 15, 2013.

For more information ….

In Person: [insert CAC name & contact info]

By Phone: Marketplace Call Center at 1 (800) 318-2596

On-line: www.HealthCare.gov

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