the marketplace and cobra: what employers and employees need to know presented by: emily brostek,...

The Marketplace and COBRA:

What employers and employees need to know

Presented by:Emily Brostek, MPH, CHES– Executive Director

Consumers for Affordable Health Care

December 17, 2014

Agenda

• ACA and Marketplace Basics

• The Marketplace & COBRA

• Helping Employees Understand Their

Options

www.mainecahc.org 2

Our Mission

To advocate the right to quality, affordable health care for every man, woman and child in Maine.

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About Consumers for Affordable Health

Care• Non-profit, non-partisan mission-driven research and advocacy organization based in Augusta (founded in 1988)oConsumer Assistance Program and

HelpLine (1-800-965-7476)oPublic Policy Research and Advocacy

www.mainecahc.org 4

Marketplace Basics

The Health Insurance Marketplace

The Health Insurance Marketplace helps people without insurance find health coverage

When you apply, you’ll learn if you qualify for:• Lower costs on private insurance plans

based on your household size and family income

• Other programs like MaineCare and the Children’s Health Insurance Program (CHIP)www.mainecahc.org 6

1. Advanced premium tax credits

(APTCs)

2. Cost sharing reductions

(CSRs)

Two kinds of financial help:

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Marketplace Eligibility

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You may be able to get help with the cost of Marketplace plans if…oYou do NOT have access to insurance

at work, or insurance at work is unaffordable AND;

oYou do NOT have access to public insurance like Medicare or Medicaid AND;

oYour household income is between:

Tax Credit Eligibility

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2014 Plans

1 person: $11,490-$45,960

2 people: $15,510-$62,040

3 people: $19,530-$78,120

4 people: $23,550-$94,2002015 Plans

1 person: $11,670-

$46,6802 people: $15,730- $62,9203 people: $19,790- $79,1604 people: $23,850- $95,400

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Financial help is on a

sliding scale.

Who can go to the Marketplace?

• Anyone can purchase a Marketplace plan

Exceptions!Those who get Medicare Part A free

(most people on Medicare)

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These groups won’t usually use the Marketplace

• Medicare recipients

• Medicaid recipients

• Military/veterans • If you have an employer plan (or dependent

coverage through a spouse’s or parent’s plan) unless it’s “unaffordable” or “crappy” www.mainecahc.org 12

• Marketplace plans may be a good option for people who are eligible for COBRA

• Employees need help understanding their options, and when different options are available

Marketplace and COBRA

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• Most people are only able to sign up for a plan on the Marketplace during Open Enrollmento For 2015: November 15, 2014 – February 15, 2015

• Some people qualify for Special Enrollment Periods outside of Open Enrollment if they have certain life events happen to themo Losing another kind of coverage qualifies you for a SEP

Timing Matters!

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• When someone loses their employer-based coverage, they can choose COBRA or the Marketplace

COBRA or Marketplace?

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• If they choose COBRA:o They can’t switch to Marketplace until the next

Open Enrollment periodo They can switch during Open EnrollmentoWhen COBRA expires, they can get a Special

Enrollment Period and sign up on the Marketplace

COBRA or Marketplace?

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• If they choose the Marketplace and forego COBRA:o They have 60 days from when coverage will

end to enroll in a Marketplace plan through a Special Enrollment Period

oDepending on income, they may be able to get financial help on the Marketplace

COBRA or Marketplace?

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• Differences between plans, including:o Costo Total out-of-pocket expenseso Provider networks

• Timing – when is each option available?• Marketplace eligibility – can they get

financial help?o Other coverage availableo Projected income

Helping Employees Understand Their

Options

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• Local help is available to help people understand their options, and apply to the Marketplace

• Find local help:o Enroll207.com oCall our HelpLine at 1-800-965-7476

You Don’t Have to Do It Alone!

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Q & A and Thank You!Consumers for Affordable Health Care

HelpLine: 1-800-965-7476

Web: http://www.mainecahc.org

YouTube: http://www.youtube.com/user/mainecahcchannel

Facebook: http://www.facebook.com/MECAHC

Twitter: @MAINECAHC

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