cops/metro workshop on the health insurance marketplace
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COPS/Metro Workshop on the Health Insurance Marketplace. An Organizing Strategy. COPS/Metro. A broad-based organization with 33 dues-paying member institutions Foster a relational culture among institutions Develop leadership and capacity to shape the common good Organizing Process - PowerPoint PPT PresentationTRANSCRIPT
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COPS/Metro Workshop on the Health Insurance
Marketplace
An Organizing Strategy
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COPS/Metro
• A broad-based organization with 33 dues-paying member institutions
• Foster a relational culture among institutions• Develop leadership and capacity to shape the
common good• Organizing Process– Learn issues affecting families– Research possibilities to act– Act to shape public policy – Evaluate & Reflect on our actions, our development
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Workshop Topics
• Background on the state of healthcare• What is the Health Insurance Marketplace?• Who can benefit from it?• How does it work?• Small Group Conversations• Next steps
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Background
• There are 6.1 million uninsured Texans – 1 million of whom are children– Texas leads the nation
• 390,000 uninsured in Bexar County– This is 23% of the population
Source: Center for Public Policy Priorities www.cppp.org
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What is the Health Insurance Marketplace?
• In 2010, the Affordable Care Act (ACA) created the Marketplace (Exchange)
• A one-stop shop to compare plans, benefits, costs
• Provides tax subsidies to make insurance more affordable
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What is the Health Insurance Marketplace?
• Benefits include:– Preventive Care covered at 100%–Maternity & Newborn care– Prescription Drugs– Mental health and substance use disorder
services, including behavioral health treatment– Children covered under parents’ plan until age 26– Caps out of pocket expenses
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Who Benefits?
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Status of Insurance Marketplace?
• Enrollment period: 10/1/13 – 3/31/14• Coverage begins 1/1/14 – So do penalties for those qualified & not covered
• 110,000 residents in Bexar County may qualify• HHS has granted resources to agencies to hire
“Navigators” who can enroll participants– “Certified Application Counselors” can also enroll
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Status of Insurance Marketplace?
• Three Navigator agencies in Bexar County– About $1.2 million in federal grants– 22 Navigators
• HHS requires 30 hours of training, including strict privacy protections
• Governor Perry asked TDI to draft tighter regulations for navigators– Additional 40 hours of training; US citizenship
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DETAILS ON THE MARKETPLACE
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Four Health Plan CategoriesBased on % the plan pays on average
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Terms to Know
• Premium: The amount you pay monthly for health insurance coverage
• Deductible: A fixed amount you pay per year before your insurance starts to make payments for covered medical services
• Co-Pay: A fixed amount you pay for each healthcare service.
• Lifetime Cap: The maximum amount your insurance will pay over your lifetime.
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Terms to Know
• Out-of-pocket: The amount you pay out of your own pocket for healthcare services.
• Healthcare Navigators,• Application Assisters,• Certified Application Counselors, and• Champions for Coverage: – Different terms for people certified, trained and
knowledgeable to help you understand your health coverage options
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What determines my costs?
• Your health insurance cost will be based only on four things:– Age–Where you live– Family Size–Whether you smoke
*Pre-existing conditions will NOT be a factor*
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Who can use the marketplace?
• Small businesses
• Families
• Individuals who:– Are US citizens or legal residents– Live in the US– Are not in jail
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Who cannot use the marketplace?
• Undocumented residents
• Residents with “deferred action” status (such as DACA)
• People with Medicaid, CHIP or Medicare
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Tax credits
• Tax credits will be given on a sliding scale to those who qualify (family size/income)
• People will pay no more than 9.5% of their income in health insurance premiums
• For people who qualify, the government will send money directly to the insurance company.
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For more information
www.healthcare.gov
1-800-318-2596
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To Enroll
• Beginning October 1, 2013– Online: www.healthcare.gov– By phone: 1-800-318-2596– In person• • •
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Documents you need to apply
• Social security card (or document number for legal immigrants)
• Employer and income information for every member of your household who needs coverage (pay stubs, W-2)
• Policy numbers of current health insurance plans covering members of your household
• An Employer Coverage Tool for every job-based plan you or someone in your household is eligible for (even if not enrolled)
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What happens if I don't get coverage?
• If you don't have coverage as of 1/1/14 (employer, Marketplace, CHIP, Medicaid or Medicare) you will have to pay a tax penalty
• 2014: 1% of income or $95 per person/year, whichever is higher – The fee for uninsured children is $47.50 per child/year– The most a family would have to pay in 2014 is
$285/year• 2016: 2.5% of income or $695 per person/year,
whichever is higher
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CONVERSATIONS
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NEXT STEPS
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BACKUP SLIDES
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Catastrophic Plans
• People under 30 and some people with limited incomes may buy a "catastrophic" health plan. – Will have lower premiums, but high deductible– Protects you from very high medical costs (worst-case
scenarios)– Generally requires you to pay all of your medical costs up
to a certain amount, usually several thousand dollars.• Will include 3 annual primary care/preventive care
visits with no out of pocket costs• People 30 and over who have received a “hardship”
exemption may be able to buy catastrophic plans
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*Disclaimer*• COPS/Metro will provide information with
respect to the Affordable Care Act and how it may affect our families
• COPS/Metro will not be engaged in the enrollment process. We can, however, refer families to reputable enrollment agencies who can assist with enrollment
• While our organization accepts contributions for the broad purposes of the organization, we will not accept any contributions stemming from the Affordable Care Act (or any other public funds)
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Medicaid Expansion