Coverage is Good Medicine

Health Insurance for You and Your Family

Last updated: 8/14/2013

On March 23, 2010,the Affordable Care Act

became law.

Health care is more secure for millions of people.

If you have insurance:You don’t have to pay extra for preventive care like annual check ups and shots

Health care is more secure for millions of people.

If you have insurance:No lifetime limits on how much of your care insurance companies will coverNo dropping your coverage when you get sick

Health care is more secure for millions of people.

http://thechart.blogs.cnn.com/2012/07/27/checks-come-as-surprise-under-obamacare/

Get a rebate if your insurance company collects too much money in premiums and only spends 80% on medical care.

8.5 million people got checks in 2013

3.1 million young adults are covered through their parents’ insurance

6.6 million seniors have saved $7 billion on prescription drugs ($1060 per person average)

500 new doctors and 600 new nurses are being trained, including a focus on primary care

Hospitals have incentives to coordinate care, decrease complications, and improve quality.

Now, health care is more secure for millions of people.

Starting January 1, 2014, if you have a pre-existing condition, you

will not be charged more or get denied coverage for it.

Half of Americans have a pre-existing condition and will be safe.

However, in America,

1 in 7 people has no health insurance right now

At some point in 2012, nearly 1 in 2 adults had no

insurance or was underinsured.

http://www.commonwealthfund.org/News/News-Releases/2013/Apr/New-Health-Insurance-Survey.aspx (accessed 8/5/2013)

2013-2014: A Historic Opportunity

Health insurance for millions of people

Largest expansion of coverage since Medicare in 1965.

Millions will have a chance to sign up for coverage.

October 1, 2013: First day to sign up for new health insurance options.

January 1, 2014: Coverage starts!

March 31, 2014: Last day to sign up until October, 2014.

78% of uninsured people don’t know about this!

Three *New* Ways to Get Covered

Expanded Medicaid* In participating states only

Insurance Marketplace(private insurance)

Higher Income

Lowest Income

Small Business Marketplace(private insurance)

Small Business

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/05/florida-rejects-medicaid-expansion-leaves-1-3-million-uninsured/ (accessed 8/5/2013)

Supreme Court Decision: States have a choice of whether to expand Medicaid

http://kaiserfamilyfoundation.files.wordpress.com/2013/07/8458-analyzing-the-impact-of-state-medicaid-expansion-decisions2.pdf (accessed 8/5/2013)

Governors and state legislators can choose to expand Medicaid at any time.

• State-run, mostly federally-funded health insurance for people with the lowest income.

• Who Qualifies:

Medicaid Expansion

Family Size Household income is less than

1 $15,281.70

2 $20,628.30

3 $25,974.90

4 $31,321.50

5 $36,668.10

6 $42,014.70

7 $47,361.30

8 $52,707.90

Health Insurance Marketplace

A supermarket where health insurance companies compete for your business.

Clear Information:• What’s covered • What it costs• Simple language• No fine print allowed

Health Insurance Marketplace

• Insurance companies have to offer you a plan even if you’ve been denied before

• Only these will affect your premium:• How old you are• Where you live• Number and age of people in your family• Whether you smoke

Health Insurance MarketplaceAll insurance plans will cover the basics.

Doctor Visits

ER Visits

Hospital Stays Maternity and Newborn Care

PrescriptionsBlood Tests

Prevention(shots, cancer screenings)

Mental Health and Substance Abuse

Physical Therapy

Pediatricswith vision and dental

Most people will get a tax credit to help pay for your insurance.

Number of people in your family You can get a tax credit if you make

1 $11,490 - $45,960

2 $15,510 - $62,040

3 $19,530 - $78,120

4 $23,550 - $94,200

5 $27,570 - $110,280

Employer doesn’t offer affordable insurance (you would have to pay more than 9.5% of your income)

You’re not on Medicare Must buy insurance on the marketplace.

Here’s how it would work.

• $50,000 annual income• Ages: 35, 32, 8, and 7

• Total estimated cost per month: $924.25• Federal tax credit covers: $643.83• You pay (estimated): $280.42

Kaiser Calculator: kff.org/interactive/subsidy-calculator

Health Insurance Marketplace

You CAN shop at the marketplace if you:

Live in the U.S. Are a U.S. Citizen or legal

resident Are not in prison

Health Insurance Marketplace

You MUST shop at the marketplace if you: Are a member of Congress or

his/her staff

Choose the Plan that Fits Your Needs

What You Pay• Lowest Monthly Premiums (fees)• You get 3 primary care visits and preventive care for free. • You pay for 100% of your other care until you reach the limit (exact

amount depends on your income).

Who Might Choose CatastrophicHealthy.

No or low expected medical costs. Ok with taking a financial risk.

Can’t afford anything else.Must be younger than 30.

“Catastrophic” Plan – for people under 30

What You Pay• Lower monthly premium (fee).• Preventive care is covered.• Insurance covers about 60% of your total medical costs.

Who Might Choose BronzeHealthy.

Don’t expect to use a lot of health care. Willing to take a financial risk.

Can’t afford a higher level plan.

Bronze Plans

Choose the Plan that Fits Your Needs

Bronze, Silver, Gold, or Platinum Plans

Platinum Plans

Choose the Plan that Fits Your Needs

Bronze, Silver, Gold, or Platinum Plans

What You Pay• Highest monthly premium (fee).• Preventive care is covered.• Insurance covers about 90% of your total medical costs.

Who Might Choose PlatinumExpect to use more health care.Already have medical problems. Don’t want to take a financial risk.

Can afford it.

What If I Don’t Get Insured?Exceptions:• Uninsured for less than 3

months in a row• All available insurance

options cost more than 9.8% of your income

• Undocumented immigrant• Belong to an exempt

religious sect

Why? Hospitals will save your life in an emergency – even if you have no insurance. If you can’t pay your hospital bills, people with insurance and the government (taxpayers) get charged more.

You’ll pay a fine:• In 2014: $95 (or 1% of your

income)• In 2016: $695 (or 2.5% of your

income)• Plus the cost of health care

($2500 for a broken ankle)

How Many Employees Do You Have?

1 to 49 50 or More

Buy insurance the way you always did.

Shop on the small business marketplace.

Small Business Marketplace (SHOP)

More information at BusinessUSA.gov

Small Business Marketplace (SHOP)

1 to 49employees

Shop on the Small Business Marketplace

2014 Coming Soon

Pick ONE plan for all employees.

Pick a VARIETY of plans for all employees.

Pay one lump sum to the SHOP exchange

More information at BusinessUSA.gov

Small Business MarketplaceTax Credits

2-24 full-time equivalent employees You pay at least 50% of premiums Average wages less than

$50,000/year

Up to 50% tax credit for premiums

Large Employer Penalties (delayed till 2015)

• More than 50 full-time equivalent employees• You don’t offer insurance OR employees can’t

afford the insurance you offer (they have to pay more than 9.5% of their income)

• One employee needs help from taxpayers (Medicaid or a tax credit) to be able to afford health care

You pay ($2000-$3000 per year) x (# of full-time employees)

*Would affect 1% of all employers.

It’s Easy to Sign Up (starting October 1)

STEP 1: You can apply in 3 ways

ONLINEHealthCare.gov

PHONE1-800-318-2596

IN PERSONSearch HealthCare.gov for

locations

*Note: If your state is running its own marketplace, you will be redirected to your state’s website and hotline.

STEP 2: Fill out the form. (5-7 minutes for an individual)

All you need is: Basic information about you and your family (age,

address, employer, social security number) Your income (W-2 or pay stubs)

If you have insurance or your employer offers insurance, you also need: Your insurance policy number Information about your employer’s insurance

ONLINEHealthCare.gov

PHONE1-800-318-2596

IN PERSONSearch HealthCare.gov

for locations

STEP 3: Submit the form.

MedicaidInsurance

marketplace with a tax

credit.

Insurance marketplace without a tax

credit.

IRS will verify your income based on last year’s tax return. Depending in income, you will qualify for:

ONLINEHealthCare.gov

PHONE1-800-318-2596

IN PERSONSearch HealthCare.gov

for locations

STEP 4: Pick Your Insurance Plan! Or enroll in Medicaid.

You’ve Signed Up! Pay your premium and wait 15 days.

Then get a doctor, and get the care you need!

ONLINEHealthCare.gov

PHONE1-800-318-2596

IN PERSONSearch HealthCare.gov

for locations

“Of all the forms of inequality, injustice in health care is the most shocking and

inhumane.”

― Martin Luther King Jr.

Spread the Word:Healthcare.gov1-800-318-2596

October 1, 2013 toMarch 31, 2014

For more resources, visit www.drsforamerica.org

SUPPLEMENTAL SLIDES

Paying for Reform1st 10-year net deficit reduction = $140 billionTaxes• Industry (insurance, pharmaceutical, medical devices) • On individuals

– Payroll: additional 0.9% Medicare payroll take on wages >$250,000 (couple), >$200,000 (individual)

– Capital gains: 3.8% tax on unearned income (interest, dividends) ONLY for those w/ income >$250,000

– “Cadillac Tax”: insurance plans >$27,500 (family) and >$10,200 (individual) taxed starting in 2018

– Tanning tax 10%

Medicare is saving $716 Billion.

• Medicare reimbursements rise at a lower rate, lower quality providers reimbursed less ($415B)– Less uncompensated care (more people with insurance) means

Medicare could slow the rate of growth of reimbursements. – Hospitals have a financial incentive to improve care.

• Medicare subsidies to private insurance companies are decreased to equal what we spend to take care of regular Medicare patients ($156B)

Bottom Line: The ACA increases benefits for seniors and the disabled.

Medicare is saving $716 Billion.

• Medicare pays lower subsidies to hospitals that were taking care of uninsured patients, now that many will be insured ($56B)

• All other, including enhanced fraud prevention ($89B)

Bottom Line: The ACA increases benefits for seniors and the disabled.