Montana Affordable Care Act Update

The Problem

Goal: Transforming Health Care

It is now illegal for insurance companies to:

• Deny coverage to children because of a pre-existing condition like asthma or diabetes.

• 319,000 Montana residents including 116,000 women and 81,000 children are free from worrying about lifetime limits on coverage.

• Cancel your coverage when you get sick by finding a mistake on your paperwork.

Coverage Now: The Law Stops Insurance Companies

from Taking Advantage of You

In 2011, 100, 762 Montanans with Medicare received free preventive services like - Cancer screenings such as mammograms & colonoscopies.

In the first 9 months of 2012 68,261 people in Montana with Medicare received free preventive services.

Montanans with private health insurance gained preventive services with no cost-sharing in 2011 benefitting 166,000 people.

140,400 women in Montana will now have guaranteed access to additional preventive services without cost sharing

Visit www.healthcare.gov/prevention for a full list.

The Law Increases Your Access to Affordable CareIn many cases, you can get preventive services for free:

The Prevention and Public Health Fund offers an investment in promoting wellness, preventing disease, and protecting against public health emergencies.

Much of this work is done in partnership with States and communities.

• For Montana this means $3,900,000 to in Prevention Funds

ACA Prevention and Public Health Fund:

Young adults under the age of 26 can now stay on their parents’health plans. 3.1 million have already done so.

In Montana--12,000 young adults gained insurance

“I honestly don’t know what we would have done…. There was no way we could have afforded it. I might not be here right now.”

--Kylie L., 23, in Illinois, who credits the health care law for enabling a life-saving heart transplant

The Law Increases Your Access to Affordable Care

• Preserves guaranteed benefits under Medicare.

• Makes recommended preventive services available without cost-sharing.

• Provides patients with an annual wellness visit.

• 50% discount on covered brand-name drugs in the donut hole – Montana residents with Medicare saved $13,612,028 on prescriptions or an average of $628.

• Donut hole closes in 2020.

• Includes strong anti-fraud measures, including tougher penalties for criminals.

Strengthens Medicare

BEFORE, insurance companies spent as much as 40 cents of every premium dollar on overhead, marketing, and CEO salaries.

TODAY, we have the new 80/20 rule: Montana, 25,353 residents with private coverage will benefit from $2,607,244 in rebates for an average of $194 for 13,400 families.

If they don’t, they must repay the money.

The Law Makes Health Care More Affordable

60% / 40%

80% / 20%

In every State and for the first time federally, insurance companies are required to publicly justify rate increases of 10% or more.

Montana has received $1,000,000 under the new law to help fight unreasonable premium increases.

The Law Makes Health Care More Affordable

Empowering states to better protect their consumers

• Partnership for Patients

• Accountable Care Organizations (ACOs)

• Bundled Payments for Care Improvement

• Comprehensive Primary Care Initiative & Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration

• A Million Hearts

ACA Programs Happening NOW

Essential Health Benefits

• Outlines policies and standards for coverage, while giving states flexibility to implement the Affordable Care Act.

• Essential health benefits are a core set of benefits that give consumers a consistent way to compare health plans in individual and small group markets.

– Actuarial Value: The percentage of total average costs for covered benefits that a plan will cover.

– Accreditation Standards: Accept existing health plan accreditation from the National Committee for Quality Assurance (NCQA) and URAC. 

New ACA Proposed Rules: Essential Health Benefits

Beginning in 2014, health insurance companies would be prohibited from discriminating against individuals because of a pre-existing or chronic condition. 

Under the rule, insurance companies would be allowed to vary premiums within limits, only based on age, tobacco use, family size, and geography. 

For more information regarding this rule, visit: http://www.healthcare.gov/news/factsheets/2012/11/market-reforms11202012a.html.

New ACA Proposed Rule: Prohibition of Discrimination

• Implements and expands employment-based wellness programs to promote health and help control health care spending.

• This and the other proposed rules would be effective for plan years starting on or after January 1, 2014. 

• For more information regarding this rule, visit: http://www.healthcare.gov/news/factsheets/2012/11/wellness11202012a.html

New ACA Proposed Rule: Employer Wellness Programs

New Health Exchanges: 2014

• Starting in 2014, if your employer doesn’t offer insurance, you will be able to buy it directly in an Affordable Insurance Exchange.

• An Exchange is an insurance marketplace for individuals and small businesses to buy coverage.

• Exchanges will offer you a choice of health plans that meet certain benefits and cost standards.  

Basic Health

Small Businesses

Individuals

IRSSSA

Qualified Health Plans

SHOP Qualified Health Plans

SHOPExchange

State Health Insurance Exchange

What is a Health Insurance Exchange?

Starting 2014:

• Discriminating against people with pre-existing conditions is illegal.

• There will be new State-based marketplaces – called Affordable Insurance Exchanges – where you’ll have a choice of private plans.

• Tax credits will make buying insurance more affordable.

The Law Provides Better Options for Getting Coverage

 • The law builds on our private health insurance system.

• The law gives states significant flexibility in implementing the law. If states can identify their own path to accomplish the same goals, they’re free to take it.

• The law does not add to the deficit. According to the independent Congressional Budget Office, the law is paid for.

Closing Thoughts

Learn More

http://www.healthcare.gov/ Social Networks

Marguerite SalazarRegional Director, Region VIIIU. S. Department of Health and Human Services999 18th Street, Suite 400Denver, CO  80202 303 844-3372 – OfficeMarguerite.Salazar@hhs.gov