oregon affordable care act_mckenzie river chamber presentation

USA Benefits Group“The State of Health Insurance”

• Patient Protection and Affordable Care Actaka: Obama Care

Tom Koanui541-914-8441

Shonna Butler541-870-0815



Cover Oregon Health Care Insurance Exchange

The Health Insurance Exchange is an online Market Place for people to shop and purchase PPACA plans. PPACA plans will be available through a public exchange, private exchanges, and off-exchanges in Oregon. The State of Oregon was granted a $182 million grant to develop what we now know as Cover Oregon. Cover Oregon is the only public exchange in the state of Oregon and will be the only means to acquiring a tax or cost share subsidy. Oregon is one of 3 states that have a fully functioning public exchange in operation today and Oregon leads the nation in health care benchmarks.

Patient Protection Affordable Care Act

• Adopted on March 23, 2010• Prior to March 23, 2010 plans are grandfathered • Most Americans are required to purchase• Exempt: certain religious groups, Native American Tribe, undocumented immigrants, prisoners, low income• 2 types of subsidies to help offset health care costs• Important dates to remember:

- Open enrollment: Oct. 1, 2013 to Dec. 31, 2013- Extended enrollment: thru March 31, 2014- Plan effective date: Jan. 1, 2014

• Creation of the health insurance exchange




Highlights for January 01, 2014• All individuals MUST have E.H.B. (Essential Health Benefits)• Guaranteed acceptance• No pre-existing condition exemptions• Maximum waiting periods of 90 days• NO RATING for health, gender, build & industry• 100% coverage for wellness visits • Metallic Levels: Bronze- Silver- Gold- Platinum• Insurance companies are required to spend 80 cents of each premium dollar on the cost of care




Essential Health Benefits (EHB):1. Ambulatory patient services2. Emergency services3. Maternity and newborn care 4. Pediatric services, including dental and vision care5. Rehabilitative/habilitative services and devices6. Mental health and substance use disorder services,

including behavioral health treatment7. Preventive and wellness services and chronic disease management8. Hospitalization9. Prescription drugs10. Laboratory services




How will Health Reform affect me?


Individual: - Required to purchase- Penalty= 1% of taxable income or $95- May be eligible for tax subsidy - May be eligible for cost share subsidy- Estimated “taxable income” from previous year- Must purchase on exchange for subsidy- Non-medicare eligible may purchase- Need a knowledgable agent

Tax Subsidy:- Federal Poverty Level: $11,490-133% to 400% FPL- Single: $15,282 to $45,960- Couple: $20,928 to $62,040- Family: $31,322 to $94,200

Cost Share Subsidy:-100-150% FPL= 94%- 150-200% FPL= 87%- 200-250% FPL= 73%- 250-400% FPL= 70%

NOTE: Based on Silver Plan Actuarial Values


How will Health Reform affect my business?


Small Business: - < 50 FTE not required to offer coverage- Penalty= 0- May be eligible for premium tax credit - May be eligible for full premium tax credit- May purchase on the exchange- Oregon zip code to purchase on exchange- Need a knowledgable agent

Premium Tax Credit:- If elect to offer coverage-Pay min. 50% of FTE only- < 25 FTE- Average income of $50K

Full Premium Tax Credit:- Up to 35% of FTE only premium- < 10 FTE- Average income of $35K


How will Health Reform affect my business?


Large Business: - > 50 FTE required to offer coverage- Penalty= the lesser of $2,000 /FTE or $3,000 for each employee that receives subsidy, minus 30.- May be eligible for premium tax credit - May be eligible for full premium tax credit- Required to notify employees of PPACA and your choice- May purchase on the exchange- Oregon zip code to purchase on exchange- Realize increased cost of materials and supplies- Must consider price increases on products and services to cover additional expenses- Need a knowledgable agent


PPACA Plan Design



Employer Program Requirements


Oregon Exchange Plan Design



Exchange Prescription Drug Plan




Proposed Rates and Subsidies



IndividualProposed Rates for Standardized Plans

(Based on age 40 Non-Tobacco) Bronze 60% Silver 70% Gold 80%

Moda (ODS): $169 $225 $276

LifeWise: $195 $252 $303

Pacific Source: $195 $257 $323

Regence: $237 $280 NA

Kaiser: $229 $291 $344

Trillium: $401 $486 $563



Subsidies

Individual:

Silver Plan $368

Income:$20 K $283$26K $212$32K $131$38K $67$42K $36

Family of 4:

Silver Plan $1,102

Income:$42K $916$50K $822$60K $693$70K $553$80K $469



Small BusinessProposed Rates for Standardized Plans

(Based on age 40 Non-Tobacco) Bronze 60% Silver 70% Gold 80%

Moda (ODS): $209 $309 $375

LifeWise: $220 $292 NA

Pacific Source: $271 $358 $448

Regence: $268 $316 NA

Kaiser: $222 $299 $354

OR Co-Op: $284 $338 $403



Please consider scheduling a time to meet with us to discuss PPACA privately or with

a group of friends or family.

Questions?If you would like to receive updates regarding

PPACA, please give us your email address


oregon affordable care act_mckenzie river chamber presentation

Health & Medicine

health reform affect

oregon zip code

cost share subsidy

premium tax credit

average income

tom koanui541

8441shonna butler541

shonna butler541