the affordable care act (aca)

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The Affordable Care Act (ACA) • Overview – Housekeeping (Introduction, Questions, Timing, ) – Why Pre-Retirees are interested in the ACA – Affordable Care Act Important Changes – How much does health care cost – Health plans offered through Covered California in Butte County – Scenarios – If I missed open enrollment – Questions

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The Affordable Care Act (ACA). Overview Housekeeping (Introduction, Questions, Timing, ) Why Pre-Retirees are interested in the ACA Affordable Care Act Important Changes How much does health care cost Health plans offered through Covered California in Butte County Scenarios - PowerPoint PPT Presentation

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Page 1: The Affordable Care Act (ACA)

The Affordable Care Act (ACA)

• Overview– Housekeeping (Introduction, Questions, Timing, )– Why Pre-Retirees are interested in the ACA– Affordable Care Act Important Changes– How much does health care cost– Health plans offered through Covered California in Butte

County– Scenarios– If I missed open enrollment– Questions

Page 2: The Affordable Care Act (ACA)

Why do “pre retirees” care about the Affordable Care Act?Not currently employed and so, without employer-

sponsored insurancePreviously rejected by insurers for pre-existing

conditionsWaiting for Medicare

Not previously categorically eligible for MediCal (no children, not aged and not disabled)

Their children not quite launched and no employer-sponsored health care (18-26yrs.)

Taking care of older adult parents and wondering if this effects them

Page 3: The Affordable Care Act (ACA)

Affordable Care Act BasicsImportant Changes

Standard comprehensive benefits– Ambulatory patient services– Emergency services.– Hospitalization.– Maternity and newborn care.– Mental health and substance use disorder services, including

behavioral health treatment.– Prescription drugs.– Rehabilitative and habilitative services and devices.– Laboratory services.– Preventive and wellness services and chronic disease management.– Pediatric services, including dental and vision care.

Page 4: The Affordable Care Act (ACA)

Affordable Care Act BasicsImportant Changes

– No denial or higher premiums for those with pre-existing conditions

– Coverage of preventative care without cost sharing

– No lifetime or annual limits in health insurance policies

– Limiting changes in premium related to age

Page 5: The Affordable Care Act (ACA)

How much does Health insurance cost?

1) Expanded MediCal Assistance Free coverage for persons with incomes up to 138% of poverty), which is income of less than $15,856 for an individualChildless, non elderly and non disabled persons

2) Sliding Scale of premium subsidy amounts- 139% of poverty to 400% of poverty, which is $15,857-$28,725 for an individual

Page 6: The Affordable Care Act (ACA)

How much does Health insurance cost? (continued)

3). Help with the out of pocket costs, such as co-payments -Up to 250% of poverty or $15, 857-$28,725 for an individual.

4). Covered California Plans without subsidies (above 400% of poverty)– Four levels of coverage and a minimum coverage plan (for

those with special hardship circumstances and under 30)– Your choice: Higher monthly premium, so when you need

coverage you pay less, or lower monthly premium and if you need coverage you will pay more.

Page 7: The Affordable Care Act (ACA)

Health plans offered through Covered California in Butte County

• Anthem Blue Cross of California (PPO)• Blue Shield of California

(EPO)

Page 8: The Affordable Care Act (ACA)

Types of Health Plans offered in Butte County through Covered California

Preferred provider organization (PPO) plan – • An indemnity plan where coverage is provided to participants through a

network of selected health care providers (such as hospitals and physicians). • The enrollees may go outside the network, but would incur larger costs in

the form of higher deductibles, higher coinsurance rates, or non-discounted charges from the providers.

Exclusive provider organization (EPO) plan – • A more restrictive type of preferred provider organization plan under which

employees must use providers from the specified network of physicians and hospitals to receive coverage;

• there is no coverage for care received from a non-network provider except in an emergency situation.

Page 9: The Affordable Care Act (ACA)

Scenarios

• 55 year old, single individual who works 20 hours a week and makes $10.00 an hour or $10,400 a year.

• Likely qualified for expanded MediCal, free coverage

• 62 year old and 63 year old married individuals, annual household income is $54,000.

• Bronze PPO plan starts at $27 a month premium (with subsidy), up to $948 monthly premium (with subsidy) for a Platinum PPO plan for the couple

Page 10: The Affordable Care Act (ACA)

If I missed open enrollment….

• MediCal has no special open enrollment period, every day is open enrollment

• If you have qualifying life event, e.g., loss of employer-sponsored health insurance, lose your MediCal eligibility due to an increase in income, marriage, you may sign up for coverage within 60 days of that event with a special enrollment.

• Tax Penalty is $95. for an individual or 1 percent of yearly income whichever is larger. The fee will increase in 2015 and 2016.

Page 11: The Affordable Care Act (ACA)

Questions?

Thank you!