The Affordable Care

Act and

Health Benefits Exchange

What is the Affordable Care Act?

The ACA put in place many reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. The law guarantees access to care for our most vulnerable, and provides new ways to bring down costs and improve quality of care.

What is the Affordable Care Act?

The ACA also requires individuals to have health insurance coverage beginning in 2014 and introduces new Insurance Affordability Programs (IAPs) that provide tax credits and cost sharing reductions to eligible individuals.

What are Insurance Affordability Programs (IAPs)?

• MAGI Medicaid • KCHIP• Advanced Premium Tax Credits (APTC)

to help pay insurance premiums

• APTC with Cost Sharing Reductions

(CSR) to help reduce out of pocket

costs

Health Benefits Exchange

As part of the requirements of the ACA, individuals and small businesses have access to a Self Service Portal (SSP) to apply for IAPs and shop for and purchase affordable Qualified Health Plans (QHPs) through an Exchange. Kentucky’s Health Benefits Exchange is known as “kynect”.

What is kynect?kynect is essentially a marketplace. It will serve individuals, families and small employers and provide access to a range of health coverage options. Individuals can enroll in a Qualified Health Plan (QHP) or MAGI Medicaid on kynect.

kynect will certify that all health plans sold meet federal requirements.

What is kynect?The kynect system will identify Insurance Affordability Programs for which the consumer may be eligible.

QHPs are displayed in a “shop and compare” format based on price, benefits, quality, and other features.

What is kynect?

Through kynect individuals can:• Get answers to questions • Compare health insurance plans• Find out eligibility requirements for Medicaid, KCHIP, tax credits and Cost Sharing Reductions• Enroll in Medicaid, KCHIP or an insurance plan

DCBS Roles & Responsibilities

• Explain what a Health Insurance plan is

• Help understand Managed Care and choose an Managed Care Option

• Address issues concerning applications using the worker portal

• Understand the roles of other kynectors

Who Can Assist?

“kynectors” will help individuals and small businesses apply for Qualified Health Plans and Insurance Affordability Programs on the Self-Service Portal.

Who Can Assist?kynectors are entities that meet the federal requirements of the Navigator program:• Maintain expertise in Exchange eligibility,

enrollment, and programs• Provide information services in a fair, accurate, and

impartial manner• Help with enrollment in health insurance plans• Provide referrals to other agencies as needed, such

as health insurance Consumer Assistance Programs or Ombudsman, State agency for complaints, questions, etc.

kynector Roles

Role Responsibility

Navigator(starting in

2015)

In-Person Assistor (IPA)

Certified Application

Counselor (CAC)

Personal advising

Cannot guide an individual towards a given plan

Cannot guide an individual towards a given plan

May offer personal guidance in regards to plans available

Level of involvement

Personal involvement, but no at-home visits

May interact with individuals at home or in person

May interact with individuals at home or in person

Overseeing Agency

Kentucky Health Benefit Exchange

Kentucky Health Benefit Exchange

Kentucky Health Benefit Exchange, DMS, KHBE Designated Employees

The three kynector roles of Navigator, IPA, and CAC have important differences in responsibilities:

The Role of Insurance Agents

Health insurance agents represent an individual or small business in the solicitation, negotiation, or procurement of insurance policies.

Agents have a duty to the individual or small business seeking coverage to match their insurance needs with proper products and options available.

Roles and Responsibilities

 kynector

Family Support worker

Insurance Agent

Customer Service Center (CSC)

Explain what a Health Insurance Plan is x x x xHelp consumers select a Health Insurance Plan xHelp understand Managed Care and choose an MCO x x x xHelp consumers understand which health plans are available to them

x x x x

Address issues concerning applications using the Worker Portal

x

Understand the roles of other kynect stakeholders x x x x