the marketplace and cobra: what employers and employees need to know presented by: emily brostek,...

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The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable Health Care December 17, 2014

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Page 1: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

The Marketplace and COBRA:

What employers and employees need to know

Presented by:Emily Brostek, MPH, CHES– Executive Director

Consumers for Affordable Health Care

December 17, 2014

Page 2: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

Agenda

• ACA and Marketplace Basics

• The Marketplace & COBRA

• Helping Employees Understand Their

Options

www.mainecahc.org 2

Page 3: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

Our Mission

To advocate the right to quality, affordable health care for every man, woman and child in Maine.

www.mainecahc.org 3

Page 4: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

About Consumers for Affordable Health

Care• Non-profit, non-partisan mission-driven research and advocacy organization based in Augusta (founded in 1988)oConsumer Assistance Program and

HelpLine (1-800-965-7476)oPublic Policy Research and Advocacy

www.mainecahc.org 4

Page 5: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

Marketplace Basics

Page 6: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

The Health Insurance Marketplace

The Health Insurance Marketplace helps people without insurance find health coverage

When you apply, you’ll learn if you qualify for:• Lower costs on private insurance plans

based on your household size and family income

• Other programs like MaineCare and the Children’s Health Insurance Program (CHIP)www.mainecahc.org 6

Page 7: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

1. Advanced premium tax credits

(APTCs)

2. Cost sharing reductions

(CSRs)

Two kinds of financial help:

www.mainecahc.org 7

Page 8: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

Marketplace Eligibility

www.mainecahc.org 8

You may be able to get help with the cost of Marketplace plans if…oYou do NOT have access to insurance

at work, or insurance at work is unaffordable AND;

oYou do NOT have access to public insurance like Medicare or Medicaid AND;

oYour household income is between:

Page 9: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

Tax Credit Eligibility

www.mainecahc.org 9

2014 Plans

1 person: $11,490-$45,960

2 people: $15,510-$62,040

3 people: $19,530-$78,120

4 people: $23,550-$94,2002015 Plans

1 person: $11,670-

$46,6802 people: $15,730- $62,9203 people: $19,790- $79,1604 people: $23,850- $95,400

Page 10: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

www.mainecahc.org 10

Financial help is on a

sliding scale.

Page 11: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

Who can go to the Marketplace?

• Anyone can purchase a Marketplace plan

Exceptions!Those who get Medicare Part A free

(most people on Medicare)

www.mainecahc.org 11

Page 12: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

These groups won’t usually use the Marketplace

• Medicare recipients

• Medicaid recipients

• Military/veterans • If you have an employer plan (or dependent

coverage through a spouse’s or parent’s plan) unless it’s “unaffordable” or “crappy” www.mainecahc.org 12

Page 13: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

• Marketplace plans may be a good option for people who are eligible for COBRA

• Employees need help understanding their options, and when different options are available

Marketplace and COBRA

www.mainecahc.org 13

Page 14: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

• Most people are only able to sign up for a plan on the Marketplace during Open Enrollmento For 2015: November 15, 2014 – February 15, 2015

• Some people qualify for Special Enrollment Periods outside of Open Enrollment if they have certain life events happen to themo Losing another kind of coverage qualifies you for a SEP

Timing Matters!

www.mainecahc.org 14

Page 15: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

• When someone loses their employer-based coverage, they can choose COBRA or the Marketplace

COBRA or Marketplace?

www.mainecahc.org 15

Page 16: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

• If they choose COBRA:o They can’t switch to Marketplace until the next

Open Enrollment periodo They can switch during Open EnrollmentoWhen COBRA expires, they can get a Special

Enrollment Period and sign up on the Marketplace

COBRA or Marketplace?

www.mainecahc.org 16

Page 17: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

• If they choose the Marketplace and forego COBRA:o They have 60 days from when coverage will

end to enroll in a Marketplace plan through a Special Enrollment Period

oDepending on income, they may be able to get financial help on the Marketplace

COBRA or Marketplace?

www.mainecahc.org 17

Page 18: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

www.mainecahc.org 18

Page 19: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

• Differences between plans, including:o Costo Total out-of-pocket expenseso Provider networks

• Timing – when is each option available?• Marketplace eligibility – can they get

financial help?o Other coverage availableo Projected income

Helping Employees Understand Their

Options

www.mainecahc.org 19

Page 20: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

• Local help is available to help people understand their options, and apply to the Marketplace

• Find local help:o Enroll207.com oCall our HelpLine at 1-800-965-7476

You Don’t Have to Do It Alone!

www.mainecahc.org 20

Page 21: The Marketplace and COBRA: What employers and employees need to know Presented by: Emily Brostek, MPH, CHES– Executive Director Consumers for Affordable

Q & A and Thank You!Consumers for Affordable Health Care

HelpLine: 1-800-965-7476

Web: http://www.mainecahc.org

YouTube: http://www.youtube.com/user/mainecahcchannel

Facebook: http://www.facebook.com/MECAHC

Twitter: @MAINECAHC

www.mainecahc.org 21