Understanding The Affordable Care Act (ACA)

Time to learn your…

The Benefit Bank of South Carolina

OUR MISSIONOUR MISSIONProvide training and access to innovative tools and resources that give people the opportunity to improve their financial, health

and household stability.

We Connect People to What They Need

1.800.726.87741.800.726.8774

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& safe

Electronic submission of applications

Quick Check: eligibility calculator

Quickly screen clients to see their potential eligibly for all programs TBB-SC offers, eligibility for tax credits or cost sharing.

After one interview, several applications for several agencies are completed and eFiled with appropriate agency.

Medicaid will transfer ineligible applicants to The Marketplace for processing.

System has ‘two key lock’ entry. Information is saved for future use.

TBB-SC Application Process

Basic ACA Provisions

The Marketplace – www.healthcare.gov

TBB-SC Sites Navigators Certified Application Counselors Agents and Brokers

Enrollment Assistance

October 1, 2013: Marketplace open enrollment startsJanuary 1, 2014: Health coverage can startMarch 31, 2014: Open enrollment ends

To enroll in the Marketplace you must:•live in the service area•be a US Citizen or lawfully present •not be incarcerated

Open Enrollment

Minimum Essential Coverage

• Any Marketplace plan or individual insurance plan you already have

• Any employer plan • Medicaid or Medicare • TRICARE • Peace Corps Volunteer plan• Certain other plans

The Penalty

Exemptions Granted by the MarketplaceExemptions Granted by the Marketplace

•Hardship, including lack of coverage based on projected income•Membership in a health care sharing ministry•Incarceration•Member of a Federally Recognized Tribal Member •Membership in a recognized sect that objects to health coverage

When the penalty does NOT apply.

Exemptions Granted by IRS on a Federal Income Tax Exemptions Granted by IRS on a Federal Income Tax ReturnReturn•Lack of coverage based on actual income•Income below the federal income tax filing threshold•Unlawful presence in the US•Lack of insurance coverage for less than 3 consecutive months between months of coverage•Hardships•Incarceration•Membership in a health care sharing ministry•Membership in a federally recognized tribe

When the penalty does NOT apply.

• An insurance plan that is certified by the Health Insurance Marketplace

• Follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts)

• Meets other requirements of qualified coverage.

Qualified Health Plan

High deductibles and lower premiums

3 primary care visits and preventive services at no extra cost

Protection from high out-of-pocket costs

Catastrophic Plans

• Small businesses with 50 or fewer employees.

• Employers must offer coverage to all full time employees.

• This gives them buying power for affordable coverage.

Small Business Health Options Program (SHOP)

All plans have a

premium

All plans have a

premium

The higher the

premium the lower the out of

pocket costs.

The higher the

premium the lower the out of

pocket costs.

Qualified Health Plan Levels of Coverage

Sometimes called Subsidy or Advance Premium Tax Credit

or Premium Tax Credit.

Based on family income and size and not eligible for Medicaid• Family of 4 with annual income between 100%FPL

($23,550) and 400%FPL $94,200)• Individual with annual income between 100%FPL

($11,490) and 400%FPL $45,960)

Lower Monthly Premiums

Lower out-of-pocket costs:Lower out-of-pocket costs:DeductibleDeductible CoinsuranceCoinsurance CopayCopay

•Family of 4 with annual income at or below 250%FPL ($58,875)

• Individual with annual income at or below 250%FPL ($28,725)

Costs Savings

Changes to SC Medicaid

• New income methodology • Mirrors Federal tax filing

income rules

• Applied to certain Medicaid groups

Modified Adjusted Gross Income (MAGI)

1. First do a Quick Check2. Submit applications3. If not eligible for Medicaid or ACA cost

savings, refer to a local FQHC or free clinic.

4. If not eligible for Medicaid but eligible for ACA cost savings1. Refer to www.healthcare.gov if comfortable

with a computer2. Go to www.localhelp.healthcare.gov to

identify local assistance3. Refer to ACA Call Center 800-318-2596800-318-2596

Assisting the Uninsured

• Counselor Training (Benefits & Taxes)• Medicaid• Computer Security• Computer 101• Financial Wellness• Affordable Care Act (ACA)• Charity Tracker• Mental Health First Aid

1.800.726.8774

TBB-SC Provides Training

Questions?

107 Saluda Pointe DriveLexington, SC 29072

800.726.8774 803.454.3860 (f)www.tbbsc.org