Understanding the New Health Insurance Marketplace

1Presenter Name, Title

Objectives for this session:

Why Does Health Coverage Matter?

Greater use of preventive services & access to primary care

More likely to take medications to help control risk factors

More likely to actually call 9-1-1

Better health outcomes & significantly lower CVD mortality

Sources: Gibbons RJ, Jones DW, Gardner TJ, Goldstein LB, Moller JH, and Yancy CW. “The American Heart Association’s 2008 Statement of Principles for Healthcare Reform.” Circulation 2008: 118. Collins SR, Robertson R, et al. “Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act: Findings from the Commonwealth Fund Biennial Health Insurance Survey.” The Commonwealth Fund, April 2013.

Overview of Health Insurance Marketplace

• A new, easier way to buy health insurance

• A single location where uninsured individuals & small employers can shop for & easily compare coverage options

• Available in all 50 states plus DC

• Know upfront what your costs & benefits will be before choosing a plan

• Choose the plan that best meets your needs, budget

Also Coming Soon – New Insurance Protections

• Cannot be denied coverage due to pre-ex condition

• Cannot be charged higher premiums due to health status, gender

• Coverage of routine clinical trial costs

• Coverage of preventive services at no additional cost

• No more lifetime or annual limits on coverage

Who can use the new Marketplace?

• Uninsured individuals & families

• Small employers with ≤ 50 workers

• Must be U.S. citizens or legal residents

• Cannot be incarcerated

** If you already have affordable coverage through your employer, Medicare, or another program, you can keep it.

Who are the Uninsured?

• 48 million uninsured (7.3 M with CVD)

•93% have incomes under 400% poverty ($45,000

individual/$94,000 family of 4)

• 75% in working families

• 45% women, 55% men

• 45% white, 32% Latino, 15% Black

• 78% unaware of new coverage options

Sources: 2010 Census Data. “Informing Enroll America’s Campaign: Findings from a National Study;” January 2013.

How the Marketplace Works• Private insurance companies compete for your business• A single application to determine eligibility for:

– Insurance coverage through the Marketplace– New types of financial assistance to make coverage

affordable– Medicaid– Children’s Health Insurance Program

Marketplace Health Plans

• Hospital care• Doctors’ office visits• Emergency care• Prescription drugs• Maternity & newborn care

• Rehabilitative services & devices

• Laboratory services• Preventive services• Mental health care• Pediatric services

• All plans sold through the Marketplace must meet minimum requirements

• All plans in the Marketplace must cover 10 categories of essential benefits:

New Type of Financial Assistance to Make Premiums Affordable

• New type of tax credit is available for individuals & families to help make premiums affordable

• 90% of uninsured will be eligible for the credit

• Amount of credit depends on income & family size – the lower your income, the more help you receive

• You choose how to take the credit – use it right away to reduce monthly premiums or receive the credit when you file your taxes

Eligibility for the Health Insurance Premium Tax Credit

People with income ≤ 400% of poverty:FAMILY SIZE INCOME ≤ ABOUT:

1 $46,000

2 $62,000

3 $78,000

4 $94,000

** Must buy coverage through the Marketplace to receive the credit

When People Can Enroll

OR

In special circumstances such as you lose your health insurance, move, get married, or have or adopt a child

OR

Anytime for people eligible for Medicaid/CHIP

How to Enroll in Coverage

Note: The application and website are also available in Spanish (www.CuidadoDeSalud.gov) and the toll-free number will provide assistance in 150 different languages. Individuals will also be able to enroll through the mail.

In-Person Enrollment Assistance

1. Certified Navigators

2. Certified Application Counselors

3. Licensed Agents or Brokers

Four Steps to Using the Marketplace

15

Key Points to Remember• Everyone should have health insurance because it helps

you get needed care and it also protects your family financially in a medical emergency.

• The new Health Insurance Marketplace opening in your state this fall makes it easier to shop for and compare health plans and choose the plan that’s right for you.

• You can’t be turned down for coverage, even if you have a medical condition.

• Most people who are uninsured will qualify for financial assistance to help make premiums affordable.

• Open enrollment is October 1 – March 31.

Need More Information?

Check out these websites for more information from the American Heart Association:

www.heart.org/healthinsurance

www.heartsforhealthcare.org