Welcome to this presentation “Find Your Way Around The Health Care Law”

If you are like many people, you may have questions about what the health care lawmeans for you. Learning the benefits and protections within the law, you can find yourway, get the facts, and make informed decisions for yourself and your family.

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Today’s session will provide an overview of the key benefits and protections within theAffordable Care Act, more commonly referred to as the health care law. We realizethere is, and will continue to be, a lot to learn about the health care law. This is astarting point to get you acquainted with the law and some of the key provisions.

Here is what today’s session will cover:

• We will go over what the law means for several groups of people:o Those who have insuranceo Those who do not have coverage or who buy coverage on their owno People with Medicare

We will also provide you with resources on where you can go for more information andassistance.

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(NOTE TO STATES: If available, please add state specific information where applicableon how the law has helped people in your state)

The health care law has already helped millions of people. Let’s start by discussing howthe law will provide benefits and protections for different groups of people - specifically,people with health insurance, people without health insurance and people withMedicare.

The first group we’re going to discuss are people who currently have health insurance.

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The law adds more consumer protections so you can be confident your health coveragewill be there for you when you need it!

For instance, as long as you continue to pay your premiums, health insurance companiescannot drop your health coverage if you become sick or disabled.

There are also protections in place to limit increases to insurance premiums. Insurancecompanies must now justify any rate increases of 10% or more and the must spendmore of your premium dollars on health care as opposed to administrative costs.

Starting in 2014, no one can be denied coverage because they have a pre-existingcondition, like asthma, diabetes, high blood pressure or even cancer.

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The law also makes changes in the limits that an insurance company can place on yourcoverage. Before the law was passed, some insurers could limit how much they wouldpay for your care during the year and over your lifetime. So, once your insurancecoverage ran out, you would either have to pay out-of-pocket for all of your medicalexpenses, or go without medical care.

Because of the health care law, insurance companies will no longer be allowed to limithow much they will pay for covered medical benefits over your lifetime—giving youpeace of mind that your benefits won’t run out when you need them the most.Insurance companies also won’t be allowed to limit how much they will pay for yourmedical benefits over the course of a year.

The ban on lifetime limits is in effect now, and the ban on annual limits starts in 2014.

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Another change under the law is in the area of preventive health services. Mostinsurance plans, including Medicare, must now cover certain preventive benefits such asimmunizations, and screenings for diabetes and certain cancers. This includesmammograms and colonoscopies.

Again, these benefits are in effect now. So, please check with your insurance plan to seewhich of these services are covered at no cost to you.

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As we all know, there are many Americans who either do not have health insurance, or haveto buy their own insurance.

Let’s take a look at how the health care law will affect this group.

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If you are uninsured or buy your own coverage, the health care law will make it easier to findhealth plans in your state and choose the plan that is best for you and your family. If you areuninsured, own a small business, or are self-employed, you will be able to purchase healthinsurance through the Health Insurance Marketplace in your state. Think of the Marketplaceas an online shopping mall for health insurance. The Marketplace is designed to help youfind health insurance in one place, where you can compare the benefits and costs of healthplans side-by-side.

The Initial Enrollment Period to sign up and purchase health insurance through theMarketplace will begin in October 1st this year (2013). Coverage will begin as early asJanuary 2014.

Remember, the Marketplace is for people by are uninsured or buy their own coverage. Ifyou are already covered by your employer or have coverage through Medicare you do notneed to purchase any additional coverage in the Marketplace. If you have Medicare,Medicare supplemental plans will not be available in the Marketplace. You will continue toenroll in Medicare or Medicare Advantage the same way you always have at medicare.gov

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Every health plan offered in the Health Insurance Marketplace is required to offer a core set of 10comprehensive benefits including doctor visits, emergency services, hospital care, prescriptions,preventive care and more.

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Health plans offered in the Marketplace will also have several levels of coverageto chose from.

Each level of coverage pays a different percentage of covered costs. This chartrepresents the levels of coverage for health plans offered through the Marketplace andwhat the plan pays on average and what you would pay on average--in addition to yourmonthly premium, of course.

For example, Silver level plans pay on average 70 percent of the costs of yourcovered benefits and you pay about 30 percent of the costs.

As you can see, these different level of coverage, gives you a way to make apples-to-apples comparisons so you can get a clear picture of coverage and costs before youdecide on a plan.

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One of the hallmarks of the law is that it provides financial help to pay for health insurancefor those who cannot afford coverage. Starting 2014, depending on your income, you maybe able to get financial help with the costs of your premiums and other out of pocket costsfor health insurance purchased through the Marketplace. For example, a family of fourearning less than $94,200 a year may be able to get financial help. Low-cost or free plans arealso available, depending on your income.

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As you know, there are many young adults who are no longer covered by a family policy or don’thave insurance through their job.

But, now, because of the health care law, you may be able to cover your son or daughter on yourinsurance policy until they reach age 26.

If you currently have your children on your health insurance, you can keep them on your familypolicy until they reach 26—even if they no longer live with you, are married, and are no longer inschool. You do not have to claim them as a dependent on your tax return. If your adult children arenot included on your health insurance, and you want them to be—you will be able to add them toyour policy — if your insurer provides family coverage.

However, if you’re adding adult children to your policy, their coverage may not begin until the startof your new insurance plan year.

It is important to note that insurance companies and employer-based plans are not required to offerfamily plans. So you will want to be sure to check with your insurance company or with youremployer to see if your adult children can be included on your family policy. Also, if you adultchildren have access to coverage through a job, you will not be able to add them to your plan. To beinsured, they will have to be enrolled in their employer’s health plan.

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Another way the health care law can help people who do not have health insurance isthrough the expansion of the Medicaid program. It is important to point out that it is up toeach state to decide if they wish to allow more people to get Medicaid.

Remember, Medicaid is a very different program than Medicare.

Medicaid is a health insurance program for low-income people that is jointly funded by thefederal government and the states. It currently provides health coverage to children, olderpersons, disabled persons, with low incomes.

Starting in 2014, if your state decides to expand their Medicaid program, you may be able toenroll in Medicaid. You would need to meet the income limits which are currently about$15,000 a year for an individual and about $20,000 per year for a couple. Note that thesefigures will most likely change in 2014 as they do every year.

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Let’s turn now to people with Medicare. What benefits and protections does the health carelaw have in store for this group?

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The law aims to improve Medicare by requiring Medicare to spend more wisely.

If you have Medicare, your guaranteed Medicare benefits are protected. This includesdoctor and hospital visits, and rehabilitation services. This is true whether you haveOriginal Medicare, which includes Part A and Part B, or a Medicare Advantage plan.

You will also receive improved benefits. For example, improvements to Medicare willlower your out-of-pocket costs for prescription drugs.

Before the health care law was passed, you would have to have paid all of yourprescription drug costs while you were in the doughnut hole. If you reach the MedicarePart D doughnut hole this year (2013), you’ll get a 52.5% discount on brand-nameprescription drugs and a 21% discount on generic prescription drugs while you are in thecoverage gap.

The gap will gradually narrow until it disappears in 2020. However, even after the gap isgone, everyone with Part D will still have the same level of cost sharing -- about 25% --from the time you meet your deductible until the time you reach catastrophic coverage.

Catastrophic coverage remains in place even after the coverage gap goes away.Catastrophic coverage starts when your total out-of-pocket drug costs have climbed to$4,750 in 2013. After that point, you only have a 5% co-payment.

(NOTE: NEXT SLIDE IS A SCREEN SHOT OF THE DOUGHNUT HOLE)

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Let’s take a minute to review the Medicare Part D Doughnut Hole. I know this can be confusing,so here’s a visual presentation of the doughnut hole that may be helpful.

Starting on the left side, this is your initial benefit period where you pay your Part D deductibleand about 25% of your drug costs. Moving to the middle, once you reach the initial coveragelimit, you are in what is commonly called the "Coverage Gap” or "Doughnut Hole,". You reachthe doughnut hole when you exceed a certain amount, which in 2013 is $2,970.

As I just noted on the previous slide, this year (2013), your Part D plan will pay about 52.5% ofthe cost of brand-name prescription drugs and about 21% of your generic prescription drug costswhile you are in the doughnut hole. By the way, exactly how much you pay out of pocket foreach drug while you are in the doughnut hole will vary widely depending on the Part D planyou’ve chosen and the price your plan has negotiated with the companies that manufactureyour drugs.

When your total out-of-pocket expenses for drugs on your plan’s approved drug list reaches$4,750, you reach the "Catastrophic Coverage " benefit. From then until the end of the year,you pay roughly 5% of your drug costs under the catastrophic benefit.

Just to clarify a bit …. your out of pocket costs include your deductible, copayments, andcoinsurance. But this does not include your Part D premiums.

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(NOTE:NEXT SLIDE IS A SCREEN SHOT OF THE DOUGHNUT HOLE CALCULATOR)

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You can use AARP’s Doughnut Hole Calculator to find out if or when you will hit thecoverage gap and you’ll also find recommendations for less expensive drugs.

When you click on the Doughnut Hole Calculator, you just enter your zip code and followthe steps. It’s easy to use and points you to ways to save right now on your drug costs.It’s at www.aarp.org/doughnuthole

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You no longer have to pay for Medicare-approved preventive care services. You will alsobe able to work with your doctor on a personalized prevention plan to keep you ashealthy as possible.

These are just a few of the examples of the preventive benefits that are now covered byMedicare. They include:•A yearly wellness visit. Screenings for diabetes and certain cancers. This includesmammograms, colonoscopies, and other preventive screenings.

•These preventive services are in addition to the free “Welcome to Medicare” checkupavailable to every new person with Medicare during the first year of entering theMedicare program.

•The Secretary of Health & Human Services may also add other tests, screenings, orcounseling, as we move forward in the future.

•You will not have to pay co-payments or deductibles for these Medicare-approvedpreventive care services.

Call Medicare at 1-800-633-4227 or visit www.medicare.gov to see which of theMedicare-approved preventive care services are covered at no cost to you. Your copy ofthe booklet Medicare and You also has a long list of all the preventive screenings nowavailable. You can get the booklet by calling Medicare at 1-800-633-4227.

If you are in a Medicare Advantage plan, check with your plan to see if you’ll have co-payments or deductibles for any screenings or tests.

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There’s a lot to absorb about the health care law. Here are some key points toremember:

The law :• Increases consumer protections• Makes it easier to find health insurance• Improves Medicare benefits

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There is a lot to learn about the health care law and the best way to stay informed is touse AARP’s online tool Health Law Answers. AARP’s Health Law Answers is the only toolof its kind in English and Spanish. This one-of-a-kind online tool explains what thehealth care law means for you and your family. Health Law Answers also provides youwith resources in your state.

The tool can be found by visiting www.HealthLawAnswers.org

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(NOTE TO STATES: If available, please add state specific information whereapplicable on where people can go for more information—for example, thephone # and website for the Health Insurance Marketplace in your state).

Of course, the AARP online health law Answers, with up-to-date information atHealthLawAnswers.org. You can also distribute the AARP factsheets and brochures.

You can also find answers to your Medicare questions at medicare.gov or by callingMedicare at (800) 633–4227.

Go to healthcare.gov for information on health insurance marketplaces and other healthresources in your state. Or you can call the Marketplace toll free contact center at (800)318-2596

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Has the health care law helped you? Will it be easier for you to get coverage now? If youhave a story that you want to share, AARP is listening. We are collecting personal storiesof people who have already benefited from the health care law. Personal storiesillustrate how the law impacts our members and their loved ones. Your stories help uslearn what is important to you, so we can continue to serve you and your family. Storiesalso help get the word out to the media, legislators, and other AARP members about theimportance of quality, affordable health care.

Your story may inspire others. Please go to:

www.aarp.org/shareyourthoughts

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You can find listings and registration information on future web events atwww.aarp.org/healthwebinars.

We will have more web events on the Affordable Care Act and on Medicare and hopeyou will join us again!

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