PNA COMPANYPresents

Healthcare Reform for Individuals/Families

This PowerPoint contains information we have gathered

from state and federal communications.

Although largely accurate, the governing bodies “CAN” and

“MAY” change some of what you hear today.

Bottom Line: This is what we know TODAY.

Patient Protection & Affordable Care Act (PPACA)Also-Known-As (AKA) - “OBAMACARE”

1. March 23, 2010 - Healthcare law enacted.

2. August 2010 - HHS (Health and Human Services Dept.) started issuing planning grants to states.

3. July 11, 2011 - HHS issued first set of proposed rules

4. June 28, 2012 - Supreme Court approves PPACA

5. October 1, 2013 - Open enrollment begins

6. January 1, 2014 - Mandatory Exchange coverage begins

Exchange TimelineHEALTHCARE REFORM

PPACA Annual Open Enrollment period (AOE)

• October 1, 2013 till March 31, 2014

• October 15, 2014 till December 7, 2014

• October 15, 2015 till December 7, 2015

• October 15, 2016 till December 7, 2016

NO UNDERWRITING/GUARANTEED ISSUE

Penalties for Individuals under PPACA:

• 2014 – The Greater of $95 or 1% of taxable income

• 2015 – The Greater of $325 or 2% of taxable income

• 2016 – The Greater of $695 or 2.5% of taxable

income

• 2017 and beyond - Annual adjustments

In California, ACA will subsidize at 100% of the premium up to 138% of the Federal Poverty Level (FPL). Once you have identified eligibility based on the client’s Modified Adjusted Gross Income (MAGI) found on the first page of your 1040, other factors decide the final subsidy.

Modified Adjusted Gross Income (MAGI)• The Modified Adjusted Gross Income (MAGI) is calculated by adding back certain

items to your Adjusted Gross Income. Your Adjusted Gross Income (AGI) can be found on line 38 of your Form 1040; line 22 of your Form 1040A; or line 36 of your Form 1040NR. IF YOU HAVE NOT FILED A PRIOR YEAR TAX RETURN, NO SUBSIDY WILL BE GIVEN!

• The following items must be added to your Adjusted Gross Income (AGI) to calculate your Modified Adjusted Gross Income (MAGI):

Traditional IRA contributions that were deducted. Student loan interest amounts deducted. Tuition and fees deducted. Domestic production activities deducted. Foreign income or housing costs excluded on Form 2555. Foreign housing deduction taken on Form 2555. Savings bond interest excluded on Form 8815. Adoption benefits from an employer excluded on Form 8839.

2013 Federal Poverty LevelHousehold Size

100% 138% 150% 200% 300% 400%

1 $11,490 $15,856 $17,235 $22,980 $34,470 $45,960

2 $15,510 $21,403 $23,265 $31,020 $46,530 62,040

3 $19,530 $26,951 $29,295 $39,060 $58,590 $78,120

4 $23,550 32,499 $35,325 $47,100 $70,650 $94,200

5 $27,570 $38,046 $41,355 $55,140 $82,710 $110,280

6 $31,590 $43,594 $47,385 $63,180 $94,770 $126,360

7 $35,610 $49,141 $53,415 $71,220 $106,830 $142,440

8 $39,630 $54,689 $59,445 $79,260 $118,890 $158,520

Each extra Person

$4,020 $5,547 $6,030 $8,040 $12,060 $16,080

2.6 Million are eligible for Premium Subsidies and 2.7 are uninsured in CA, 5.3 total

Healthcare Providers in CA

58 COUNTIES HOSPITAL PHYSICIANS NETWORK

Anthem Blue Cross All regions 300 30,000PPO

EPO (SF 4)HMO (Santa Clara 7)

Blue Shield of CA All regions 223 22,040PPO

EPO (Monterey)

Healthnet 13 counties 204 44,0002,4,5,7,8,9,10,14,15,16,17,18,19

PPO/HMO (LA)

KaiserAll Regions(except 9)

35 14,219HMO Santa Cruz,

Monterey,San Bernito

Alameda Alliance 6 (Alameda) 12 31,000 HMOContra Costa H.P. 5 (Contra Costa) 10 5,000 HMO

Chinese Community H.P. 4 (SF) San Mateo 9 315 HMO

Ventura County H.C.P.12 (San Luis Obispo,

Ventura)6 176 HMO

LA Care H.P. 15 & 16 (LA) 35 1,005 HMOValley Health Plan 7 (Santa Clara) 4 993 HMO

Molina Health Care 3 (Sacto), 15,16,17,19 29 4,508 HMO

Western Health Advantage

2,3 15 3,000 HMO

Sharp Health Care 19 7 2,600 HMO

Standard benefits for IndividualsKEY BENEFITS Silver 70/30 Bronze 60/40 Gold 80/20 Platinum 90/10

Deductible (if any) $2000 Medical Deductible$5,000 Deductible for

Medical and DrugsNo Deductible No Deductible

Preventative CareNo Cost

at least 1 yearly visitNo Cost

at least 1 yearly visitNo Cost

at least 1 yearly visitNo Cost

at least 1 yearly visit

Primary Care Visit $45 $60 - 3 visits per year $30 $20

Specialty Care Visit $65 $70 $50 $40

Urgent Care Visit $60 $120 $90 $40

Generic Medication $25 $25 $20 $5

Lab Testing $45 30% $30 $20

X-Ray 465 30% $50 $40

Emergency Room $250 $300 $250 $150

High cost and infrequent services like Hispital Care and Outpatient Surgery

$25030% of your plan's

negotiated rate

HMOOutpatient Surgery -

$600Hospital - $600/day up

to 5 daysPPO - 20%

HMOOutpatient Surgery -

$250Hispital - $250/day up to

5 daysPPO - 10%

Imaging(MRI, CT, PET Scans)

$250 40% $250 $150

Brand Medications may be subject to Annual

Drug Deductible before you pay the copay

$250 deductible then paythe copay amount

$50-$75 after meetingdeductible

No Deductible No Deducctinle

Preferred brand copay after Drug Deductible

(if any)$50 $50 $50 $15

MAXIMUM OUT-OF-POCKET FOR ONE

$6,400 $6,400 $6,400 $4,000

MAXIMUM OUT-OF-POCKET FOR FAMILY

$12,000 $12,800 $12,800 $8,000

Sliding Scale for Silver PlanAnnual Income --> $15,856-$17,235 $17,235-$22,980 $22,980-$28,725 $28,725-$45,960

KEY BENEFITS $19-$57 $57-121 $121-$193 $193-364

Deductible (if any) No Deductible $500 $1,500 Medical Deductible$2,000 Medical Deductible

Preventative Care No Cost No Cost No CostNo Cost

1 Annual Visit

Primary Care Visit $3 $15 $40 $45

Specialty Care Visit $5 $20 $50 $65

Urgent Care Visit $6 $30 $80 $90

Generic Medication $3 $15 $40 $45

Lab Testing $5 $20 $50 $65

X-Ray $3 $5 $20 $25

Emergency Room $25 $75 $250 $250

High cost and infrequent services like Hispital Care and Outpatient Surgery

10% 15%20% of your plan's

negotiated rate20% of your plan's

negotiated rate

Imaging(MRI, CT, PET Scans)

Brand Medications may be subject to Annual

Drug Deductible before you pay the copay

No Deductible$50 then pay

the copay amount$250 then pay

the copay amount$250 then pay

the copay amount

Preferred brand copay after Drug Deductible

(if any)$5 $15 $30 $50

MAXIMUM OUT-OF-POCKET FOR ONE

$2,250 $2,250 $5,200 $6,400

MAXIMUM OUT-OF-POCKET FOR FAMILY

$4,500 $4,500 $10,400 $12,800

A blog post (July 11, 2013) created by Marilyn Tavenner, the Administrator of the Centers for Medicare and Medicaid Services (CMS), clarifies concerns surrounding Exchange operability after last week’s release of new Affordable Care Act (ACA) regulations. In the post, Tavenner proclaimed that the Exchanges will be fully operational by the October 1st enrollment deadline. Of chief import, Tavenner responded to concerns about whether or not the Exchanges will verify an applicant’s submitted income information and if there are safeguards in place to prevent applicants from fraudulently receiving subsidies. Tavenner responded in the affirmative to both, stating that an applicant’s income will be compared against tax filings, social security data, and income reports. Tavenner found that individuals who falsely apply for subsidies will run the risk of receiving a penalty for perjury, and that the Internal Revenue Services (IRS) already has mechanisms in place to recollect subsidies that were overpaid or provide subsidies to those that did not initially receive the correct amount.

Thank you. www.pnacompany.com

EnrollmentProduct type: Health

Product name: OBAMACAREComments: Income, Household size, etc.

Kenny Phan (800)810-4762Email: info@pnacompany.com