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Affordable Care ActWhat does it mean for our families and
communities?
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Review of Affordable Care Act (ACA)
Private insurance reforms and the Marketplace
ACA and immigrants/refugees
Overview
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Everyone needs to have insurance by March 31, 2014 with some exceptions
If you have insurance through your employer that is affordable, you don’t have to do anything
If you have private insurance that complies with the base requirements, you don’t have to do anything
If you are on public insurance (Medicare, Medicaid), you don’t have to do anything and your coverage will be getting better
Already Have Insurance?
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October 1, 2013◦ “Get Covered Illinois” opens to buy health care
insurance December 15, 2013
◦ Last day to sign up for insurance to have a January 1, 2014 effective date
January 1, 2014◦ New health insurance coverage purchased on “Get
Covered Illinois” begins March 31, 2014
◦ Last day to sign up for health care insurance for 2014
Key Dates
Changes today: Costs Preexisting
condition Lifetime limit Underinsured Women
Currently and after 2014: Insurance companies will
cover some of the costs Preexisting conditions Preventive care services Women Medicare patients Children under the age of 26 Small businesses Lifetime limits High-risk pool Medicaid Tax credits
Why is the new health care law important?
Dependent Coverage up to age 26 Consumer protections/transparency No pre-existing condition exclusion for children No lifetime limits Health plans cannot drop people when they get sick Insurers are required to spend 80-85% of premium dollars
on patient care (and refund consumers when they spend less!)
Preventative Services – no co-pay for many services in private insurance & Medicare
Small business tax credits Increased primary care rates for Medicaid providers in
2013-2014 Closing of Medicare Part D “donut hole” (entirely by 2020)
Available Now
State or federal “Health Insurance Marketplace” – new marketplaces with Essential Health Benefits package (Enrollment begins Oct. 1, 2013)
Large Medicaid Expansion to Adults up to 138% FPL No pre-existing condition exclusion Consumer protections – no annual limits, no rating
by health status or gender only by age, location & smoker/non-smoker
Shared Responsibility Provisions Individual Mandate Employer Mandate (for orgs with 50+ FTEs) –
postponed until 2015
Starting in 2014 and beyond
All non-grandfathered health plans in individual & small group market must cover these essential benefits at a minimum
Illinois has chosen BCBS Blue Advantage as the Benchmark Plan supplemented by AllKids for dental and Federal VIP for vision for children. Illinois is currently developing their Medicaid Expansion Benchmark – most likely similar to FamilyCare.
Ambulatory patient services; Emergency services; Hospitalization; Maternity and newborn care; Mental health and substance
use disorder services; Prescription drugs; Rehabilitative and habilitative
services and devices; Laboratory services; Preventive and wellness
services including chronic disease management;
Pediatric services including oral and vision care.
Essential Health Benefits Package: What is it?
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User friendly format to understand terms, compare benefits & services across plans
Enables you to: ◦ Enroll in Medicaid and possibly other public
benefits◦ Find out if you’re eligible for financial assistance
that make coverage more affordable Health plans required to have enough
doctors, perform well on quality measures Will keep health insurance low
The Marketplace (“Get Covered Illinois):
Financial help for families with household incomes100%-400% FPL
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Blue Cross & Blue Shield of Illinois Humana, Inc. Aetna Inc. Land of Lincoln Health Inc. Co-Op Coventry Health Care Inc. Carle Foundation
These 6 Insurance companies will be selling over 150 plans in the Marketplace.
List of Insurance Companies selling plans in the Marketplace
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Individual Mandate/Responsibility Provision• Requires most individuals (including children) to carry “minimum
essential” health coverage• Many exemptions:• Religious reasons• Undocumented non citizen• Household income is below the minimum threshold for filing a
tax return (Go to www.irs.gov/uac/Do-I-Need-to-File-a-Tax-Return%3F for tax assistant)
• Unaffordable coverage (insurance premiums exceed 8% of family income)
• Payment, exemption or penalty is through the federal income tax return:
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ACA’s New Medicaid Eligibility Category
Current ProgramNew Category Why it is good for Illinois?
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On top of the traditional Federal program, Illinois has three programs for families and children
Current Specialized Medicaid Programs in IL
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In 2014:◦U.S. Citizens, Lawfully Residing
Immigrants and LPRs with five years in U.S., ages 19-64 with incomes up to 133% FPL ($14,856 individual)
◦Enrollment is via Get Covered Illinois or through ABE (Application for Benefits Eligibility – www.abe.illinois.gov)
◦Also able to apply for SNAP and cash benefits at same time
Medicaid’s New Eligibility Category
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What? A new Medicaid program Who?
Lives in Cook County. Be 19-64 years old Have income at or below 133% of the FPL ($14,856
individual;$20,123 couple-annually) Not be eligible for “State Plan” Medicaid (Parent,
Pregnant, Blind or receiving disability income) Not be eligible for Medicare Be a legal immigrant for 5 years or more OR be a US
citizen Have a SS# or have applied for one
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The ACA and Immigrants
Naturalized CitizensLegally present immigrantsUndocumented
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U.S. Citizens and Immigrants under the ACA
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www.ifrpil.org Getcoveredillinois.gov www.kff.org www.healthcare.gov http://www.ageoptions.org/services-and-
programs_AffordableCareActTipSheets.html www.illinoishealthmatters.org http://www.illinoisfreeclinics.org/clinic-search http://www.nafcclinics.org/clinics/search www.ilmaternal.org
Resources
Special Thanks to
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