Transcript Navigators for a Healthy Louisiana

ACA Impact in Louisiana
April 11th, 2015
Addressing the Needs of HIV Providers & Health
Professionals in Louisiana
LA Area Health Education Centers
AHEC’s Role in the Affordable Care Act
Navigators play a vital role in helping consumers prepare
electronic and paper applications to establish eligibility and
enroll in coverage through the Marketplace.
In Louisiana, Navigators are certified by the Federal
government, licensed by the LA Dept. of Insurance and have
undergone rigorous training, criminal background checks,
and fingerprinting prior to assisting consumers.
Louisiana Federal Navigators
Certified Application Centers
The Federally-Facilitated Marketplace has designated
organizations to certify application counselors who perform
many of the same functions as Navigators, completely free
at no cost to the consumer – including educating
consumers and helping them complete their application for
coverage. These groups include community health centers
or other health care providers, hospitals, or social service
organizations.
LA Federally Qualified Health Centers
Open Enrollment
November 15th, 2014 marked the beginning of Open Enrollment
in the Health Insurance Marketplace under the Affordable Care
Act, a period that spanned from November 15th, 2014 to
February 15th, 2015. During this time, Louisiana residents were
able to fill out or update a Health Insurance Marketplace
application and enroll in a 2015 plan.
Penalty for not Having Health Insurance
5 Years Later: How the Affordable Care Act
is Working in Louisiana
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In Louisiana, 186,277 individuals selected a Marketplace
plan between November 15, 2014 – February 15, 2015.
(Nationwide 11.7Million)
89% of Louisiana consumers who signed up qualified for
an average tax credit of $319 per month.
63% of LA enrollees obtained coverage for $100 or less
after an applicable tax credits in 2015 and 95% had the
option for doing so.
68,792 consumers in Louisiana under the age of 35 are
signed up for Marketplace coverage (37% of the plan
selections in the state).
Insurance Providers in Louisiana
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In Louisiana, consumers could choose from 5 issuers in
the marketplace in 2015 – up from 4 in 2014.
Louisiana consumers could choose from an average of 44
health plans in their parish in 2015 – up from 33 in 2014
The ACA and HIV/AIDS
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The ACA is one of the most important pieces of
legislation in the fight against HIV/AIDS in our history. Its
implications for people at risk for and living with
HIV/AIDS.
Essential Health Benefits
Important Conversations Providers need to
have with patients on prescription drugs.
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Plans offered in the Health Insurance Marketplace are broken
into meta-levels: Bronze, Silver, Gold, and Platinum.
Cost-sharing reductions are an exception to this rule.
Silver level plans
Each of the plans offered by the providers in Louisiana will
generally vary in regards to how prescription drugs affect their
overall deductible. Plans will fall into one of three categories:
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A single deductible comprised of both medical and prescription
expenses that must be met before co-insurance or copay takes
effect.
A separate drug deductible that must be met before co-insurance or
copay takes effect for prescription medication.
A zero dollar drug deductible with either a fixed copay or coinsurance for prescription medication.
Important Conversations Providers need to
have with patients on prescription drugs.
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Out-of-pocket maximums will also vary between plans
and providers. Plans will fall into one of two categories.
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A single out-of-pocket maximum comprised of both medical
and prescription expenses.
A separate out-of-pocket maximum for prescription
medication.
Prescription Drug Coverage
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For Louisiana each provider will cover at a minimum two
of the once-daily combination tablets approved to treat
HIV.
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In most cases the once-daily pills will count as “specialty
drugs” for billing purposes for all plans. The cost to
consumers for a thirty day supply per drug will range
between forty five dollars to one hundred fifty dollars
after the deductible is met (if there is one).
LA Plan Drug Formularies
United
Healthcare
Blue Cross
Blue Shield
of Louisiana
Atripla
Atripla
Louisiana
Health
Cooperative
Atripla
Complera
Vantage
Health Plan
Atripla
Complera
Complera
Stribld
Stribld
Stribld
Triumeq
Triumeq
Stribl
Brian Burton, MPH
Louisiana State Director, Navigators for a Healthy Louisiana
Southwest Louisiana Area Health Education Center
103 Independence Blvd.
Lafayette, LA 70506
196 Williamsburg St.
Lake Charles, LA 70506
337.478.4822 ext. 15
[email protected]
www.swlahec.com
www.LAHealthcareNAV.com