Transcript Health-Insurance-Marketplace-Presentationx

New Health Insurance Marketplace:
Opportunities for Public Health
Open Enrollment Began October 1, 2013
Coverage Starts January 1, 2014
Health Insurance Marketplace—HealthCare.gov
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The Health Insurance Marketplace is a new and easier way
to find affordable health insurance.
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Many people can get a break on costs at the Marketplace.
New tax credits can reduce insurance premiums right away.
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Every health plan offers comprehensive coverage from
doctors to medications to hospital visits to free preventive
care.
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Through the same streamlined application process, many
can find out if they are eligible for Medicaid or CHIP.
Covering more people with health insurance
improves population health.
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People can get care they need to stay healthy.
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Many preventive care services are free for new health
plans.
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People with health coverage get more preventive care and
report better physical and mental health.
Baicker K, Taubman SL, Allen HL, et al. The Oregon experiment -- Effects of Medicaid on clinical outcomes. N Engl J Med 2013;368:17131722.
Baicker K, Finkelstein A. The effects of Medicaid coverage -- learning from the Oregon experiment. N Engl J Med
2011;365:683-685
Essential Health Benefits
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Ambulatory patient services
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Emergency services
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Hospitalization
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Maternity and newborn care
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Mental Health and substance abuse disorder services, including behavioral
health treatment
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Prescription drugs
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Rehabilitative and habilitative services/devices
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Laboratory services
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Preventive and wellness services and chronic disease management
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Pediatric services, including oral and vision care
Mental Health and Substance Use Disorder Coverage
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The Affordable Care Act requires that health insurance
plans on the Health Insurance Marketplace cover mental
health and substance abuse disorder services.
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Because of the law, health plans must now cover
preventive services like depression screening for adults
and behavioral assessments for children at no cost.
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And starting in 2014, most plans won’t be able to deny you
coverage or charge you more due to pre-existing health
conditions, including mental illnesses.
Preventative and Wellness Services
Most insurance plans, including all plans on the Marketplace, provide
many free preventive services. Examples include:
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Blood pressure, diabetes, and cholesterol tests
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Cancer screenings, including mammograms and colonoscopies
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Counseling to help quit smoking, lose weight, eat healthfully, identify
depression, reduce alcohol use, and avoid sexually transmitted infections
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Screenings for sexually transmitted infections
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Regular well-woman, well-baby, and well-child visits
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Routine vaccinations against flu, pneumonia, measles, polio, meningitis,
and many other diseases
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Care to ensure healthy pregnancies
healthcare.gov/what-are-my-preventive-care-benefits
Financial Assistance
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Premium tax credits
 Will reduce the premium amount the consumer owes each month
 Available to eligible consumers with household incomes between
100% and 400% of the federal poverty level ($45,960 for an individual
and $94,00 for a family of 4)
 Based on household income and family size for the taxable year
 Paid each month to the insurer or consumer can wait until they file
taxes to receive the premium tax credit
Financial Assistance
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Cost Sharing Reductions
 Reduce out-of-pocket costs (deductibles, coinsurance, copayments)
 Generally available to those with income at 250% of the federal
poverty level or below ($27,925 for and individual and $57625 for a
family of 4 in 2012)
 Based on household income and family size for the taxable year
Marketplace Enrollment
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Open October 1, 2013 to March 31, 2014
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Open October 15 to December 7 each year beginning in 2014
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Special Enrollment Periods available in certain circumstances
during the year (childbirth, employment changes, etc.)
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Medicaid and CHIP enrollment open year-round
Apply by December 15, 2014
for coverage starting on January 1, 2014.
Basic Information to Enroll
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To enroll in the Marketplace, individuals should be prepared to provide
basic information, such as:
 Names of family members who need insurance coverage
 Birthdates
 Social security numbers
 Income information
PA Marketplace
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Pennsylvania will be a Federally Facilitated Marketplace
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1.3 million uninsured in PA
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600,000 Pennsylvanians eligible to enroll through the marketplace
 If Medicaid is expanded in PA, an additional 650,000 Pennsylvanians
will be eligible for health insurance
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15 insurance companies participating
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56 plans available
Marketplace Navigators
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Health Insurance Marketplace Navigators can help you
 Understand how the Marketplace works
 Complete eligibility and enrollment forms
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In PA, The Advocacy Alliance, Mental Health America Westmoreland
County, Mental Health Association in PA, and PA Mental Health
Consumers’ Association offer
 Trained navigators with a special focus on helping people who use or
need behavioral health services
 Language interpreter services
 Navigator help to anyone who contacts us
Get Help
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If you have behavioral health needs and want help understanding and
using the Marketplace, contact one of our Health Insurance Marketplace
Navigators
 1-855-724-5626 (toll free)
 [email protected]
 [email protected]
 [email protected]
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Visit HealthCare.gov
 Learn about available health coverage choices
 Find community-based Navigators that will provide unbiased advice
about coverage choices
 Sign up for coverage online or on the phone
Additional Navigators in Pennsylvania
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Find Local Help
https://localhelp.healthcare.gov/#address=PENNSYLVANIA&start=50&nu
m=83&filter=off&lang_filter=0&navc_filter=1&shop_filter=0&chip_filter=
0
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Mental Health America / Mental Health Association of
Southeastern PA
 267-507-3894 or [email protected]
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PA Association of Community Health Centers
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Resources for Human Development (RHD)
 http://www.rhd.org/navigator/partners/partnerscontact.aspx
Resources
For more information
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HealthCare.gov; CuidadoDeSalud.gov
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Sign up to get updates at healthcare.gov/subscribe,
twitter.com/HealthCareGov, and facebook.com/Healthcare.gov
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24/7 Call Center: 1-800-318-2596 ( 1-855-889-4325 TTY/TDD)
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http://www.pmhca.org
Information About the Health Insurance Marketplace
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Marketplace Application Checklist:
http://marketplace.cms.gov/getofficialresources/publications-andarticles/marketplace-application-checklist.pdf
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Tips for Helping Consumers Navigate the Marketplace:
http://marketplace.cms.gov/getofficialresources/publications-andarticles/tips-for-assisters-to-help-consumers-navigate-themarketplace.pdf
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Things for Consumers to Think About When Choosing A Plan:
http://marketplace.cms.gov/getofficialresources/publications-andarticles/things-to-think-about-when-choosing-a-plan.pdf
Resources
Information About the Health Care Law and Health Insurance Marketplace
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How the health care law is making a difference for the people of
Pennsylvania: http://www.hhs.gov/healthcare/facts/bystate/pa.html
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Articles about the Health Insurance Marketplace; Using the Marketplace;
Getting Lower Costs on Coverage; Young Adults; Rights, Protections, and
the Law; Prevention; and more: https://www.healthcare.gov/all-topics/
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Videos about the Health Insurance Marketplace:
http://www.youtube.com/HealthCareGov
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The project described was supported by Funding
Opportunity Number CA-NAV-13-001 from the U.S
Department of Health and Human Services, Centers for
Medicare & Medicaid Services.
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The contents provided are solely the responsibility of the
authors and do not necessarily represent the official views of
HHS or any of its agencies.
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 Thank you
Navigator Toll Free Number
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1-855-724-5626
Presenter Contact Information