aca and vets & families
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ACA and Vets & Families. NASW IL Conference Oct 28 2013. ACA 101. ACA 101. ACA 101: Key Components. Available Now…. 2014 and Beyond…. Extended dependent coverage to age 26 No pre-existing condition exclusion for children Preventive services without cost sharing - PowerPoint PPT PresentationTRANSCRIPT
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ACA and Vets & Families
NASW IL ConferenceOct 28 2013
+ ACA 101
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ACA 101
ACA signed into law on March 23, 2010 with major provisions to start January 1, 2014
“Health Insurance Marketplaces” have been established and will open October 1, 2013
Individuals are responsible to obtain health coverage through an employer, directly from an insurance company or through the Marketplace
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ACA 101: Key Components
Extended dependent coverage to age 26
No pre-existing condition exclusion for children
Preventive services without cost sharing
CountyCare-the early expansion of Medicaid in Cook County
No lifetime limits on care Small business tax credits No insurance rescissions except in
cases of fraud/intentional misrepresentation
New Marketplace to buy insurance and receive financial help to pay for it
New Medicaid Adult Group available to adults under 138% FPL
Financial Assistance to purchase private insurance
Medicaid available to former foster children up to age 26 at any income level
No pre-existing condition exclusion for adults All plans must cover Essential Health Benefits No annual limits on care No gender rating Closing Medicare Part D donut hole Individual and Employer Responsibility
Available Now… 2014 and Beyond…
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ACA 101: Preventive Care
No Cost Sharing for certain preventive services, if provided in-network. However, there may still be some costs for the doctor’s visit if the visit includes other services besides the preventive service.
List of covered services the same for all plans and includes immunizations, cancer screenings, access to birth control, and a range of other services.
The full list is available at healthcare.gov/prevention
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26 Covered Preventive Services-- HighlightsAlcohol & Drug Use Assessments Behavioral Health Assessments
Depression for adolescents Developmental Screening & Surveillance
Immunizations – birth to age 18 Obesity screening & counseling
Hearing, Vision screenings STI – screening & counseling
Oral health screening & assessment for birth – 10
HIV screening -- adolescents
Autism screening at 18 & 24 months Blood Pressure screening for children
www.healthcare.gov for full list and more details
ACA 101: Highlights of Preventive Care 6
ACA 101: Essential Health Benefits
Federal VIP for vision for children
Supplemented by All Kids for dental
for children
BCBS Blue Advantage
• 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
All health plans in the Marketplace, individual & small group, are qualified
health plans (QHP).
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Illinois’Benchmark
8ACA 101: New Pathways to Coverage
+ Healthcare Coverage Pathwaysfor Veterans and their Families
VA
Tricare
Marketplace and Medicaid
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Important Dates
OCTOBER 1, 2013- Open Enrollment in the Marketplace/New Medicaid Begins.
DECEMBER 15, 2013
- Must be enrolled by this date for Marketplace health coverage to begin by 1/1/14
JANUARY 1, 2014
- New Medicaid Adult Group Coverage begins. (No backdating before this date.)
MARCH 31, 2014
- Open Enrollment for Marketplace ends (Medicaid is always open).
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+ Marketplace in IL
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Marketplace in IL: Overview 12
Web shopping tool for individuals and small business to purchase private and public health insurance.
Gives consumers the tools and power to have control over their insurance decisions Apples-to-apples comparison of plans Find the right fit!
www.getcoveredillinois.gov
Marketplace in IL: Eligibility & ApplicationThe applications for Medicaid and Financial
Assistance in the Marketplace will ask for information about:
Illinois ResidencyCitizenship/immigration status Income/Tax filing status Dependents and household composition
Information will be electronically verified.
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+Eligibility: Income
Modified adjusted gross income (MAGI) guides paths to health coverage
Why MAGI? It will standardize the calculation of income across all insurance
affordability programs It is used both by the Marketplace and Medicaid to determine
eligibility.
Income is compared to program limits to determine source of health coverage
MAGI is an income counting methodology, it is not a number on a tax form
When using MAGI, resources/assets are not a consideration Veterans benefits are not counted
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+Application: Household Composition
How a household is determined is different
for the Marketplace and Medicaid
The information collected affects the
person’s benefits so it must be entered
correctly.
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+Application: Household Composition
Household information is provided to the Marketplace based on whether a person files taxes, plans to file taxes or is claimed as a dependent
Tax information is used to determine the group size to compare income to the FPL and determine eligibility and amount of tax credits and subsidy
Application for health coverage can be for all persons who file taxes together
Medicaid programs use tax information to determine the group size and income eligibility for Medicaid benefits
Eligibility for Medicaid is determined by income limits for the type of Medicaid program considered
Application for health coverage is generally for persons living in the house together
Marketplace Medicaid
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+ Veterans and their Families
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+VA Health Care Information
Veterans who obtain health care through the USVA meet the requirements for minimum essential health benefits
Veterans may be able to blend other health coverage with USVA coverage to increase access to providers
• Veterans enrolled in USVA health coverage are eligible to enroll in Medicaid if the individual qualifies for the benefit
• Veterans enrolled in USVA health coverage are able to access this benefit as well as Medicare if the individual qualifies for Medicare
• Veterans who have private insurance through an employer can be enrolled in USVA health coverage as well as private insurance
If enrolled in USVA healthcare coverage the veteran is not eligible for tax credits and subsidy through the Marketplace
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+ VA and Families
Families members of Vets enrolled in VA health care cannot receive VA health benefits
Exception: Civilian Health and Medical Program (CHAMPVA); Spina Bifida Health Care Program
Options for families: Tricare, Marketplace (Medicaid)
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+ CHAMPVA Eligibility Definitions
Term Definition
Beneficiary A CHAMPVA-eligible spouse, widow(er), or child.
Child Includes birth, adopted, stepchild, or helpless child as determined by a VA regional office (see the “Rules that Impact CHAMPVA Eligibility” section of the CHAMVPA handbook).
Dependents A child, spouse, or widow(er) of a qualifying sponsor.
Qualifying Sponsor A Veteran who is permanently and totally disabled from a service-connected condition, died as a result of a service-connected condition, was rated permanently and totally disabled from a service-connected condition at the time of death, or died on active duty and whose dependents are not otherwise entitled to DoD TRICARE benefits.
Service-Connected A VA regional office determination that a Veteran's illness or injury is related to military service.
Spouse The wife or husband of a qualifying sponsor.
Widow(er) The surviving spouse of a qualifying sponsor.
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+ Tricare and ACA
Two Beneficiary categories: Sponsor (SM) and Dependents (family members)
Some Tricare Plans qualify for Minimum Essential Coverage (MEC) and others don’t Tricare Prime; Reserve Select; Young Adult = yes Tricare for dependent parents and in-laws = no
If electing Tricare, then no tax credit or subsidy through the marketplace
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+ Tricare Eligibility
Eligibility depends on military status
Active Duty
Reserve/National Guard SMs and Families are eligible so long as the SM is attending drills
Families
Survivors’ remaining eligible when a sponsor dies depends on If the sponsor was AD or not If the survivor is a spouse or child
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+ Tricare’s differences
Tricare Young Adult Tricare’s current age limit for children: 21 or age 23 if in
school full-time Young Adult is a Tricare option that the child (or parent)
may purchase for additional coverage
Mental health and substance use disorder coverage limits may not meet the requirements for parity
Other costs
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+ Medicaid Expansion in 2014• In 2014, anyone up to 138% (133% plus 5% income
disregard) FPL is eligible for Medicaid, called “newly eligible” Medicaid.• No disability requirement.• Must be under 65, not entitled to or enrolled in
Medicare A or enrolled in Part B.• Modified gross income (MAGI) and no asset test,
which is different from current Medicaid and All Kids Programs.
• Federal government pays for much greater percentage of this expansion.
• Veterans Benefits are not countable income
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+ Additional information and Resources
Visit http://getcoveredillinois.gov
Talk to a navigator: http://getcoveredillinois.gov/get-help/
http://tricare.mil
www.va.gov
www.Illinoishealthmatters.org
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