aca booklet
DESCRIPTION
A look at the Affordable Care Act, Wyoming, and You. This booklet will help you gain knowledge and understanding of the Affordable Care Act as it relates to Wyoming. Key dates to remember, a checklist for readiness, facts and figures, and much more are provided in this 16-page booklet.TRANSCRIPT
What’s InsIde:
A basic ACA overview 2
Wyoming healthcare statistics 4
How is the ACA going to affect you? 6
Warnings about penalties 12
Key dates you need to know 14
HealtHcare reformThe Affordable Care Act, Wyoming, and You
tHe “wHen”• For2014,theOpen
EnrollmentPeriodisOctober1,2013–March31,2014
• For2015andlateryears,theOpenEnrollmentPeriodisOctober1toDecember7
FormoreinformationaboutSpecialEnrollmentPeriodsandQualifyingLifeEvents,visitwinhealthplans.com.
tHe “wHat”ThePatientProtectionandAffordableCareAct(ACA)isthecomprehensivefederalhealthcarereformlawenactedinMarch2010.
KEyPrOviSiOnSOFThEACT:
• nomoreexclusionsforpre-existingconditions
• newwaystopurchasecoverageplans
• Expandedcoverageforyoungadults
• Taxpenaltiesfortheuninsured
• AdvancedPremiumTaxCredits(APTC),i.e.subsidies
• Taxcreditsforqualifiedsmallemployers
GrEETinGS,
As the healthcare industry enters a new era of change, I’d like to take this
opportunity to reach out to you with information about your choice in health care
and possible changes for next year and into the future.
The Affordable Care Act created in 2010 is now becoming
a reality. For us, it’s been a journey to develop our plans so
that they not only meet the federal requirements, but also
give our members the best value we can. For you, it’s a new
opportunity to explore your options for healthcare plans,
benefits, and costs.
At WINhealth, we’ve long recognized the need for healthcare to
do more than just provide protection against those “what if”
moments in life– your healthcare plan should help you live your best life. Through
personal customer service, wellness programs, and education, we empower our
members to take control of their own health.
I’m pleased to let you know that we have added new benefits to our health plans.
Beginning in January, WINhealth plans will cover a set of preventive services,
such as preventive visits and immunizations, plus screening tests including
mammograms, colonoscopies and cholesterol tests, at no cost to our members,
regardless of whether deductibles have been met. Also, coverage limits will
disappear with new plans purchased for 2014.
The
5 W
s of
Th
e A
CA
stephen K. Goldstone
2 hEALThCArErEFOrM
tHe “wHy”intendedtoaddressrisinghealthcosts,theACAisdesignedtoprovidemoreoversightofinsurancepremiumsandpractices,emphasizepreventivecare,reducehealthcarefraudandabuse,andfostercomparison-shoppingtoincreasecompetitionandpricetransparency.
tHe “wHere”ThehealthinsuranceMarketplaceisanewwaytofindqualityhealthcoverage.itcanhelpifyoudon’thavecoveragenow,orifyouhaveitbutwanttolookatotheroptions.WithoneMarketplaceapplication,youcanlearnifyoucangetlowerpremiumsbasedonyourincome,compareyourcoverageoptionsside-by-side,andenroll.
tHe “wHo”nooneplanstogetsickorhurt,butmostpeopleneedmedicalcareatsomepoint.healthinsurancecoversthesecostsandprotectsyoufromveryhighexpenses.in2011,almost48millionAmericanswereuninsured.TheACAseekstomakeiteasierandmoreaffordablefortheuninsuredtogetcoverage.
Our new plans will meet – and in many instances exceed – the Essential Health
Benefits criteria for the ACA and we are excited to announce that we are able
to offer them on the new insurance exchange, known as the Health Insurance
Marketplace (Federally Facilitated Marketplace).
If you’re curious about our new plans, you can see them now that the
Marketplace is open by visiting: winhealthplans.com and clicking the link at the
top left of the homepage. On the Marketplace, you can also see if you qualify
for an Advanced Premium Tax Credit or subsidy, and select a WINhealth ACA-
compliant plan through the exchange.
We hope you will call us if you have any questions about your health plan options.
We are available at (307) 773-1300, or you can visit our website any time at
winhealthplans.com.
Sincerely,
Stephen K. Goldstone
President & CEO, WINhealth
ThEAFFOrDAbLECArEACT,WyOMinG,AnDyOu3
Seeourcalendarofimportantdates
onpage14tobesureyouwon’tmissthe
windowofeligibilityfortheMarketplace.
the affordable Care act (aCa) can be confusing – it’s long, complicated, and
affects millions of people. It can be difficult to decipher just how it will have an
impact on you or the residents of Wyoming. Below are some aCa facts and figures
to help clarify what’s new, what’s changing, and what it means to you in Wyoming:
4 hEALThCArErEFOrMW
yom
ing
heA
lThC
Are
Fac
ts &
Fig
ures
8382,494
that’s 17%
the percentage of Wyoming residents currently insured through health care plans. For them, the aCa will provide more health plan choices and stronger coverage.
the number of Wyomingites who are not currently insured. For these individuals, along with families and
businesses who purchase their own health care coverage, the health Insurance Marketplace will make
new options available.
10•1•131•1•14
the open enrollment start date for the health Insurance Marketplace, also known as the health exchange.
the earliest coverage start date if you sign up for health insurance
during open enrollment (no later than december 15, 2013).
OCt 1
Jan 1
1
5 6
2
3
4
26 80the maximum age
at which children
can remain on their
parents’ health
insurance plans.
the number of cents
per premium dollar
that health insurance
companies are required
to spend on health care
or improvements to
care, or else they must
provide a refund.
ThEAFFOrDAbLECArEACT,WyOMinG,AnDyOu5
$15,888,085the amount of funding provided to Wyoming community health centers to support ongoing health center operations and to establish new health center sites, expand services, and/or support major capital improvement projects.
10
7 9
8
11 12
13
196,000 62
136,000
$2.2 $10
48,752
the number of people in Wyoming who are already free from worrying about lifetime dollar limits on health coverage. the aCa also currently restricts the use of annual limits and bans them completely in 2014.
the number of national health service Corps (nhsC) clinicians providing primary care services in Wyoming. the nhsC repays educational loans and provides scholarships to certain primary care providers who practice in areas of the country that have too few health care professionals to serve the population.
the number of Wyomingites with private health insurance who gained preventive service coverage with no cost-sharing in 2011 and 2012.
the grant money received from the federal prevention and public health Fund to support effective policies in Wyoming and its communities.
the amount of money that Wyomingites saved on prescription drugs due to the aCa.
data provided by the U.s. department of health & human services, as of July 29, 2013.Visit www.hhs.gov/healthcare/facts/bystate/wy.html for more information.
MilMil
the number of Wyoming individuals with traditional Medicare who used one or more free preventive services in 2012.
hoW is The ACA going to affect you?
6 HealtHcare reform
healthcare reform is going to impact all of us differently, based on our lifestyles,
incomes, employment, and family status.
We’d like to introduce you to five people here in Wyoming who wanted to
explore how health care reform will affect them.
here are theIr storIes.
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8
9
10
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CarrIe pre-eXIstInG MedICal CondItIon
erIC hUsBand & Father
MarCUs sMall BUsIness oWner
alICe loYal patIent
toM & sUsan neW parents
a:
ThEAFFOrDAbLECArEACT,WyOMinG,AnDyOu7
Meet CarrIe | pre-eXIstInG MedICal CondItIon
Carrie, 24, loves her job, but struggles to pay the monthly health insurance premium on her employer-provided plan and her rent, as well as other expenses. she doesn’t want to drop coverage because she takes several medications and needs regular health screenings to manage her bi-polar disorder. how will the aCa help her?
By checking the Marketplace, Carrie may find that a WINhealth plan
is an affordable health insurance option. Since her bi-polar disorder
is a pre-existing condition, she can’t be denied coverage or charged a
higher premium because of it. Plus, mental health services and treatments will
now be covered by the Ten Essential Health Benefits provision. Carrie may qualify
for an Advanced Premium Tax Credit (APTC), sometimes referred to as a premium
subsidy, or she may decide she still cannot afford insurance and may be able to
access dependent coverage on her parents’ plan until she is 26 years old.
8 hEALThCArErEFOrM
eric and his family have always received health insurance through an employer-provided plan, but recently he received a letter saying that his employer will cover only employees next year. Can his family get coverage through the Marketplace? What about eric?
Both individual and family plans are offered by WINhealth on the
Marketplace. Some families will learn that they qualify for subsidies
to help offset their monthly premiums or a tax break for signing up for
insurance through the Marketplace. If Eric has questions about the plans available
to his family, he should call a WINhealth advisor, a licensed broker, or a Navigator
who will help him understand his options. Eric can also change plans along with
his family during the Open Enrollment Period of Oct. 1, 2013 through March 31,
2014, but if Eric’s group (employer) plan meets the Affordability & Adequacy criteria,
he would not be eligible for the APTC subsidy and he may decide to stick with his
employer’s plan.
a:
Meet erIC | hUsBand and Father
ThEAFFOrDAbLECArEACT,WyOMinG,AnDyOu9
Marcus is a small business owner with less than 25 employees. he values his employees and believes that providing benefits such as health care is one important factor in helping to attract and retain talented workers. even though he wants to continue to offer health benefits, the costs have continued to rise higher and higher over the past few years, and now he’s not sure he can afford the rates or that his employees are happy with the limited coverage. What are his options?
Small businesses with fewer than 50 full-time employees face different
obligations for the ACA and may have more advantages than larger
businesses. The Small Business Healthcare Options Program (SHOP)
Marketplace will offer small employers a choice of qualified health plans that
make it easy to compare prices and benefits side-by-side. Marcus can get help
from an insurance broker, a Navigator, or work with WINhealth to evaluate how
much of his budget he can contribute toward his employees’ health care and he
can explore his eligibility for the Small Business Healthcare Tax Credit.
a:
Meet MarCUs | sMall BUsIness oWner
10 hEALThCArErEFOrM
alice likes her doctor, but she wonders if there is a more affordable health insurance option available to her. Can she keep her doctor?
Depending on the plan Alice chooses in the Marketplace, she may
be able to keep her current doctor. When comparing plans in the
Marketplace, like the WINhealth plans, she will see a link to a list of
providers in each plan’s network. If staying with her current doctors is important
to her, she can check to see if they are included before choosing a plan.
a:
Meet alICe | loYal patIent
do you have specific questions or concerns about how
the aCa will affect you? share your story with us at
winhealthplans.com and we’ll be glad to discuss your
options with you.
ThEAFFOrDAbLECArEACT,WyOMinG,AnDyOu11
tom makes a great hourly wage, but his company doesn’t provide benefits. his wife susan works full-time but really wants to stay home with their new baby. susan has high blood pressure and diabetes and has been told that if she leaves her job, she would have limited health insurance for the first two years because of her “pre-existing” conditions. tom’s salary is enough to allow them to meet their expenses, especially if they don’t have to pay for childcare anymore, but susan continues to work so the family can keep their access to affordable insurance. they both wonder if the affordable Care act (aCa) will allow them to change their lifestyle?
The ACA prevents insurance companies from limiting or denying
coverage to people with pre-existing conditions, so Susan may find
that a WINhealth plan available through the Marketplace would allow
her to make the career change she has been seeking. Getting WINhealth insurance
through the Marketplace eliminates the need to depend on an employer for
benefits, allowing members to switch jobs or stop working and still access
affordable, quality health care.
a:
Meet toM & sUsan | neW parents
A WArning about penalties
12 hEALThCArErEFOrM
WhY do We all need to
haVe InsUranCe?
When someone without health coverage
needs urgent (often expensive) medical
treatment but cannot pay the bill, these
“uncompensated” costs spread across
everyone else and we all end up paying
a higher price.
What IF I don’t haVe health
CoVeraGe In 2014?
there are a few exemptions,
but people who can afford to
take responsibility for their
healthcare and choose not to
have coverage will have to pay
a penalty.
What’s the BIG ConCern?
anyone without health coverage will also have to pay the entire cost of all his
or her medical care and there’s no more protection from very high medical bills
that can sometimes lead to bankruptcy.
the fee in 2014 is 1% of your yearly income or $95 per person for the year, whichever is higher. the fee increases every year. In 2016 it is 2.5% of income or $695 per person, whichever is higher. In 2014 the fee for uninsured children is $47.50 per child. the most a family would have to pay in 2014 is $285.
Remember, if a person fails to enroll during Open Enrollment, he or she won’t be eligible to enroll or receive a subsidy (APTC) until the next open enrollment period unless there is a qualifying event.
For more information about exemptions or insurance that qualifies as minimum essential coverage, visit winhealthplans.com.
$95pp
$695pp
2014 2016
the penaltIes
The 10 essenTiAl health benefitsall private health insurance plans offered in the Marketplace will include the same set of essential health benefits. these are services all plans must cover. the essential health benefits include at least the following items and services:
Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Emergency services
Hospitalization (such as surgery)
Maternity and newborn care (care before and after your baby is born)
Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
Prescription drugs
Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services
If you’d like more explanation about
what these benefits mean or if you
have questions about any of these
services, please visit our website
or contact us.
ThEAFFOrDAbLECArEACT,WyOMinG,AnDyOu13
Winhealth
plansmeetthe
requirementsforall10
Essentialhealthbenefits
andevenprovideadditional
coverageforourmembers.See
exactlywhateachplanoffers
andcompareyouroptions
side-by-sideinthe
Marketplace.
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14 hEALThCArErEFOrM
oCtoBer 2013
dATes To remember
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FeBrUarY 2014
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ThEAFFOrDAbLECArEACT,WyOMinG,AnDyOu15
oCtoBer1: Open enrollment begins
for individuals
Employers must notify employees of the ACA health insurance exchange
noVeMBer15: Last day to apply for or renew
a Freedom plan
16: WINhealth begins offering only ACA-compliant plans
deCeMBer15: Last date to enroll in order to start
coverage on Jan 1, 2014
JanUarY1: Coverage begins for individuals and
premium tax credits will be available to certain low-income individuals
Individual Mandate starts, requiring individuals to obtain minimum essential coverage or pay a personal income tax penalty
15: Last date to enroll in order for coverage to begin Feb 1, 2014
FeBrUarY15: Last date to enroll in order for
coverage to begin Mar 1, 2014
MarCh15: Last date to enroll in order for
coverage to begin Apr 1, 2014
31: Open enrollment closes; last date to enroll in order for coverage to begin May 1, 2014
Wehopeyou
willcallusif
youhaveany
questionsaboutyour
healthplan.Weareavailable
at(307)773-1300, oryoucanvisitour
websiteanytimeat
winhealthplans.com.
enrollment reopens on october 1, 2014. If you’re not sure what to do in between that timeframe, call us and we’ll help you understand your options.
CheCklisT to get ready
create an ACCOunT
APPLyFOr COvErAGE*
PiCKA PLAn
enroll
Go to WInhealthplans.CoM,
ClICK the lInK to the MarKetplaCe,
then FolloW these steps.
YoU WIll also need:
social security numbers (or document
numbers for legal immigrants)
employer and income information for every member of your household who needs coverage (for example, from
pay stubs or W-2 forms—Wage and Tax
Statements)
policy numbers for any current health insurance plans covering members of your household
a completed employer Coverage tool (you can find this on our website) for every job-based plan you or someone in your household is eligible for. (You’ll
need to fill out this form even for coverage
you’re eligible for but don’t enroll in.)
PRSRT STD
US POSTAGE
PAID
CHEYENNE, WY
PERMIT NO. 161
1200 East 20th Street Cheyenne, WY 82001
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