affordable care act update- de pere area chamber of commerce 2-11-15
TRANSCRIPT
A Pulse on the
Affordable Care Act
February 2015
An Update for Local Policy Makers and Leaders
February 11 2015
1. ACA Overview2. BadgerCare+3. SHOP4. Health Insurance Marketplace5. How To Apply6. Special Enrollment Periods7. Renewals8. Tax Time9. Resources10. Next Steps
Topics to Cover
February 11 2015
Uninsured 10%
Employer Based Plan 53%
Other Plan 6%
BadgerCare+ / MA 16%
Medicare 15%
Wisconsin Health Insurance Coverage
Find Your Slice of the Health Insurance ‘Pie’ (Before October 2013)
February 11 2015
What Did We See During the First Open Enrollment Period?
February 11 2015
And How About The Second Open Enrollment Period?
February 11 2015
Open Enrollment 1 (Oct 2013 –March 2014)
• 8 million enrolled in coverage during the first open enrollment period
• 3 million stayed on parent’s insurance• 5 million more on Medicaid• 5 million selected plans outside the Marketplace
• Nationwide uninsured rate lowest in 5 years
February 11 2015
• 139,815 people enrolled in the Marketplace – 56 percent are female and 44 percent are male;
– 25 percent are age 34 and under;
– 26 percent are between the ages of 18 and 34;
– 72 percent selected a Silver plan; and
– 90 percent selected a plan and are eligible to receive Financial Assistance
• 81,274 people are newly eligible for the BadgerCare+ program,
• 62,776 people lost their BadgerCare+ coverage
What Did We See in Wisconsin (OE1)
February 11 2015
Open Enrollment 2 (Nov 2014 –Feb 2015, so far)
• 7.7 million enrolled in coverage during the first open enrollment period
• 6.6 million stayed on parent’s insurance• 5+ million more on Medicaid• 5+ million selected plans outside the Marketplace
• Nationwide uninsured rate lowest in 5 years
February 11 2015
1. Since Open Enrollment began on Nov. 15, 182,581 Wisconsin consumers have selected a plan or were automatically re-enrolled.
2. In the first two months of Open Enrollment, 90 percent of Wisconsin consumers who selected health insurance plans were determined eligible for financial assistance to lower their monthly premiums.
3. In Wisconsin, consumers can choose from 15 issuers in the Marketplace in 2015 – up from 13 in 2014.
4. Wisconsin consumers can choose from an average of 67 health plans in their county for 2015 coverage – up from 49 in 2014.
5. 78 percent of Wisconsin Marketplace enrollees as of Dec. 2014 could obtain coverage for $100 or less after any applicable tax credits in 2015.
What Did We See in Wisconsin (OE2 so far)
February 11 2015
The health reform law was passed in March of 2010, but we saw most of the law be fully implemented in Wisconsin this last year.
• The Health Insurance Marketplace
• State changes BadgerCare+ (As of April 1, 2014)
• People receiving financial assistance to pay for their health care costs (90% in Wisconsin)
The Affordable Care Act
February 11 2015
• Insurance plans may not deny enrollment based on pre-existing conditions
• Lifetime and annual coverage limits for essential health benefits are prohibited
• Free preventive care for those with insurance, including Medicare
• Young adults must be allowed to remain on parent’s private insurance plans until age 26
ACA Overview
February 11 2015
• Also referred to as the Shared Responsibility Payment
• Requires most individuals to have insurance or pay a tax penalty/fee 2014: $95 per adult or 1% of income 2016: $695 per adult or 2.5% of income,
whichever is more
• Fee will be prorated per household member each month applicable
February 11 2015
Individual Mandate
Everyone * Needs Coverage
Public ProgramsEnrolled in Medicare, BadgerCare+
or another Medicaid program ? That meets the requirement
Employer and PrivateCoverage
Covered by a workplace plan or purchased a private plan ?
That meets the requirementFederal Marketplace Coverage
Purchased a plan from the Healthcare Insurance Marketplace ?
That meets the requirement
* Some exemptions applyhttps://www.healthcare.gov/exemptions/Site provides detail of exemptions, some are related to hardship, some related to recognized groups.
February 11 2015
• Some people will be exempt due to personal circumstance, religion, tribal membership or low income but will still need to apply for the exemption
February 11 2015
The Individual Mandate
• Medicare is the federal health insurance program for people over 65 and certain younger people with disabilities
http://www.ssa.gov/medicare/
• Individuals with health insurance through Medicare will not have to changetheir coverage or benefits under theAffordable Care Act
February 11 2015
The ACA and Medicare
• BadgerCare+ is the Wisconsin Medicaid program providing low-cost or free comprehensive coverage for children, families, pregnant women and non-elderly adults who meet the income guidelines
• Must be US citizen or qualified immigrant to apply
The ACA and BadgerCare+
February 11 2015
As of April 1, 2014:
• BadgerCare+ eligibility for adults changed from 200% to 100% of the federal poverty level (FPL)
• BadgerCare+ eligibility for children changed from no income level to 300% FPL
• There are no changes in eligibility rules for pregnant women, people with disabilities and people over age 65 (EBD Medicaid), Family Care or other long-term care programs
BadgerCare+ Changes
February 11 2015
• All BadgerCare+ members will have Standard Plan benefits
• Young adults leaving foster care will be eligible for BadgerCare+, regardless of income, until age 26
• ACCESS system updated to reflect changes with new/modified questions about income and tax filing status
Other BadgerCare+ Changes
February 11 2015
BC+ Eligible Groups 2014
300% FederalPoverty
Level
300% FPL 300% FPLNo premiums
200%FederalPoverty
Level
Premiums start at 200%
100%FederalPoverty
Level
100% FPLNo premiums
100% FPLNo premiums
CHILDREN(under age 19)
Youth exiting foster care up to age 26, no income limit
PREGNANT WOMEN
PARENTS/CARETAKERRELATIVES
ADULTS WITHOUT DEPENDENT CHILDREN
April 1, 2014Income Eligibility
February 11 2015
Group size100% FPL
Adults
300% FPL
Children, Pregnant Women
1 $972.50 $2,917.50
2 $1,310.83 $3,932.50
3 $1,649.17 $4,947.50
4 $1,987.50 $5,962.50
5 $2,325.83 $6,977.50
6 $2,664.17 $7,992.50
Each add’l
person, add$338 $1015
dhs.wisconsin.gov/medicaid/fpl/fpl.htmExpanded table found at WI Dept. of Health Services
Monthly Income CategoriesBadgerCare+ Using 2014 Federal Poverty Level (FPL)
February 11 2015
https://access.wisconsin.gov/
February 11 2015
If someone is eligible for BadgerCare+ they can apply anytime.
Applications can be completed at access.wi.gov or at healthcare.gov, or by telephone.
BadgerCare+ is Always Open
• Employees with coverage through their job:o Most will experience no changes unless
the employer decides to make changes
February 11 2015
ACA and Employer Coverage
Employees without coverage through their job:
• If you work for a large employer (over 100 employees), they must offer insurance beginning in January 2015 or pay a fine
• If you work for a medium employer (50-99 employees), they must offer insurance beginning in January 2016 or pay a fine
• If you work for a small employer (less than 50 employees) the employer is not required to offer insurance, but can choose to provide health insurance through the SHOP
ACA and Employer Coverage
February 11 2015
• Small businesses struggle with costs• 86% of small businesses who don’t offer
coverage say it is because of costs• 25% of small business owners are uninsured• 30% of the 22 million self-employed are
uninsured• Small firms pay 18% more than large
businesses to provide insuranceSmall Business Majority Survey
February 11 2015
Why Small Businesses?
• Small Business Health Options Program (SHOP): online Marketplace where small businesses choose health insurance plan(s) to offer their employees
• Small business is defined as 2-50 FTE employees, fewer than 100 FTE in 2016
• Housed at www.healthcare.gov
Browse plans: https://www.healthcare.gov/find-premium-estimates/
What is the SHOP?
February 11 2015
• SHOP Call Center: 1-800-706-7893• Number specific to SHOP at the Marketplace
• www.healthcare.gov• Follow “Small Businesses” option
• www.cciio.cms.gov• Consumer Information and Insurance Oversight
February 11 2015
More SHOP Information
The Marketplace
February 11 2015
In the Marketplace, an individual or family can complete one application for:o Medicaid (BadgerCare+)o Private plans with tax credits (discounts)o Catastrophic plans
People are eligible to apply for insurance through the marketplace, if they:o Are currently uninsuredo Do not have access to affordable insurance through their employero Have affordable insurance, but would like to explore their optionso Are not incarcerated
The Marketplace
February 11 2015
1. Create an account and password
2. Complete application for health insurance and learn if financial assistancewill be available
The Marketplace Process
February 11 2015
3. Compare and pick a plan that seems right in cost and services
4. Enroll in the plan you like and pay the first month’s premium so the coverage will start at the start of the following month
The Marketplace Process
February 11 2015
Pay monthly premium for coverage
But before a consumer can even get started…
…one of the biggest slowdowns in the application process is not having an e-mail address:
Mobilizers and other community partners could help consumers sign up for many free e-mail options:
The Marketplace Process
February 11 2015
All health plans in the Marketplace must offer:
Essential Health Benefits
ambulatory patient services laboratory services
emergency services maternity and newborn care
mental health and substance use disorder services
prescription drugs
rehabilitative and habilitative services and devices
Pediatric services, including oral and vision care
preventive and wellness services
chronic disease management
February 11 2015
What is the cost of coverage?
Cost is influenced by: tobacco use geographic location age
Costs will vary based on the plan and tier of coveragechosen (ex: bronze, silver, gold, platinum, etc.)
Bronze - 60% Silver - 70% Gold - 80% Platinum - 90%
February 11 2015
February 11 2015
Coverage Tiers in the Marketplace
6070
8090
4030
2010
0
20
40
60
80
100
120
BRONZE SILVER GOLD PLATINUM
COST SHARING BY "METAL TIER"
Help Paying with Costs
Depending on income, people may be eligible for financial assistance on health insurance costs.
February 11 2015
February 11 2015
Financial AssistanceIndividual Sample
• Premium Tax Credits (PTCs) are available for individuals with income between 100-400% FPL selecting any plan type. $11,490-$45,960 for an individual
• Cost-sharing assistance is available for individuals with income between 100-250% FPL . Assistance will be applied only when a silver level plan is purchased.
$28,725 for an individual
Applicants can enroll in Marketplace coverage and get help:
• Online• By phone• By mail• In person
February 11 2015
Application Assistance
Application Process
access.wi.gov
• State of WI website, English and Spanish• Can also apply for FoodShare (food
stamps) and WI Shares (childcare assist)• If applicant is not eligible for
BadgerCare+, application will be forwarded to the Marketplace for processing
healthcare.gov
• Federal Marketplace, English and Spanish• If applicant is eligible for BadgerCare+,
application will be forwarded to the regional Wisconsin Consortia for processing
February 11 2015
Applying Online
• By phone:
National call center 1-800-318-2596 (150 languages,
TTY option)
For BadgerCare+, call local Income Maintenance
Consortia. All numbers found online:
http://www.dhs.wisconsin.gov/forwardhealth
/imagency/consortia.htm
February 11 2015
Applying by Telephone
• In person:
Call 2-1-1 for a full list of sites providing enrollment assistance
Reference the Wisconsin Enrollment Directory for a local site, or the list of insurance agents and brokers:
www.e4healthwi.org
February 11 2015
Applying with In Person Assistance
Local and regional collaborations to meet the enrollment and education needs of our
communities around the Affordable Care Act
Regional Enrollment Networks
February 11 2015
• Next Open Enrollment period for the Health Insurance Marketplace is Nov. 15th, 2014 - Feb. 15th, 2015
• Special Enrollment Periods due to qualifying events: Loss of job Change in income Change in household composition (birth/death) or
marital status And others…
• There are no open enrollment periods for BadgerCare+
February 11 2015
Enrollment Periods
Special Enrollment Periods
February 11 2015
If a person or family experiences a qualifying life event or in certain other circumstances related to the enrollment process, they may be eligible for a Special Enrollment Period (SEP)
This SEP will allow them to enroll in health insurance coverage through the Health Insurance Marketplace outside of a open enrollment period. The individual or family will typically have 60 days from the qualifying life event or approval of their SEP request to enroll in new Marketplace coverage
February 11 2015
Special Enrollment Periods
• *If you took no action by December 15th, 2014, you were re-enrolled in the same plan (or the most similar plan available) for 2015
• If your income increases or decreases this year and you do not report the change, the financial assistance you received must be adjusted when you file your taxes
February 11 2015
Marketplace Renewals
• Consumers enrolled in BadgerCare+ will be notified by their Income Maintenance Consortia (in Milwaukee-MilES) when it is time for yearly renewal.
• Consumers can renew coverage by:
Online: acccess.wi.gov
Mail: paper application or pre-printed renewal packet
Phone: contact your Consortia to schedule an appointment
February 11 2015
BadgerCare+ Renewals
• If uninsured, you may be subject to the Individual Mandate penalty at tax time
• You may be eligible to apply for an exemption
• You may be able to apply later this year if your income changes
• BadgerCare+ may be an option for coverage NOW, or
• You may have to wait for the next Open Enrollment period to get coverage
What if I don’t enroll?
February 11 2015
The Individual
Mandate and Your Taxes
February 11 2015
• Most individuals will be required to have insurance or pay a tax penalty/fee• 2014: $95 per adult or 1% of income• 2015: $325 per adult or 2% of income• 2016: $695 per adult or 2.5% of income,
whichever is more
• Some people will be exempt due to personal circumstance, religion, tribal membership or low income but will still need to apply for the exemption
February 11 2015
The Individual Mandate
• Most people who had insurance in 2014 will simply check a box on their tax return this year• Employer coverage• Badgercare Plus/Medicaid• Medicare• Tricare (veteran health benefits)
• Those who got insurance through the Marketplace in 2014 will reconcile their tax credits
2014 Taxes – If you were insured
February 11 2015
February 11 2015
• “Advance payments” of the premium tax credit helped many individuals pay for Marketplace coverage in 2014.
• These payments were based on estimated income. An individual’s actual 2014 income may be different from this estimate.
• Any discrepancy will be corrected this year when you file your taxes.
2014 Taxes – If you were insured
February 11 2015
• If you received any premium tax credit last year, the IRS will send form 1095-A by early February
• This form will also be available on your healthcare.gov account
• Use the information on this form (how much tax credit you received) to complete form8962, which you will submit as part of your tax return
2014 Taxes – Marketplace Forms
February 11 2015
• The new tax forms make sure you get the right premium tax credit.
**For 2014 only (taxes filed this spring), some taxpayers may haveextra time to pay back the extra credit they received without late fees
2014 Taxes – Reconciliation
If your actual 2014 income was:
Then you qualify for: And on your 2014 federal income tax you will:
…MORE than you estimated on healthcare.gov.
LESS premium help than you received
PAY BACK some of your premium tax credit**
…LESS than you estimated on healthcare.gov.
MORE premium help than you received
RECEIVE ADDITIONAL premium tax credit
• Some people already applied for an exemption through the Marketplace
• Enter your exemption certificate number (ECN) on form 8965• You can also apply for some exemptions
using this form
• Those covered for part of the year will be pro-rated the fee for any months they did not have coverage
Exemptions from the Tax Penalty
February 11 2015
• If you do not have insurance and do not qualify for an exemption, you will have to pay the 2014 penalty
• You can still apply for coverage for 2015 to ensure you do not have to pay the penalty next year but…
• The deadline to apply for 2015 coverage is February 15th (5 days left!)
Uninsured and Not Exempt
February 11 2015
www.ckfwi.org
February 11 2015
www.dhs.wisconsin/health-care
Webcast, PowerPoint training, FAQs on BadgerCare+ changes
February 11 2015
Training/event calendar, enrollment directories and other resources for assisters and consumers
February 11 2015
www.e4healthwi.org
February 11 2015
www.marketplace.cms.gov
Federal fact sheets, training materials, applications and resources
February 11 2015
www.healthcare.gov
Learn about the law, apply for insurance, report changes, find local help
Caroline Gomez, [email protected], 414-270-2963
Questions
February 11 2015
Covering Kids & Families - Wisconsin