employee guide to enrolling in the health insurance marketplace
DESCRIPTION
Employee Guide to Enrolling in the Health Insurance Marketplace. - PowerPoint PPT PresentationTRANSCRIPT
Employee Guide to Enrolling in the Health Insurance
Marketplace
ASSOCIATION INSURANCE COOPERATIVE
Indiana Assisted Living AssociationIndiana Association of Area Agencies on AgingIndiana Association of Home and Hospice CareIndiana Hospice and Palliative Care Organization
LeadingAge IndianaLeadingAge Ohio
Ohio Council for Home Care & Hospice
Today’s program will show you how to apply for tax credits and insurance subsidies, compare benefits, and enroll in a PPACA Reform Health Insurance Plan
Comparing Benefits and your “Out of Pocket” expense.PREMIUMDEDUCTIBLEThe amount that you will have to pay annually for your healthcare (such as surgical procedures, blood tests, or hospitalizations, but not routine office visits) before the health insurance pays anythingOUT-OF-POCKET MAXIMUM (OOP)The most cost-sharing you will ever have to pay in a year. It is the total of your deductible, copays, and coinsurance (but does not include your premiums). Once you hit this limit, the insurance company will pick up 100 percent of your costs for the remainder of the year.
CO-PAYYour co-pay is the fixed amount you pay for using routine services like visiting your primary care physician or an emergency room or purchasing a prescription drug. For example, a plan may require co-pays of $20 for office visits, $100 for emergency room visits, and $15 for generic prescriptions or $30 for name-brand drugs.
CO-INSURANCECo-insurance generally applies to less routine expenses. Co-insurance is in addition to your deductible. So if your plan has a $100 deductible and 30% co-insurance and you use $1,000 in services, you’ll pay the $100 plus 30% of the remaining $900, up to your out-of-pocket maximum.
COST - SHARING
Let’s see how this works
The Plan that you are evaluating pays $500.00 deductible. 30% co-insurance, OOP $4,000. What is the benefit?
You Break a LegMEDICAL EXPENSES • Hospital Charges $2,000• Doctor Fees $3,000Without insurance you would pay out-of-pocket $5,000.00
Impact of Deductible and Co-Insurance • Deductible $500.00• 30% Coinsurance - after you pay the deductible ($500.00), you pay 30% of the remaining amount. $5,000.00 - $500 deductible = $4,500.00 times 30% = $1,350.00Total that you pay out-of-pocket = $500 + $1,350 = $1,850 – You save $ 3,150.00 with this insurance plan
Let’s see how all of this works
Have an AppendectomyMEDICAL EXPENSES • Hospital Charges = $12,000• Doctor Fees = $4,000Without insurance you would pay out-of-pocket $16,000
Impact of Deductible and Co-Insurance • Deductible = $500.00• OOP = $4000.00• 30% Coinsurance – after you pay the deductible ($500.00), you would pay 30% of the remaining $15,500.00 = $4,650.00, but your out-of-pocket maximum is $4,000.Total that you pay out-of-pocket = $4,000 – You save $12,000.00 with this insurance plan. Note that some plans state that their out-of--pocket maximum does not include the deductible, so your total out of pocket cost would be $4,500.
If you enroll between October 1 and December 15, 2013, the effective date for when your insurance coverage begins will be January 1, 2014.
After December 15, 2013 the effective dates will change.Enroll between:Effective Date is:December 16 – January 15, 2014 February 1, 2014January 16 - February 15, 2014 March 1, 2014February 16 – March 15, 2014 April 1, 2014March 16 - March 31, 2014 May 1, 2014
2014 and beyond – Open enrollment Dates: October 15 – December 7
REFORM INSURANCE INITIAL ENROLLMENT DATES
ACA Enrollment Pathways
www.HealthCare.gov – Use this Federally Facilitated Marketplace site to determine your eligibility for government programs and to enroll in the Marketplace.
CMS 10-4-2013: “When the consumer is logged in to the healthcare.gov page, the consumer will be shown a screen labeled, “Help applying for coverage.” On this screen, it is vital that the consumer enters the agent’s/broker’s name, NPN, and FFM User ID”.
• AIC Agent/Broker Name: Kennth Lee • NPN: 7873397 • FFM ID: lee2020
AIC Application Information on the AIC home page: www.associationinsurance.us
CLICK HERE for ACA Reform Insurance for Persons Not Needing Subsidies and ACA Paper Application for Subsidies
AIC Insurer Pathway
November: Determine Eligibility and Enroll via Insurer Website
December: Eligibility and Enrollment in both On-Exchange and Off-Exchange Marketplace – “one stop”
Set up an account. First you'll provide some basic information. Then choose a user name, password, and three security questions for added protection.
Enrollment Process Overview at HealthCare.gov
Fill out the online application.
Enrollment Process Overview
Compare your options. Shortly upon entering the information, you will see all the options you qualify for, including private insurance plans and free and low-cost coverage through Medicaid and the Children’s Health Insurance Program (CHIP).
The Marketplace will tell you if you qualify for lower costs on your monthly premiums and out-of-pocket costs on deductibles, copayments, and coinsurance. You’ll see details on costs and benefits.
Make sure that your physician is part of the network – On Exchange Policies may have a limited provider network
Enrollment Process Overview
Health Insurance Marketplace Plans, Benefits, and Costs
“Metal Tiers”
• Bronze Plan: You pay 40% and the plan pays 60%.• Silver Plan: You pay 30% and the plan pays 70%.• Gold Plan: You pay 20% and the plan pays 80%.• Platinum Plan: You pay 10% and the plan pays 90%.
Catastrophic plans will be available for persons who are under 30, persons with financial hardship, and certain other demographics. These plans will be qualified health plans and have lower premium cost, but the plans will have less coverage and higher co-pays and co-insurance. Persons with this coverage are not eligible for tax credits or subsidies.
Health Insurance Marketplace Plans, Benefits, and Costs
A Qualified Health Plan is a Marketplace certified “health plan” that offers an “essential health benefits package.”
To provide the essential health benefits package, a plan must include:• ACA required preventative services.• Essential health benefits.• Include the four metal tiers.
Age Forty, Male, Non-Smoker
Indiana - 46151 Ohio - 44130
AIC SUMMARY• AIC will assist you to determine eligibility for tax credits and insurance subsidies. Enrollments between October 1 and December 15, 2013 have an effective date of January 1, 2014.• Qualified Health Plans: guarantee issue, no pre-existing condition limitations, Essential Health Benefits (EHB).• Only DHHS certified agents and brokers can help you to choose and purchase QHP.• An Employee Guide to Enrolling in the Indiana, Ohio, Illinois, and Michigan Health Insurance Marketplace.
ACA Application - Short Form (Individuals)ACA Application - Short Form Instructions
ACA Application - Long Form (Applicants with Dependents)ACA Application - Long Form Instructions
Determining Eligibility for Subsidies Using a Paper Application
Important Links
Federally Facilitated Marketplace https://www.healthcare.gov/index.html
Estimate Your Tax Credits or Subsidy at http://kff.org/interactive/subsidy-calculator/
ACA Required Preventive Services
Individual Mandate Flow Chart
Employee Guide to Health Care Reform's Tax Credits
Association Insurance Cooperative Website – www.associationinsurance.us
AIC Insurer Marketplace – www.associationinsurance.info
Contact Information
Kenneth S. Lee, Program Director – email: [email protected]
Bob Brodell, AIC General Agent – email: [email protected]
AIC Website: www.associationinsurance.usAIC Insurer Website: www.associationinsurance.info
