explaining the health insurance marketplace october 2013
DESCRIPTION
Basic information about the healthcare.gov marketplace. What is it, how is it affecting Wisconsin, and what is to come? Presented in October of 2013, there is a lot we did not know and still do not.TRANSCRIPT
Copyright © 2013 Holy Family Memorial. All rights reserved.
October 23, 2013 hfmhealth.orghfmhealth.org
What you need to knowWhat you need to knowShawn Daughenbaugh, MHA
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Education GoalsEducation Goals
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• What is the marketplace• When does it begin• Who is affected• How to enroll• Doing What’s Right
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The Marketplace The Marketplace ExplainedExplained
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In Wisconsin… land of In Wisconsin… land of cheesecheese
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• Wisconsin is operating a Federally Facilitated Marketplace– Initial set up and operation controlled by
federal government– No state involvement in operations
• Marketplace is an online entity• National hotline and website at
healthcare.gov
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Participating Participating insurersinsurers
• Including HFM– Common Ground Healthcare Coop– WPS Health Plan, Inc. (Arise)– Dean Health Plan, Inc. (Preva 360)
• Not including HFM– Molina Healthcare of WI, Inc– Compcare Health Services Ins. Corp. (Anthem)
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hfmhealth.orghfmhealth.orgPremiumsPremiumswww.healthcare.gov/find-premium-estimates/
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hfmhealth.orghfmhealth.orgReimbursementReimbursementFinancial Impact on HFM
• Reimbursement will remain at current negotiated rates for each insurer
• While contracted rates will remain the same, the ability of individuals to pay deductible and copayments may be an issue
• What will private insurance do?7
hfmhealth.orghfmhealth.orgTiers of CoverageTiers of Coverage“Metal Plans”
• Each metal indicates the actuarial value
8Source:HealthPocket
hfmhealth.orghfmhealth.orgTax CreditTax CreditHow it works
• An “advanced premium” paid directly to insurer
• Based on federal poverty level, the individual may get 2% to 9.5% of income back for credit
• Credit is based on benchmark– That difference between 2nd lowest silver
and specified percent from above
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Mathematical Mathematical example example All figures are annual costs
• Smith Family: Married couple with 2 children
• Income: $47,100; equals 200% of FPL– This means the Smith family gets 6.3% of
$47,100 back to them. Equals $2,968 per year
• 2nd lowest silver plan premium $10,000/ year
• Credit due to Smith Family is $7,032– $10,000 minus $2,968
10Source: Health Affairs
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Ready or Not!Ready or Not!
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hfmhealth.orghfmhealth.orgThe days of infamy The days of infamy
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hfmhealth.orghfmhealth.orgWho is affected?Who is affected?
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Fantastic. How does one Fantastic. How does one enroll?enroll?
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hfmhealth.orghfmhealth.orgCommunity HelpCommunity Help
• Community “Mobilizers” are key• Manitowoc County will have 3,000-
5,000 individuals affected• HFM stepped up to Do What’s Right
– Manitowoc County Community Action Enrollment Coalition
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hfmhealth.orghfmhealth.orgAt HFMAt HFMWhere to find help
• Insights is already hard at work– The point of contact for most patients with
concerns– Activity
• www.hfmhealth.org/EnrollAmerica– Website hosted by HFM for citizens
• CAEC Toolkits at Wellness Center, Main Entrance, Clinics, ER, EVERYWHERE!
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Enroll America: Answers for Enroll America: Answers for youyou
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hfmhealth.orghfmhealth.orgRecapRecap
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• Nationally speaking uneven expansion of Medicaid leaves many holes
• Health Insurance Marketplaces will insure millions of Americans –though many may remain or become uninsured
hfmhealth.orghfmhealth.orgRecap ContinuedRecap Continued
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• Qualified Health Plans will be sold with different levels of coverage – several options tailored to peoples’ need but will be confusing
• Open Enrollment is from October 1-March 31
•Healthcare.gov
Copyright © 2013 Holy Family Memorial. All rights reserved.
October 23, 2013 hfmhealth.orghfmhealth.org
Thank you. Questions?Thank you. Questions?