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The Affordable Care Act:

What Does It Mean for You and YourFamily?

June 26, 2012

Series 1 of 4

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Acronyms

ACA Affordable Care Act

AI/AN American Indian/Alaska Native

FPL Federal Poverty LevelIHCIA Indian Health Care Improvement Act

I/T/U Indian Health Services, Tribal and Urban

Indian organization programs/providersCHIP Childrens Health Insurance Program

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Basic Health Insurance Terms

Premium: The amount paid to an insurance company, usually ona monthly basis, for health insurance coverage.

Out-of-pocket costs: Health care costs paid by the patient. These

include copayments, coinsurance, and deductibles.

Deductible: A specific dollar amount paid by the user each yearbefore your health insurance plan starts to make payments for aclaim. Not all health insurance plans require a deductible.

Exclusions: Things not covered by the health insurance policy.Make sure to check the fine print of the health insurance policy forwhich conditions are excluded.

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Basic Health Insurance Terms cont.

Benefit:Any service or supply (an office visit or a prescription drug)your health insurance plan will pay for.

Co-payment (copay): The dollar amount paid for a medical service

or supply according to your insurance plan. ($20 for sick visit)

Pre-existing condition:A health problem or diagnosis that you hadbefore applying for health insurance or before the effective date ofyour new health plan. By 2014, companies will be unable to deny

you coverage based on pre-existing conditions.

Lifetime maximum: Refers to the amount of money the healthinsurance policy will pay for the entire life plan.

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The Health Care Law

On March 23, 2010, PresidentObama signed into law the PatientProtection and Affordable Care Act(ACA)

The ACA protects the right of allAmericans, including AmericanIndians and Alaska Natives, toaccess affordable health care

More than 32 million in this countrywho would otherwise not havehealth insurance will have access tohealth coverage

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The Federal Trust Responsibility

The ACA fulfills thefederal trust relationship& strengthens

tribal sovereignty through:

o Protection of the IHSsystem

o Providing equal access toquality care

o Expansion of tribalgovernments role in healthcare decisions

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What Does the ACA Mean for Indian Country

New sources of funding toimprove your experience

Better health carecoverage for you and yourfamily

Empowering action tochange our future

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You Can Help Strengthen

Indian Health Services

Did you know?

The more American Indians &Alaska Natives who are

covered with some form ofHealth Insurance,

the more contract health $$$will be available

to care for the most vulnerable inyour community.

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What Are You Eligible for Now & In the Future2010

Children with pre-existing conditionscan not be denied coverageYoung Adults under age of 26 can stay

on parents insurances

2011

Free Elders Annual Wellness VisitInsurance companies must spend atleast 80% of their profit on health careservices

2014The Insurance Exchange will start inStatesMedicaid will apply to low incomechildless adults

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What is the Insurance Exchange

Exchange is also called marketplace States may set up one up but can opt out. The federal

government will set it up in that case

Sign up on a clear, easy-to-use website

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Protection for Indian Country

American Indians & AlaskaNatives will not be penalized forbeing uninsured

But did you know about theother protections you haveas an American Indian & Alaska

Native?

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More Choices for Health Care for AI/AN

More AI/ANs willqualify for Medicaidbased on higherincome level

No premiums ordeductibles for AI/ANs

No copays for services

received from anIndian health careprovider

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More Affordable Coverage Options

For the first time ever, single,childless adults will qualify forMedicaid

Affordable private insurance Allows tribes and tribal

organizations to purchasehealth coverage for IHS

beneficiaries through theFederal Employees HealthBenefits program

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Improved Insurance

Under the ACA InsurersAre Required To:

Pay the cost of many preventiveservices

Cover all consumers with pre-existing conditions

Provide reasonable explanationfor cancellation of insurance

policies End annual and lifetime limits

Carry young adults under theirparents plan until the age of 26

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Elders Have More Medicare Services

The Law Will:

Provide prescription drugcost relief

Eliminate deductibles andco-payments for certainpreventive services

Incentivize physicians tosee more Medicarepatients

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What is Your SituationYou may

Live on a reservation, in a small village, or urban areaBe changing jobs or moving to another stateWork for a tribe or are planning to retire earlyBe fresh out of school

You will have access to affordable health insurance

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Learn More At

http://www.tribalhealthcare.org http://www.HealthCare.gov

http://www.IHS.gov

http://www.tribalhealthcare.org/http://www.healthcare.gov/http://www.ihs.gov/http://www.ihs.gov/http://www.healthcare.gov/http://www.tribalhealthcare.org/

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National Indian Health Outreach & Education(NIHOE) Initiative

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NIHOE National Partners

* With generous support from the Indian Health Service

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13 NIHOE Area Coordinators

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National Indian Health Board

Tyra Baer - Tribal Health Care Reform Project CoordinatorTbaer@nihb.org

mailto:tbaer@nihb.orgmailto:tbaer@nihb.org