The Affordable Care Act

:
What does it mean for California?

Community Health Councils

Community Health Councils
Works to promote social justice and achieve equity in community and environmental resources for underserved populations.

2

The Uninsured
1 out of 5 children and adults in LA County have no insurance

• • • • • • •

Children Parents Adults without children Workers Our Neighbors Our Friends Our Own Families
3

Health Coverage Changes and Improves
 More Coverage Options
– Medi-Cal: Expands – Covered CA: Opens  New Consumer Protections & Benefits  Medicare: Improvements

 Opportunities for Small Businesses
4

Millions will receive Coverage
LA County Covered CA
(with premium assistance)
)

• 779,000 • 460,000 • 970,000
5

Medi-Cal
Remaining Uninsured

Know the Facts – Individuals/Families
In 2014 health insurance is required for Most People
If you already have insurance through a job, Medi-Cal or Medicare you don’t have to do anything

You can be excused if: • Cannot afford coverage • Do not file Taxes • Your religion does not allow it. • Native Americans, Incarcerated People and the Undocumented

6

Why is this important?

More people with coverage means lower costs for everyone Know the facts:

If you do not have coverage, you may pay a tax penalty.

Penalties start low in 2014 but go up higher every year
7

Know the Facts – Employers
• Employers with at least 50 full-time equivalent staff must provide health insurance.

• If full time (not part-time) employees go into Covered CA, the employer must pay a tax penalty.
• The penalty only occurs if the employer has 30 or more full time employees.

More Health Coverage Options
Program Eligibility by Federal Poverty Level Covered California with Premium Assistance Household Size Medi-Cal Adults Medi-Cal Children 139% Covered California no Premium Assistance

<100% 1 2 3 4 5 6 7 8

138%

200%

250%

300%

400%
$45,960 $62,040 $78,120 $94,200 $110,280 $126,360 $142,440 $158,520

401% & up
$45,961 + $62,041 + $78,121 + $94,201 + $110,281 + $126,361 + $142,441 + $158,521 +
9

<$11,490 $15,856

$15,971
$21,559 $27,147

$22,980
$31,020 $39,060

$28,725
$38,775 $48,825

$34,470
$46,530 $58,590

<$15,510 $21,404
<$19,530 $26,951 <$23,550 $32,499

$32,735
$38,322 $43,910 $49,498 $55,086

$47,100
$55,140 $63,180 $71,220 $79,260

$58,875
$68,925 $78,975 $89,025 $99,075

$70,650
$82,710 $94,770 $106,830 $118,890

<$27,570 $38,047
<$31,590 $43,594 <$35,610 $49,142 <$39,630 $54,689

• Adults do not have to have children in Medi-Cal • Income level goes up • Former foster youth eligible up to age 26

• Those In Healthy Way LA will become Medi-Cal

The paper & online application is simpler.

• Less Documentation and more electronic verification
Changes start January 1 2014 ~ Healthy Way LA open today
10

Medi-Cal Benefits Today & 2014
Adult & Children Adultos y Niños

• Medical Coverage - Medically Necessary

Children & Pregnant Woman Niños y Mujeres Embarazada

• Dental & Vision

Adults May 2014

• Dental (preventative, diagnostic, restorations and full dentures
11

Covered California
• Helps make comparing, applying for and purchasing coverage easy.
• Enroll as soon as October 2013. • Coverage will start as soon as January 2014

12

Whose Eligible?
Citizen and Lawfully Present Resident  California Resident  Household income above 138%  financial assistance 139% - 400%  Don’t have public coverage (i.e. Medi-Cal)  Cannot have employer coverage unless
 Health Plan pays less than 60%  Employee’s share of premium exceeds 9.5% of household income (not dependent share)

13

Benefits
10 essential health benefits: • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health & substance use disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including dental and vision care
14

Premiums
Based On Not Based On

• Age • Household Size • Region • Health Plan & Benefit Level Selected

• Health Status • Gender • Pre-Existing Conditions • Tobacco Usage

15

Plans & Tier Levels/Planes y Niveles
LA County Health Plans
Anthem Blue Cross of California Blue Shield of California Health Net Kaiser Permanente L.A. Care Health Plan Molina Healthcare

Children’s Dental Plan
Anthem Blue Shield Delta Liberty Premier Access

Paid by the health plan vs. the consumer Tiers Bronze Silver Gold Health Plan 60% 70% 80% Consumer 40% 30% 20%

Dental Plan Consumer

High
Low

85%
70%

15%
30%

Platinum

90%

10%

Minimum Plan: for those under age 30 (no premium assistance & higher out of pocket costs)
16

Bronze
Preventive
Primary Care Specialty Care Urgent Care Emergency Generic Medication Lab Testing X-Ray Deductible

Silver*

Gold

Platinum

$0 $60 (3 visits per year)
$70 $120 $250 30% 30% 30%

$0
$4 - $45 $6-$65 $8 - $90 $25 - $250 $4 - $25 $6 - $45 $10-$65

$0
$45 $65 $90 $250 $25 $45 $65

$0
$25 $50 $50 $150 $5 $25 $40

$5000
$6,350 $12,700

$2000
$6,350 $12,700

None
$6,350 $12,700

None
$4,000 $8,000

Maximum Out of pocket
Individual Family

*Sliding Scale co-payments offered at the Silver level based on income
17

Health Premium Tax Credits
Take in advance to lower premiums or As a credit on your taxes
Based on family income and size

Can only get the credit at Covered CA
Tax Credit Can Change If… Income Changes • You get a raise • You lose your job • You take a salary cut Family Size Changes • You get married or divorced • You have a baby or adopt a child • Stop claiming a child on your taxes
18

Shop and Compare Tool

Example: Family of 4 - $60,000 (Parents - 40 years old).

o Estimated premium: $783 per month o Tax credit: $374 per month o Family pays: $409 per month

19

Enroll Anytime Using Various Ways
One Application for Covered California and Medi-Cal

CoveredCA.com

Benefitscal.org
(Medi-Cal & other Social Service)

County Offices

Service Center • Covered CA 800-300-1506 • County Customer Service Lines

Certified Enrollment Counselors

Certified Insurance Agents (SHOP)

Covered CA: Enrollment Periods
Year One Regular - After Year One Outside Regular Period October 1, 2013- March 31, 2014 October 15 – December 7
Within 60 days after a qualifying life-changing event Medi-Cal: Enroll Anytime
20

New Consumer Protections
• Free preventive services
• Stay on parent’s health plan until the age of 26.

• Plans cannot deny coverage due to a preexisting conditions.
• Plans cannot drop coverage or stop treatment. • No lifetime or Annual dollar limits

Plans in and outside of Covered California
21

Improving Medicare
• Increased coverage for wellness and preventative care. – One free “wellness” visit per year. – Covers more preventative services

• Provides discounts on brand name and generic drugs while you are in the Part D coverage gap.
• Closes the Part D coverage gap by 2020. Medicare Beneficiaries DO NOT have to purchase new Coverage
22

Covered California: Small Business Health Options Program (SHOP)
• Small business = 1-50 employees

• Small businesses can enroll at any time
• Enrollment assistance provided by Certified Agents & Brokers • Employer selects plan metal tier (i.e. bronze, silver, gold, platinum)  Employee chooses health plan within metal tier. • Tax credits available to pay for employee premiums.

23

Programs Continue for Undocumented Immigrants
• Emergency/Pregnancy Medi-Cal • Local program at community/county clinics • Healthy Kids for children 0-5

24

Get Involved!
Talk with family, friends, and community members
For more Information:
• • • • • • Kaiser Family Foundation: healthreform.kff.org Health Reform website: www.healthcare.gov Covered California: http://www.coveredca.com/ La Opinion http://www.laopinion.com/lasaludempiezaaqui Univision Univision.com/saludaqui Telemundo http://www.telemundo52.com/secciones-especiales/asegurate

Share YOUR Thoughts with Lawmakers
• State: http://www.legislature.ca.gov/ • Congressional: http://www.usa.gov/Contact/Elected.shtml (202) 224-3121
25

Questions?
Sonya Vasquez - Community Health Councils
sonya@chc-inc.org ~ (323) 295-9372 www.chc-inc.org www.facebook.com/CommunityHealthCouncils https://twitter.com/chcinc http://letsallgetcovered.org/

26

Master your semester with Scribd & The New York Times

Special offer for students: Only $4.99/month.

Master your semester with Scribd & The New York Times

Cancel anytime.