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Our Journey

Understanding the Affordable Care Act

June
Understanding ACA ACA Impact on Women’s Contraceptives ACA Objection Handling

October
ACA Health Exchanges

Today

July

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Chapter 2: Learning Objectives
After completion of this e-learning module you should be able to:

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Understand the impact of health reform on women’s access to coverage in the four sections of the health insurance market: employer sponsored insurance, health insurance exchanges, the individual market, and Medicaid Understand the impact of the essential benefits package on women’s access to preventive care, family planning and contraception, maternity care, abortion and mental health services Understand key challenges facing women in accessing insurance coverage

SALES EDUCATION. BACKGROUND INFORMATION ONLY. NOT FOR PROMOTION.

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E-Learning Instructions
 Please review each educational slide in its entirety before proceeding to the next

 You will be asked to complete several knowledge check questions throughout the elearning activity

 At the completion of this e-learning activity, please proceed to the assessment to
complete the requirement for this training

 For internal use only. Not to be forwarded or distributed to customers. These
materials are current as of April 2013 and are subject to change at any time.

SALES EDUCATION. BACKGROUND INFORMATION ONLY. NOT FOR PROMOTION.

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Chapter 2:

IMPACT OF HEALTH REFORM ON WOMEN’S PREVENTIVE SERVICES

SALES EDUCATION. BACKGROUND INFORMATION ONLY. NOT FOR PROMOTION.

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Chapter 2: Table of Contents
 Section 1: Impact on Access to Coverage
 Section 2: Impact of Essential Benefits Package on Women’s Health
Benefits and Access to Care

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Section 1: Impact on Access to Coverage
 Employer Sponsored Health Insurance  Health Insurance Exchanges  Individual Market  Medicaid

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Employer Sponsored Health Insurance

 ACA does not require employers to provide coverage. 1  Most women (59%) with health coverage have employer sponsored
insurance2

 Key Challenges: - Fewer women are able to get coverage through their jobs than men1 - Women are almost twice as likely to be covered as dependents
compared to men, putting them at higher risk of losing coverage1

- Most employers (58%) have grandfathered health plans, although this
percentage is decreasing.3

- Grandfathered health plans are exempt from most of the ACA’s new
requirements, such as coverage for essential health benefits

1. .

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Health Insurance Exchanges

 Prohibits Gender Rating - Insurers will be prohibited from charging higher premiums based on sex,
health status, or occupation; premiums can vary by age and tobacco use

 Essential Health Benefits
– Qualified Health Plans sold in the Exchange must offer a minimum level of benefits including women’s preventive care and contraception.

 Assistance with Premiums
– Low income individuals and families may be eligible for subsidies or tax credits towards the purchase of health insurance.  Key Challenges – Cost is a barrier to care and treatment for many women who are disproportionately low income
1. The Kaiser Family Foundation. Impact of Health Reform on Women’s Access to Coverage and Care. April 2012.
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Cost is a Barrier to Care and Treatment for Many Women

1. The Henry J. Kaiser Family Foundation. Impact of Health Reform on Women’s Access to Coverage and Care. April 2012

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Individual Market

 Impacts a small percentage of women (6%)  Major insurance reforms apply to the individual market  Many people with individual coverage may seek subsidized insurance in
the Exchanges

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Medicaid
 Currently two-thirds of adult Medicaid recipients are women
– Overall 12 percent of women are covered by Medicaid.

 Changes to Medicaid eligibility requirements
– Eliminates program’s categorical eligibility requirements: pregnancy, parent of a dependent child, over 65, or disability. – Expands Medicaid eligibility to all individuals with incomes up to 138% FPL

 A majority of women currently uninsured may qualify for Medicaid  Not all states will expand Medicaid
– Per the U.S. Supreme Court Ruling in 2012, states can opt out of Medicaid expansion.

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Knowledge Check
Chapter 2: Section 1

1. Which statement is false about employer sponsored insurance?

A. The ACA does not require employers to provide coverage to their workers. B. A grandfathered plan does not have to provide essential health benefits. C. The number of grandfathered plans is increasing. D. Most women with coverage have employer sponsored insurance. E. Most women are covered as dependents.

Answer: C

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Section 2: Impact of Essential Benefits Package on Women’s Health Benefits and Access to Care
 Access to Primary Care Providers  Preventive Care  Maternity Care

 Abortion
 Mental Health  Older Women with Disabilities

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Access to Primary Care Providers

 Addresses shortage of primary care providers  Increases Medicare and Medicaid primary care rates  Promotes coordinated primary care for dually eligible Medicaid and
Medicare eligible beneficiaries; nearly two-thirds (63%) are women

 Provides incentives for primary care health care professionals to
practice in underserved or rural areas

 Expands Community Health Centers (CHC)
– CHCs will be expanded and modernized to serve up to 20 million more patients.

 Allows direct OB-GYN access
– Women in group health plans will be allowed direct access to participating ob-gyns without needing a primary care provider referral

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Preventive Care: Family Planning / Contraception

 Employer-Sponsored Plans  Most workers in employer-sponsored plans are currently covered for
contraceptives

 Exemptions and accommodations for religious employers  New private “non-grandfathered” plans

 Family planning counseling and FDA approved contraceptives are
preventive services for women that must be covered as of August 2012

 Medicaid  Already requires that states cover family planning services without
cost-sharing

 States can now extend eligibility for Medicaid family planning programs
without a federal waiver (27 states have programs)

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Preventive Care: Teen Pregnancy and STI Prevention

 Additional Funding Provided
– Provides $75 million a year to states for evidence-based sex education programs to reduce teen pregnancy and incidence of sexually transmitted infections.

 Screening for HIV, chlamydia, gonorrhea and syphilis are preventive services
covered without cost-sharing for those getting coverage through qualified health plans in Exchanges and new private plans.

– Restores $50 million a year for abstinence unless married educational programs.

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Maternity Care

 New private plans
– Coverage for prenatal, maternity and well-baby care are required as part of the essential benefits package

 Medicaid
– Women covered under Medicaid will be able to maintain their coverage before pregnancy, during the prenatal and postpartum period and beyond. – Coverage of comprehensive tobacco cessation programs for pregnant women – Support of reimbursement of nurse midwives, birth attendants, and freestanding birth centers – All newborns lacking any other coverage will be eligible for Medicaid

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Abortion

 Abortion is explicitly banned from being included as an essential benefit  Medicaid
– No federal funds, tax credits or subsidies may be used for abortions except in cases of rape, incest, or life endangerment, consistent with the Hyde Amendment. – States can continue to use state funds to cover other “medically necessary” abortions

 State Exchanges
– States can ban coverage in exchanges – All of the exchanges must offer consumers the choice of at least one plan that does not provide abortion coverage – Plans that do cover abortions beyond Hyde limitations must segregate premium payments for coverage of abortion; individuals enrolled in these plans must make separate premium payments
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Mental Health

 General mental health screening and treatment services are included as
essential health benefits

 Screening and counseling services to detect and prevent interpersonal
and domestic partner violence are covered

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Older Women and Those with Disabilities

 Medicare beneficiaries, coverage without cost-sharing for:
– Preventive services that the USPSTF has rated A or B, including mammograms, pap smears, and bone density screenings – A personalized health plan, annual comprehensive risk assessment and screenings for chronic conditions

 Prescription drugs
– Makes important changes to reduce the Medicare Part D “donut hole”

 Long-term care
– The voluntary savings program to assist those with disabilities to purchase non-medical services and supports – called the CLASS act - was stopped due to the financing limitations.

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Summary of Women’s Preventive Services
Preventive Services Covered by New Private Plans Without Cost Sharing Cancer
Breast Cancer Screenings

Chronic Conditions
Cardiovascular Health

Healthy Behaviors
Tobacco Cessation Interventions

Reproductive Health
Contraception

Pregnancy Related
Tobacco Cessation Interventions

Cervical Cancer Screenings
Colorectal Cancer Screenings

Type 2 Diabetes

Alcohol Misuse Screening/ Counseling
Healthy Diet Counseling Well Woman-Visits Domestic Violence Counseling Immunizations

Education / Counseling
STI/STDs Screenings

Alcohol Misuse Screening/ Counseling
STI/STDs Screenings Iron Deficiency Anemia Screening Breastfeeding Supports Rh Incompatibility Screening

Depression Screening

Osteoporosis Screening Obesity Screening

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Knowledge Check
Chapter 2: Section 2

1. Which statements are true about coverage for preventive care services?

A. Mental health treatment is not a covered benefit. B. Preventive care services are covered without cost-sharing. C. States can determine if they will cover family planning services under
Medicaid. D. Contraception is a covered preventive care benefit. E. The co-insurance for Medicare beneficiaries is reduced to 10%.

Answer: B, D

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Summary
 The Affordable Care Act (ACA) will increase women’s access to coverage through
creation of the health insurance exchanges and Medicaid expansion.

 Provision of the essential benefits package will have a significant impact on
women’s access to preventive care, family planning and contraception, maternity care, and mental health services.

 Essential health benefits are covered without cost-sharing, which eases the financial
burden on women for whom affordability is an issue.

 Most women with health insurance are currently covered by employer-sponsored
plans, which may be grandfathered and exempt from essential benefit requirements. However the number of grandfathered plans is decreasing each year.

 The ACA provides addresses the shortage in primary care providers by increasing
payments in Medicare and Medicaid and providing incentives for health care professional to practice in underserved areas.

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