The Affordable Care Act. What does it mean for you and how we advocate for it?

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1 The Affordable Care Act What does it mean for you and how we advocate for it?

2 Who are Young Invincibles?

3 Agenda Overview of the ACA How does health insurance work? What s included in a health insurance plan? What are the costs? How we do healthcare advocacy? Key takeaways

4 What is the ACA? In March 2010, President Obama signed the Affordable Care Act (ACA) into law ACA = Obamacare Starting in 2014, individuals are required to have health insurance or pay a penalty Insurance plans are required to be more comprehensive New types of tax credits are available to help make health insurance more affordable

5 Ways to get covered Stay on a parent s plan (if you re under 26 and the plan covers dependents) Student health plans Job-based coverage [HealthCare.Gov], the official health insurance marketplace Medicaid Qualified Health Plans (QHP)

6 Definitions Premium: The amount of money you pay for health insurance every month Deductible: Your out-of-pocket costs with a health insurance plan Co-Pay/Co-insurance: The fixed amount/percentage that you pay at each doctor s appointment or when filling a prescription Marketplace: a website where you and your family can go to compare plans and apply for insurance coverage Tax Credit: A discount that you receive through the marketplace, based on your income, to offset the cost of health insurance

7 How does health insurance work? You pay a monthly amount (premium) for health coverage When using health services, you share costs with your insurance company (deductibles, co-pay) Some services like blood pressure or cholesterol screenings, will be covered at no extra cost

8 What do I pay? When you buy health insurance, you will have two kinds of cost Monthly Premium + Out-of-Pocket = Your total cost

9 Do I really need insurance? Financial security for you and your family Annual check-ups are crucial to maintaining long-term health Invest in your health Save money with early detection More bang for your buck: Essential health benefits Free preventive services Insurers have to spend 80% of premiums on health coverage or send you a rebate No annual or lifetime dollar limits on benefits Can t be denied coverage or charged more because you have a pre-existing condition It s required Or pay a penalty

10 Preventive Services Help you stay healthy Free preventive services covered by all plans: Flu shots Obesity counseling STI testing And more! Preventive care also includes women s health benefits

11 Women s Preventive Services Well-woman visits Support for breastfeeding Equipment, counseling Domestic violence screenings and counseling Mammograms and cancer screenings

12 Contraception Health plans now cover contraception with no co-pay Covers generic prescriptions, and brandname in cases were generic is not available Coverage is free with a prescription from a doctor Does not cover condoms or male contraception Religious institutions (ex. churches, temples) are exempt

13 Qualified Health Plans Plans that have been certified by the marketplace All plans offer the essential health benefits All plans must include an adequate network of doctors and hospitals Individuals may be eligible for tax credits to help reduce the cost of premiums [HealthCare.Gov] [ ] In person help

14 10 Essential Health Benefits Ambulatory patient services Emergency services Hospitalization Maternity/ne wborn care Mental health and substance use disorder services Prescription drugs Rehabilitative and habilitative services Laboratory services Preventive and wellness services/chronic disease management Pediatric services

15 Beyond the Basics Some plans also offer additional benefits: Visits to the dentist Visits to the optometrist Healthy lifestyle coaching Discounts on gym memberships These plans may cost more in the form of higher premiums or out-of-pocket costs

16 Catastrophic Plans Available to: Young adults under 30; OR Those unable to find a plan under 8% of income or with a special hardship (as determined by HHS) What it covers: Three primary care visits a year Preventive services without co-pay or deductible Further services, but with high deductible

17 Catastrophic Plans Caution! Very high deductible Tax credits DO NOT apply

18 Individual Mandate and Penalties Individuals must have qualifying health insurance If not, penalties: Greater of $95 or 1% of income the first year $695 or 2.5% of income by 2016 Penalties are pro-rated Exemptions: Native Americans Religious reasons Incarcerated individuals Those who can demonstrate hardship Those below the tax filing threshold Those who would have qualified for Medicaid in states that do not expand

19 Comparing Health Plans Comparing Plans in [DC]: Online: [Healthcare.gov] Phone: [ ] In person with the help of a Navigator Paper application

20 Tax credits Those making between [100]- 400% of FPL could qualify for tax credits (subsidies) 400% of FPL for 1 person is $45, % of FPL for a family of four is $94,200 An advanceable tax credit allows a person to receive assistance at the time that they purchase insurance

21 Tax credits: Take it now or later Open Enrollment Take it Now: Credits apply each month to lower the cost of monthly premiums Oct. Nov. Dec. Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov Dec. -OR - Be Covered File Taxes in 2015 Take it Later: Pay full cost of monthly premium Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec. Take it Later: claim tax credit on your 2014 taxes, get a bigger refund or owe less Be Covered

22 How much of a tax credit Four tiers of plans Bronze, Silver, Gold, and Platinum Tax credits are calculated based on Silver plan Individuals can use tax credit for any plan Tax credits will change with income Hrly. Wage Monthly Income Monthly Premium Tax Credit Actual Cost $8.25 $1,430 $180 $123 $57 $10 $1,733 $180 $86 $94

23 Understanding the coverage levels The level of coverage you choose affects your monthly premium and your out of pocket costs. Generally, lower premiums mean higher out-of-pocket costs 100% Amount of Coverage 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Bronze Silver Gold Platinum

24 Things to consider The amount and type of care you expect to need The plan s network of doctors and hospitals Prescription drug coverage Any specialists you may need to see Dentists and eye doctors Any specific prescription drugs or services that may not be covered under the EHB umbrella

25 Important dates to remember Mar 31 Last day of open enrollment May 1 Day coverage begins if enrolled after March 15 th

26 Advocacy and the ACA

27 Lobbying is: The act of attempting to influence a politician or public official. The majority of lobbying is comprised of educating lawmakers about an issue that we care about. We do this by: Briefing the lawmaker and their staff Providing lawmakers with facts, trends, and data Sharing our personal stories Making an ask Keeping lawmakers updated with new information

28 Know Your Audience Familiarize yourself with your State Representative Past votes they have taken Do some online research What committees are they on?

29 Types of members: 1. Champions co-sponsors, leaders Thank them! Ask how you can help 2. Supporters agree Ask them to take a leadership role 3. Opponents disagree Ask them why? Thank them 4. Undecided Persuade, talk about why this is important to you personally Follow up with answers to questions

30 General tips Lobby as a group Schedule visits with your Senator or Delegate before they head to the Capitol. Monitor the work of legislative commission that meets during the interim sessions Schedule visits to Capitol with like-minded individuals when the General Assembly is in session. Communicate with money committee staff.

31 Meeting Roles Once you have your group, decide what roles each of you will play: Facilitator manage the course of the meeting, deliver the core message, make a hard ask. This person helps keep the meeting moving along. Storytellers EVERYONE can provide personal stories. Note-taker one person should thoroughly document the meeting, especially the commitments of the person you re meeting with. Be sure to take down any follow-up requests.

32 Follow up 1. You can follow up with a short note thanking them for taking the time to meet with you. 2. Follow up with any information you said you d send. 3. Follow up with any information you think would be helpful to them.

33 Things We ve Done: Raise Awareness around the ACA Encourage Medicaid Expansion Submit Public Comments Testify Lobby Federal Legislators

34 Summary Explore your options at [HealthCare.Gov], health insurance marketplace [HealthCare.Gov] [ ] Starting in 2014, individuals are required to have health insurance or pay a penalty Young adults can stay on their parents plans until age 26 The new insurance plans you pay for are must now be more comprehensive New types of tax credits are available to help make health insurance more affordable

35 Keep in Touch Like us on Facebook Follow Health.YoungInvincibles.org Contact Information: Jasmine Hicks Phone: (617)