NEW HEALTH MARKETPLACE

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1 NEW HEALTH INSURANCE MARKETPLACE

2 DISCLAIMER The information in this presentation is based on information provided It is not provided as advice for your personal situation. Georgia Perimeter College assumes no liability for decisions made based on this information.

3 WHAT IS THE HEALTH INSURANCE MARKETPLACE (EXCHANGE)? Insurance that meets individual/family needs Fits individual and family budget Place to find and compare private health insurance options Place to determine eligibility for tax credit and lower premiums Place to determine eligibility for Medicaid

4 CAN I SAVE MONEY ON HEALTH INSURANCE PREMIUMS IN THE MARKETPLACE? If employer does NOT offer coverage If employer offers coverage that does not meet certain standards Tax credit and premium savings depend on household income

5 HOW DOES EMPLOYER HEALTH COVERAGE AFFECT ELIGIBILITY FOR SAVINGS? If employer plan meets certain standards for care then employee is not eligible for tax credit and premium savings USG plans meet the standards for care If no plan offers employee only coverage that is less than 9.5% of annual household income, then employee may be eligible for tax credit

6 WHAT IF A FULL-TIME EMPLOYEE BUYS INSURANCE FROM THE MARKETPLACE? Will lose employer contribution to premium - 70% Will pay premiums on an after-tax basis out of pocket - no pretax payroll deduction Will not be eligible for marketplace premium savings or lower out of packet costs Will pay 100% of premium for marketplace plan

7 HOW DOES THIS AFFECT A RETIREE ON AN ACTIVE EMPLOYEE HEALTH PLAN? Retirees continue to be eligible to participate in GPC health plans Coverage continues

8 HOW DOES THIS AFFECT A RETIREE ON MEDICARE? Does not affect them - Medicare is not part of marketplace Will not affect Medicare choices or benefits

9 WHAT IF AN EMPLOYEE LOSES JOB-BASED INSURANCE? Option 1-Buy insurance in the Marketplace Option 2-Keep job-based plan through COBRA-in most situations for up to 18 months Employee pays 102% of premium under COBRA

10 WHAT IF AN EMPLOYEE CURRENTLY HAS COBRA COVERAGE? Employee may keep COBRA Employee may buy Marketplace insurance plan May change from COBRA to marketplace plan at any time

11 WHAT HAPPENS IF SOMEONE DOES NOT ENROLL IN HEALTH INSURANCE? If a person/family can afford health insurance but does not buy it, they must pay a fee and must pay all of their medical expenses People without health insurance will not be protected from high medical bills that could lead to bankruptcy Fee for adults is 1% of income in 2014 and will increase to 2.5% of income in 2016 Fees charged for children also Will be assessed on Federal tax return Proof of insurance will need to be filed with tax return

12 RESOURCES Human resources website HealthCare.gov Kaiser Permanente Blue Cross Blue Shield p// /

13 INFORMATION FOR PART TIME EMPLOYEES The remaining slides are for part time employees

14 WHO WILL QUALIFY FOR LOWER MONTHLY PREMIUMS IN THE MARKETPLACE? Employees who are not eligible for health insurance through their employer At GPC, part-time employees who work less than 30 hours per week Savings depend on income and family size Handled through Advance Premium Tax Credit Tax credits can be applied directly to monthly premium More information at HealthCare.gov

15 HOW DOES THE PREMIUM TAX CREDIT WORK? If one qualifies, choose amount (up to maximum allowed) of advance credit payments to apply to monthly premium costs If one underestimates, then will receive refundable credit when file Federal tax return If one overestimates, then required to repay excess advance payments with tax return

16 WHO WILL QUALIFY FOR LOWER OUT-OF- POCKET COSTS Employees who are not eligible for health insurance through their employer Savings depend on income and family size Silver Plan is baseline for determining tax credit/subsidy Maybe able to get lower costs on deductibles, co-payments and coinsurance based on level of coverage elected

17 WHAT ARE THE CATEGORIES OF MARKETPLACE INSURANCE PLANS? Four categories Category affects premium cost, amount of co-pays and total out of pocket costs for the year Premiums higher for plans that pay more out- of- pocket medical costs

18 WHAT ARE THE FOUR PLAN CATEGORIES? Bronze-Lower premium and higher out-of-pocket of costs Silver- Baseline plan for determining tax credit/subsidy Gold-Higher premium and lower out-of-pocket costs Platinum-Highest premium and lowest out-of-pocket costs

19 HOW SHOULD A PERSON DETERMINE WHICH PLAN TO CHOOSE? Think about health care needs of household # of expected doctors visits # of regular prescriptions Eligibility for tax credit which can be used to lower premium costs If health care needs are high, then Gold or Platinum plan may be better choice

20 WHAT DOES MARKETPLACE HEALTH INSURANCE COVER? Ambulatory (outpatient) care Emergency services Hospitalization Maternity and newborn care Mental health and substance use, counseling and psychotherapy Prescription drugs

21 WHAT DOES MARKETPLACE HEALTH INSURANCE COVER? Rehabilitative and habilitative services and devices Laboratory Preventive and wellness services for children, women and adults Pediatric services

22 ARE CATASTROPHIC PLANS AVAILABLE IN THE MARKETPLACE? Available to people under age 30 and people over 30 with limited income who have received a hardship exemption. Person must pay several thousand dollars of medical costs before plan pays anything Lower premiums Only covers person if need a lot of care

23 CAN DENTAL INSURANCE BE PURCHASED IN THE MARKETPLACE? Dental coverage is essential for children Must be available as part of health plan or as a free-standing plan

24 HOW DO PREMIUMS VARY BY AGE AND HEALTH STATUS? ACA prohibits denying coverage or charging higher premiums based on health status ACA limits degree to which premiums may vary by age- premium of 64 year old may not be more than 3 times premium of 21 year old Premiums for older people will be lower and premiums for younger people will be higher

25 CAN PREMIUMS BE COMPARED TO CURRENT PREMIUMS? Marketplace Plan coverage will most likely cover more than plans accessible today. Will be difficult to compare premiums due to differences in coverage

26 WHAT HAPPENS IF SOMEONE DOES NOT ENROLL IN HEALTH INSURANCE? If a person/family can afford health insurance but does not buy it, they must pay a fee and must pay all of their medical expenses People without health insurance will not be protected from high medical bills that could lead to bankruptcy Fee for adults is 1% of income in 2014 and will increase to 2.5% of income in 2016 Fees charged for children also Will be assessed on Federal tax return Proof of insurance will need to provided d when file tax return

27 WHEN IS OPEN ENROLLMENT FOR THE MARKETPLACE? It begins October 1, 2013 Must enroll during open enrollment unless experience a qualifying event

28 RESOURCES Human resources website HealthCare.gov Kaiser Permanente Blue Cross Blue Shield p// /

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