Welcome to the KASA webinar series!

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1 Welcome to the KASA webinar series! Today s topic: What Youth Leaders and Millennials Need to Know about Health Insurance and the Affordable Care Act Presenter: Erin Hemlin, Young Invincibles Hosted by: Ronald Tasker, KASA co-chair Leslie Carroll, KASA Interim Director KASA Board of Directors

2 KASA MISSION STATEMENT Kids As Self Advocates [KASA] is created by youth with disabilities for youth to educate society about issues concerning youth with a wide spectrum of disabilities and healthcare needs. KASA believes in supporting selfdetermination, creating support networks and proactive advocacy for all youth with disabilities in our society. For more information and resources, please visit

3 The Affordable Care Act What does it mean for

4 Who are Young Invincibles?

5 Agenda Overview of the ACA How does health insurance work? What s included in a health insurance plan? What are the options? What are the costs? Open enrollment is over, how do I get covered? Key takeaways

6 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

7 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)

8 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

9 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

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

11 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

12 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

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

14 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

15 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

16 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

17 Young Adults with Special Needs No Pre-existing condition discrimination No longer tied to a job for assured health care No Annual Dollar limits on benefits 10 EHBs Make sure the plan you pick covers specific prescriptions and/or services Transition Plans Plan for continuation in care when transitioning from pediatric care to adult providers

18 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

19 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

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

21 Medicaid Matters In states that choose to expand their Medicaid programs all people making under 138% of the Federal Poverty Level (about $15,856/year for an individual) will qualify for free Medicaid If you work 30 hours a week at $7.25/hour, you may qualify for Medicaid Covers hospital visits, prescription drugs, mental health services, and many other types of care Without expansion, all people making less that about $11,490 a year are left without an affordable option Under 100% FPL will not qualify for tax credits However, those in the expansion population will not have to pay a penalty

22 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

23 Comparing Health Plans Comparing Plans: Online: Healthcare.gov Phone: In person with the help of a Navigator Paper application

24 Tax credits Those making between % 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

25 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

26 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 $257 $200 $57 $10 $1,733 $257 $163 $94

27 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

28 How do I get covered? Year-round Eligibility Medicaid Native Americans Special Enrollment Periods Qualifying life events Next open enrollment: November 15, 2014 February 15, 2015

29 Special Enrollment Period Special enrollment periods are times outside the designated open enrollment period when you can apply for insurance Individuals and/or families must have a qualifying life event in order to apply during this time You typically have 60 days after the event to sign up If you don t, you ll have to wait until the next open enrollment starts on Nov. 15 to get covered

30 Special Enrollment Qualifying Events Losing Health Coverage Getting married Having a baby Moving to an area where different plans are available on the marketplace Gaining a new immigration status Changing jobs Turning 26 and losing eligibility to be on parent s plan Leaving incarceration Individuals have 60 days from the qualifying event to enroll in health insurance

31 Young Adults and SEP Young Adults more likely to experience special enrollment event than any other age group 83% of new mothers are Median ages for marriage are 28 for men and 26 for women Change jobs every two years Young people move at twice the national rate Estimated 4.2 million young people will turn 26 in 2014

32

33 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

34 Summary Explore your options at HealthCare.Gov, the federal 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: Erin Hemlin Phone: (713)

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