The Health Insurance Marketplace 101

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1 The Health Insurance Marketplace 101 National Newspaper Association 127th Annual Convention & Trade Show September 13, 2013

2 Office of the Regional Director Community Resource California-Based Arizona, California, Hawaii, Nevada, and the U.S. Affiliated Pacific Islands Educate the public on the benefits of healthcare reform -- Healthcare.gov -- CuidadodeSalud.gov (Spanish) 2

3 The Problem At least 51 million Americans without coverage Fast rising health care costs, partially due to uninsured Premiums had more than doubled over the last decade, while insurance company profits continued to rise Economic hardship for families, small businesses and the U.S. Economy

4 Affordable Care Act In March 2010, President Obama signed into law the Affordable Care Act. 4

5 Three Aims of the Affordable Care Act Better Care Better Insurance Staying Healthy Patient- Centered Care Coordination Accessibility Prevention Quality Affordability Public Health 5

6 Affordable Care Act Protection from the worst insurance company abuses Makes health care more affordable Better access to care Stronger Medicare 6

7 Affordable Care Act Young adults under the age of 26 can now stay on their parents health plans. It is now illegal for insurance companies to: Deny coverage to children because of a pre-existing condition like asthma or diabetes Put a lifetime cap on how much care they will pay for if you get sick

8 Affordable Care Act Slowest sustained national health spending growth in 50 years Low growth continuing in 2012 for Medicare and Medicaid $2.1 billion returned to consumers in 2011 and /20 rule: Plans must spend 80% now on healthcare Rate increases fell from 75% in 2010 to 14% so far in 2013 $4.2 billion recovered in 2012 from anti-fraud efforts a record high for a total of nearly $15 billion over the last 4 years, double that of the previous 4 years 8

9 Health Insurance Marketplace The Marketplace Place for individuals and small employers to directly compare private health insurance options Qualified Health Plans (QHPs) Can directly compare on the basis of price, benefits, quality, and other factors Include info re: open enrollment and coverage start date 9

10 All Qualified Health Plans Will Cover These Essential Health Benefits 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance use disorder services, including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 8. Laboratory services 9. Preventive and wellness services and chronic disease management 10. Pediatric services, including oral and vision care 10

11 The Health Insurance Marketplace A new way to get health insurance Enrollment starts October 1, 2013 Coverage begins January 2014 About 25 million Americans will have access to quality health insurance Up to 20 million may qualify for help to make it more affordable Working families can get help through the Marketplace 11

12 Health Insurance Marketplaces: Health Insurance Marketplaces will be established in every state: 1) Federally Facilitated Marketplace (FFM) 2) State Partnership Marketplace (SPM) 3) State Based Marketplace (SBM) 12

13 State-by-State Health Insurance Marketplace Status Federally Facilitated Marketplace (FFM) Conditionally Approved State Partnership Marketplace (SPM) Alabama Ohio Arkansas California Alaska Oklahoma Delaware Colorado Arizona Pennsylvania Illinois Connecticut Florida South Carolina Iowa DC Georgia South Dakota Michigan Hawaii Indiana Tennessee New Hampshire Idaho Kansas Texas West Virginia Kentucky Louisiana Virginia Maryland Maine Wisconsin Massachusetts Mississippi Wyoming Minnesota Missouri Nevada Montana New Mexico Nebraska New York New Jersey Oregon North Carolina Rhode Island North Dakota Utah Vermont Conditionally Approved State Based Marketplace (SBM) Washington Total: 26 Total: 7 Total: 18 13

14 Health Insurance Marketplace: Top-line Messages 1. It s an easier way to shop for health insurance Simplifies the search for health insurance All options in one place One application, one time, and an individual or family can explore every qualified insurance plan in the area 2. Most people will be able to get a break on costs 90% of people who are currently uninsured will qualify for discounted or free health insurance 3. Clear options with apples-to-apples comparisons All health insurance plans present their price and benefit information in plain language 14

15 Health Insurance Marketplace Enhances competition in the health insurance market Increases affordability through premium tax credits, cost sharing reductions, or public insurance programs Ensures quality through QHPs that must meet basic standards, including quality standards, consumer protections, and access to an adequate range of clinicians Makes costs clear by providing information about prices and benefits in simple terms consumers can understand, so they don t have to guess about costs 15

16 Health Insurance Marketplace: Example Based on family income and size Premium discount Family of four with annual income $23,550* $94,200* And not eligible for certain other insurance coverage like Medicaid Lower cost-sharing (like copays) Family of 4 with annual income $58,875* or less (250% FPL) *2013 amounts 16

17 Small Business Health Options Plan (SHOP) Starting in 2014, you ll have more choice and control over your health insurance spending through the Small Business Health Options Program (SHOP), a new program that simplifies the process of buying health coverage for your small business. 17

18 The Situation for Small Employers Today Issues to offering health insurance to employees: Difficulty comparison shopping between plans Unpredictable rate increases Higher rates for groups with: o Older workers o Workers who have chronic conditions or high cost illnesses O Women charged more than men Waiting periods for coverage of pre existing conditions 18

19 Removing the Obstacles: Tax Credits The Small Business Health Care Tax Credit eligibility: With fewer than 25 full time equivalent employees Whose employees (not owner/employer) wages average less than $50,000 per year Who contribute at least 50% of employees premium costs Who buy health insurance through the SHOP only, starting in 2014 Tax credits: Up to 35% of employer s premium contribution (up to 25% for tax exempt employers) now Up to 50% of employer s premium contribution (up to 35% for tax exempt employers) starting in

20 Small Business Health Options Plan: Who, When & How? Who s eligible? 2014 / Upper limit of 100 FTEs. Some Marketplaces may opt to set the upper limit at Marketplaces must accommodate 100 FTE and below and Beyond States can decide their upper limit. When can businesses enroll? Starting October 1, 2013, for coverage beginning January 1, 2014 Thereafter, throughout the year How can businesses enroll? Directly through the SHOP Through a broker registered with the SHOP 20

21 Employer Requirement (Shared Responsibility) Businesses with less than 50 full-time equivalent employees are exempt from any requirement. 96% of American businesses are less than 50 employees There is no Shared Responsibility until

22 Summary The Health Insurance Marketplace is a new way to find and buy health insurance Individuals and small businesses can shop for health insurance that fits their budget There is financial help for working families and other people with limited income to obtain health insurance There is assistance available to help consumers get the best coverage for their needs 22

23 Marketplace Call Center (Consumers) - 24/7 English and Spanish and 150 Languages , (TTY) SHOP Marketplace for Businesses , (TTY) Stay Connected Want more information about the Marketplace? Go to / Updates and resources for partner organizations are available at facebook.com/healthcare.gov 23

24 Thank you! Steven Wiener Regional Outreach Specialist, Region IX (415) Main Number (415) Direct Number HHS Website: 24

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