Health Care Reform Basics

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1 Health Care Reform Basics

2 You may be asking yourself what health care reform is all about. Don t worry, you re not alone many people are asking the same question! This booklet will give you the basics to help you make sense of it all. For more information, go to HealthCareReformBasics.com/Now

3 This section will explore health care reform and why it s happening. Why do we need health care reform?

4 Why Reform, Why Now Almost 50 PERCENT of all Americans have chronic diseases that cost us about $1.4 TRILLION annually. TRILLION $1.4 Our over-65 population is growing much faster than other age groups. That means higher costs for health care needs. 17% { health care costs in 2010 everything else age group 3 to 5 65 and over Annual health care costs are TIMES HIGHER Simply, health care costs are spiraling out of control. As a nation, we now spend over 17% of every dollar we earn on health care. 4

5 The Patient Protection and Affordable Care Act was passed in 2010 to help people of various income levels, employment situations, and health status access health care. HealthCareReformBasics.com/whyreform.html 5

6 What is health care reform? In this section we ll explore the four major components of the health care reform law: 1 Everyone should have health insurance. 2 There will be a Health Insurance Marketplace. 3 Health care will be more affordable. 4 All insurance plans will include a standard set of basic medical benefi ts.

7 1 Insurance for Everyone While the government played a large role by passing the law and will play a role in running the Health Insurance Marketplace, individuals and employers will play a role in making reform work, too. Whether you purchase it on your own, get it through your employer, or are covered by a government program such as Medicaid or Medicare, everyone should have insurance. Individuals Beginning in January 2014, everyone is required to have insurance just like how everyone has to have car insurance or else they will pay a penalty. There are no exceptions. HealthCareReformBasics.com/individual.html 7

8 1 Insurance for Everyone (cont.) Employers The cost of health insurance will be shared by some employers, or they will pay a penalty. UNDER 50 EMPLOYEES Employers DO NOT have to offer health insurance, and are NOT penalized if they don't. Employers that DO offer insurance may get tax credits to help with the cost. Employees can buy insurance directly from insurers or on the Marketplace if their employers do not provide it. 50 EMPLOYEES OR MORE Large employers must offer health insurance to workers. If they don t, they will be fined $2,000 per employee every year. Employers must offer quality health care. Employers must offer affordable coverage it can t cost more than 9.5 percent of an employee s income. 8 HealthCareReformBasics.com/employer.html

9 2 The Health Insurance Marketplace The law introduces the HEALTH INSURANCE MARKETPLACE, also sometimes known as the MARKETPLACE or HEALTH EXCHANGE. Starting October 1, 2013, many of us will buy our health insurance in a new way through the Health Insurance Marketplace. Think of the Marketplace as a one-stop shopping experience where you can compare all your options and where everyone has the same information. The Marketplace will be available online, by phone, or in certain areas, by visiting a physical location. HealthCareReformBasics.com/subsidyqualify.html 9

10 2 The Health Insurance Marketplace (cont.) If you DON T get insurance from your employer or parents or through the government, the Marketplace is where you can buy it. But remember, the Marketplace will be the only place you can receive tax credits and cost sharing that may help you lower your insurance costs. All insurance plans from all companies on the Marketplace will be presented in the same way and will offer similar coverage. This will help you compare your plan options and pricing in order to fi nd what s best for you. 10

11 Insurance plans on the Marketplace: Four metal levels All insurance plans from all companies on the Health Insurance Marketplace will be arranged by four levels: Bronze, Silver, Gold, and Platinum. Depending on which plan you pick, your costs could change. $$$$ Platinum $$$ Gold $$ Silver $ Bronze 10% 20% 30% 40% 90% 80% 70% 60% Your monthly costs What you will pay out of pocket at time of incident The benefi ts you receive The amount your insurer will pay HealthCareReformBasics.com/Marketplaceplans1.html 11

12 3 Making Health Care More Affordable The law is intended to help make health care more affordable for everyone. It will do this by offering government-sponsored subsidies such as tax credits and reduced cost sharing as well as an expanded Medicaid program. First, let s start with the subsidies. You may qualify for tax credits and... if you do You may qualify for reduced cost sharing You can get a credit on your taxes if your income meets the federal poverty level guidelines. If you qualify for tax credits, you might also qualify for reduced cost sharing. This means that you would get lower deductibles and copayments if your income meets the federal poverty level guidelines. 12 HealthCareReformBasics.com/subsidy.html

13 Number of people in your family/household $ $ If you make less than this... If you make less than this... 1 $45,960 $28,725 Use this chart to determine if you may be eligible for subsidies $62,040 $78,120 $94,200 $38,775 $48,825 $58,875 5 $110,280 $68,925 6 $126,360 $78,975 7 $142,440 $89,025 8 $158,520 $99,075...then you may qualify for tax credits...then you may qualify for reduced cost sharing *The income levels are based on 2013 federal guidelines. Guidelines may vary by state. HealthCareReformBasics.com/Marketplaceplans1.html 13

14 4 Standard Medical Benefi ts All insurance plans on the Health Insurance Marketplace must include a standard set of basic medical benefits. There are no exceptions. Preventive services Chronic disease care Outpatient services Hospital stays Maternity and newborn care Mental health and substance abuse disorder services Prescription drugs Rehabilitative and habilitative services and devices 14 HealthCareReformBasics.com/medicalbenefi ts.html

15 How much is this going to cost me? This section provides direction on who may be paying what for health care. 15

16 Costs YOU ARE NOT ALONE if you re wondering how much this will cost you. Many people are asking that very same question. But there s no easy answer because it really depends on your situation. Here are a few examples. If you work for a large company and get health insurance through your employer: You may not see much change in your costs or coverage unless your employer decides to drop your coverage or change your plan. If this happens, you will now have more options to fi nd and buy insurance that meets your needs. These options include purchasing directly from an insurer. If you buy your own health insurance or work for a small employer who does not offer insurance: You ll be able to buy your insurance on the Marketplace, and your costs will depend on the plan level you choose. Keep in mind that some people will qualify for government subsidies to offset the costs of insurance. 16 HealthCareReformBasics.com/howmuch.html

17 If you re uninsured now, you should buy insurance starting in If you don t, the government may fi ne you 1 percent of your income or $95, whichever is larger. By 2017, this fi ne will grow to 2.5 percent of your income or $695 per year, whichever is larger. HealthCareReformBasics.com/penalties.html 17

18 Possible Medicaid Expansion If you are on GOVERNMENT ASSISTANCE like Families that make up to 133 percent of the federal poverty level may now be eligible for Medicaid and the health care benefi ts that come with it. This percentage has increased from 64 percent. Medicaid or Medicare, little will change for you. However, the Medicaid program may be expanding to cover more people as part of the health reform law. Note: States can choose whether or not they will expand their Medicaid programs to follow the new federal poverty level guidelines in the health care reform law. Check the webpage below for the latest Michigan Medicaid expansion status. 18 HealthCareReformBasics.com/medicaidexp.html

19 Number of people in your family/household $ $ If you currently make less than this... In 2014, if you make less than this... 1 $7,354 $15,282 Use this chart to determine if you may be eligible for Medicaid $9,926 $20,628 $12,499 $25,975 $15,072 $31,322 $17,645 $36,668 $20,218 $42,015 $22,790 $47,361 $25,363 $52,708...then you may qualify for Medicaid *The income levels are based on 2013 federal guidelines. Medicaid guidelines may vary by state. HealthCareReformBasics.com/medicaidqualify.html 19

20 What do I need to know and do? This section highlights important dates to remember.

21 Important Dates Remember that by January 1, 2014, you MUST purchase health insurance either directly or through your employer. Learn about the individual mandate and penalties you may pay if you don t have health insurance. On October 1, 2013, you can begin shopping for insurance on the Health Insurance Marketplace. Take some time now to learn about the Marketplace and the products available so you understand your options for quality, affordable health insurance. Understand the options that may be available to help pay for your health insurance. HealthCareReformBasics.com/whatnext.html 21

22 For More Information If you have more questions about health care reform, you can call a Health Plan Advisor at: or contact an independent Blues agent. Scan to visit HealthCareReformBasics.com/Now 22

23 Notes 23

24 Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. We provide health insurance in Michigan.

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