HEALTHY PA 101. Help for Your Health Care is Here!! Pennsylvania Health Access Network HELPLINE:

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1 HEALTHY PA 101 Help for Your Health Care is Here!! Pennsylvania Health Access Network HELPLINE:

2 About Us: Statewide coalition advocating for seniors, working families, and small business. Non-Partisan; No Involvement in Elections Provide one-to-one assistance as a Navigator organization. Helpline: Partners: Faith-Based Organizations, AARP, Doctors, Health Centers, Women s Health Groups, Community Groups 2

3 The Questions We ll Answer Today: Who Medicaid Covers Today (under old rules) and what s changing under Healthy PA! Who Medicaid Will Cover in 2015 and Beyond who is newly-eligible! What Healthy PA Medicaid Expansion Covers the benefits you and your family will have! What Healthy PA Medicaid Expansion Costs it s free! no monthly premiums When and Where You Can Get Help Signing Up free, in-person help is available and you can sign up year-round 3

4 Who Does Medicaid Cover Today? Medicaid (or Medical Assistance) provides free or low-cost health insurance to low-income Pennsylvanians who fall into certain categories: Pregnant women Children Individuals with long-term disabilities Very low income families Seniors (ages 65 and older) Individuals with shorter-term disabilities Domestic violence survivors (9 months in lifetime) Individuals in active drug and alcohol treatment (9 months in lifetime) Covers 1 million children and 1.2 million adults 4

5 Problem: That Left Out a Lot of People Who COULD NOT Qualify for Medicaid? Low-income adults who are: - Between the ages of 19 and 64; - AND not disabled; - AND not pregnant; - AND not parents or related caregivers with very low incomes; - AND not eligible for General Assistance-related Medical Assistance. This is the group that s eligible for Medicaid Expansion under the Affordable Care Act approximately 600,000 adults in Pennsylvania. 5

6 The Affordable Care Act and Medicaid Expansion The Affordable Care Act intended for ALL states to expand Medicaid to cover people with incomes below 138% FPL The Supreme Court ruled it OPTIONAL for states; 26 are, PA missed the chance to expand coverage January 1st, 2014 as the law intended It s a great deal for PA! Federal government covers 100% of the cost to states in first 3 years, then 90% after 2019 Medicaid Expansion would cover 600,000 Pennsylvanians, create 40,000 family-sustaining jobs, and strengthen our hospitals (3 independent economic impact studies) Advocates, uninsured, business community and providers on the same team 6

7 Pennsylvania DID NOT HAVE Medicaid Expansion in 2014 That means the people who needed help the most those with the lowest incomes could not get help Last year during Open Enrollment, you might have heard you re not eligible or been quoted the full price of Marketplace plans YOU WILL NOT HAVE TO PAY A PENALTY IF YOU WERE IN THE COVERAGE GAP IN 2014 Anyone who cannot find insurance that costs less than 8% of your household income is EXEMPT from the individual responsibility fee You can get this exemption when you file your taxes. If you don t file taxes at all, you are automatically exempt. 7

8 Medicaid Expansion Coming to Pennsylvania in 2015! Pennsylvania IS expanding Medicaid in 2015 via Healthy PA. That means that you and your family can get FREE health insurance if your monthly income is below: Single Person Family of 2 Family of 3 Family of 4 Family of 5 Family of 6 Family of 7 Family of 8 $1,342 $1,809 $2,276 $2,743 $3,210 $3,677 $4,143 $4,610 It does not matter if you have money in savings, or if you fall into a certain category (ex: being pregnant, having a disability, etc.) You must be a U.S. Citizen or Legal Permanent Resident who has had legal status for more than 5 years; you cannot be currently incarcerated. 8

9 What Benefits Does Medicaid Expansion Healthy PA Cover? All Healthy PA PCOs (Private Coverage Option plans) cover the Essential Health Benefits that are included in all Marketplace plans, and more: Doctor and Specialist Visits Maternity and Newborn Care Prescription Medicine Hospital, ER and Outpatient Care Preventive and Wellness Care Bloodwork, X-Rays and Scans Mental Health and Substance Abuse Treatment OB/GYN Care Chiropractor and Podiatrist Services Vision Care (Exams) 9

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11 What Does Healthy PA Medicaid Expansion Coverage Cost? NOTHING! There are NO premiums in 2015 There are no deductibles, and very small co-pays for medicine.! In 2016, Pennsylvania has the power to impose premiums on people with incomes above 100% of the poverty level BUT: Nothing is set in stone that this will happen Premiums cannot be more than 2% of your monthly income 11

12 How Can You Sign Up for Healthy PA Medicaid Expansion Coverage? You can sign up anytime AFTER December 1st! By phone, with help from the PA Benefits Center (a Navigator): They answer calls LIVE Monday-Friday 9am-5pm and can help you complete the whole process over the phone Online, through COMPASS: Through DPW: or at your local County Assistance Office 12

13 Which Healthy PA PCO Plan Should You Pick? It depends! Think about: - Is the doctor you like in the plan s network? - Are the medicines you take covered? - Is the hospital you like in the plan s network?! Pennsylvania s Enrollment Broker will help you apply: - Call them at once you get a letter from DPW saying you re eligible for Healthy PA coverage - Get information online: 13

14 Which Healthy PA PCO Plan Should You Pick? In Erie, there are 4 companies to choose from: - Amerihealth Connect - Gateway Health Plus - United Healthcare Community Plan for Adults - UPMC for Best Health Hospitals choose which plans to accept: - Hamot and St. Vincent accept: Gateway Health Plus, UPMC for Best Health - Corry and Millcreek accept: Gateway Health Plus, UPMC for Best Health, Amerihealth Connect 14

15 Resources Marketplace Open Enrollment: Nov Feb. 15 Medicaid Expansion Enrollment Opens Dec. 1 Pennsylvania Health Access Network helpline@pahealthaccess.org 1 (877) Kaiser Family Foundation Families USA Consumer Health Coalition (412) x200 lbachurski@consumerhealthcoalition.org #InsurePA Statewide Hotline: to meet with a Certified Application Counselor near you 15