The Affordable Care Act. President Obama signed the Affordable Care Act (ACA) into law on March 23, 2010.

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2 The Affordable Care Act President Obama signed the Affordable Care Act (ACA) into law on March 23, 2010.

3 The ACA was enacted to: v Increase quality and affordability of health insurance v Lower the uninsured rate by expanding public and private coverage v Reduce the costs of healthcare for individuals and the government It also establishes a minimum standard for health insurance policies: v No spending caps on annual or lifetime coverage v No exclusions based on pre-existing medical conditions v No individual can be denied treatment, regardless of citizenship status

4 During the open enrollment period from November 15, 2014 to February 15, 2015, anyone can apply for and enroll in health insurance. Some individuals may enroll at any time outside of the open enrollment period. This includes: v Medicaid eligible individuals v Members of federally recognized Native American tribes v Alaska Native shareholders

5 If an individual has a qualifying life event occur outside of open enrollment, they should re-apply or enroll in a different health insurance plan within 90 days of the event. Qualifying life events include: v Marriage or divorce v Birth or adoption of a child v Changes in employment or income v Loss of job-based health insurance v Move out of state or outside of coverage area

6 The Federal Poverty Level (FPL) is an income amount determined by the Department of Health and Human Services. It establishes the income necessary to cover clothing, food, and shelter based on income and family size. Federal Poverty Guideline Chart

7 Medicaid and Expanded Medicaid: Free health insurance if you have low or no income v No premiums, some services require a co-payment, co-pay maximum of $200 in a service year v Must be a U.S. citizen or qualified immigrant, a NYS resident, meet income eligibility levels, and be under age 65 Child Health Plus: Free or low-cost insurance for children (under 19) regardless of income or immigration status v For children at or below 400% of Federal Poverty Level v Low or no cost premiums, no deductions of co-pays v Must be a NYS resident, under age 19, ineligible for Medicaid, and without equivalent health coverage

8 All Qualified Health Plan insurance providers are categorized by metal levels. These differ in costs for premiums and out-of-pocket coverage: v Bronze: Lower premium with higher out-of-pocket costs v Silver v Gold v Platinum: Higher premium with lower out-of-pocket costs v Catastrophic

9 The ACA-approved plans must offer essential health benefits in order to be considered a Qualified Health Plan (QHP). These essential health benefits cover: v Ambulatory patient services, emergency services, and hospitalization v Rehabilitative and habilitative services and devices v Maternity and newborn care; pediatric services including oral and vision care v Mental health and substance use disorder services, including behavioral health treatment v Preventive and wellness services and chronic disease management v Prescription drugs and laboratory services

10 QHP Full Pay (No Income Requirements) Medicaid Advanced Premium Tax Credits (APTC) 0% 138% 250% 400% Cost Sharing Reduction (CSR) Tier Levels

11 The Advanced Premium Tax Credit (APTC) lowers the cost of the monthly premium. v Available for all individuals or families under 400% of the Federal Poverty Level The Cost Sharing Reduction (CSR) lowers the cost of out-of-pocket expenses like co-pays and prescriptions. v Available for all individuals or families under 250% of the Federal Poverty Level v Only available for Silver level plans in the Marketplace

12 As more individuals register in the marketplace, the cost of insurance should decrease. Individuals who are not covered by an acceptable health insurance policy will be charged an tax penalty of $95. This penalty will increase to $695 by This penalty, called the Individual Shared Responsibility Payment, will be assessed on your taxes.

13 How to apply You can apply for health insurance online at the website for the New York State of Health, The Official Health Plan Marketplace, at nystateofhealth.ny.gov. You can also contact an Affordable Care Act Navigator or Certified Application Counselor. A Navigator or CAC can: v Advise you on what metal level seems most appropriate based on health status and health risk factors, such as age, lifestyle, family history, and other factors v Determine if you qualify for a financial subsidy for private insurance v Answer questions about benefits, tax credits and cost-sharing reductions v Help you enroll in public and private plans offered through the marketplace

14 The Neighborhood Resource Center has licensed health care advisors on staff. The NRC also offers: v Benefits screenings v Legal and financial counseling v Parent support services Neighborhood Resource Center 281 East Broadway New York, NY All services are free and open to the public Services are offered in Mandarin, Cantonese, Spanish, and English

15 Here s what you need to apply: v Valid I.D. Green Card, U.S. Passport, Naturalization Certificate, Birth Certificate, D.M.V. License v Social Security Cards(s), if available v Birth Date(s) v address v Phone number v Income (minimum one month s pay stubs) and/or last year s IRS tax return v Policy numbers for any current health insurance v Information about any health insurance you or your family could get from your employers

16 Questions?

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