The Affordable Care Act: A Different Future for Florida Health Consumers

Transcription

1 The Affordable Care Act: A Different Future for Florida Health Consumers

2 Overview Why Florida needed help Benefits of the ACA 2014: Coverage for the uninsured Changes to non-profit hospital charity care

3 Why did we need the ACA? 4.1 million uninsured Floridians 800,000 are kids Only 39% of Florida small businesses offer coverage

4 Why did we need the ACA? Health insurance for families increased by 88% Florida businesses and families pay hidden tax of $1400/year Public health system overburdened

5 How do you benefit from the ACA?

6 En Español : HealthCare.gov

7 The Patient s Bill of Rights

8 What is a grandfathered plan?

9 Insurers cannot: Deny coverage to kids with pre-existing conditions Put lifetime limits on benefits Cancel your policy without proving fraud Deny claims without a chance for appeal

10 Consumers in new health plans can now: Receive cost-free preventive services Keep young adults on a parent s plan until age 26 Choose a primary care doctor, ob/gyn, and pediatrician Use the nearest emergency room without penalty

11 Last year Bekky was diagnosed with breast cancer. After three months of treatment, she returned to work to learn her employer had to drop her coverage.

12 Under the Affordable Care Act: Insurers can t deny coverage for pre-existing conditions You can't lose your coverage when you get sick and need it most No lifetime limits on coverage Small businesses now get tax credits to help pay for coverage

13 PCIP: Pre-Existing Condition Insurance Plan Transitional program until 2014 Offers insurance to adults denied due to pre-existing conditions To qualify: US citizen or national legally residing in U.S. Uninsured for at least the last six months Have a pre-existing condition or been denied coverage

14 Nathan's son, Thomas, was born with hemophilia. His family had great insurance, but the insurance company raised the price of their group coverage to compensate for the costs of Thomas's treatments.

15 The Affordable Care Act: Bans lifetime and annual limits Bans pre-existing conditions

16 Both of Karen's parents had type 2 diabetes. A few years ago, her doctor discovered that she was pre-diabetic.

17 Under the Affordable Care Act: New insurance plans cover preventive services Illegal for health insurance companies to take away your coverage because you get sick Women across the country no longer need a referral for OB-GYN visits. Medicare will fully cover annual check-ups and most preventive services and treatments for seniors

18 More Medicare improvements : Closes the donut hole in Medicare Rx drug coverage Reins in Medicare Advantage plans while protecting plan members Puts Medicare on more solid financial footing No cuts to benefits or changes guaranteed by Medicare

19 David was covered for a year before the insurance company went back in his record and cancelled his plan retroactively. They claimed David didn't disclose all his medical history on his original form.

20 The Affordable Care Act: Illegal to take away your coverage Tough and fair rules to protect you from insurance abuses New appeals process

21 Kristin was graduating from college. This meant she was no longer covered by the student health plan.

22 Under the Affordable Care Act: Young adults under 26 can now stay on their parents health plan

23 Brian is a small business owner. He's always provided healthcare coverage for his employees. But every year Brian worries about the 15-20% hike in premiums.

24 The Affordable Care Act: Provides small business tax credits Focuses on prevention and wise investments Makes our health care system fairer

25 Jason drives a van delivering flowers for the local florist. During rush hour one day, he was struck by an oncoming driver in a large pickup truck. The nearest hospital wasn t in his network.

26 Under the Affordable Care Act, new health plans: Can t require prior approval before seeking emergency room services outside your network Can t charge higher copayments or co-insurance for out-of-network emergency room services.

27 Coverage for the Uninsured: 2014

28 Coverage for the Uninsured: 2014 More people qualify for Medicaid Employers must offer coverage and others get tax credits to buy it Adults with pre-existing conditions can t be denied coverage

29 How will Medicaid be Expanded? More people will qualify: Low-income working parents Disabled Low-income childless adults Medicaid asset test eliminated

30 What is an Exchange? A new, transparent, and competitive insurance marketplace Individuals and small businesses can buy affordable and qualified health benefit plans Choices of health plans that meet certain benefits and cost standards

31 What if I can t afford the insurance? Tax credits for those up to 400% of poverty level Two types of tax credits: Help with premiums Out-of-pocket costs

32 Who benefits from ACA? If you are: Uninsured & Very Low-Income Uninsured & Middle-Income Insured with Good Private Coverage You may be covered through: Medicaid Health Insurance Exchanges with Tax Credits Keeping your current plan

33 Who Benefits from ACA? If you are: Insured with inadequate or unaffordable coverage Insured by Medicare/Medicaid You will benefit from: Insurance Reforms Lower Costs and Better Care

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35 Non-Profit Hospital Charity Care Establish and communicate a written financial assistance and debt collection policy Limit what they charge for care Stop unfair billing and collection activity Conduct a community health needs assessment

36 Non-Profit Hospital Charity Care Financial assistance and debt collection policy Say whether you offer free or discounted care List eligibility criteria Describe how to apply Say how you decide charges Explain steps you d take to collect on a bill Explain how you ll publicize the policy widely in your community

37 Non-Profit Hospital Charity Care Limit what you charge for care No more gross charges Added protection for patients who qualify for financial assistance Emergency or medically necessary services only Amounts generally billed to insured patients

38 Non-Profit Hospital Charity Care Stop unfair billing and collection activity No extraordinary collection activity unless you ve made a reasonable effort to qualify the patient for financial assistance

39 Non-Profit Hospital Charity Care Conduct a community health needs assessment Identify community s needs Get input from community Make results public every three years

40 Partner Resources

41 Questions?