Overview of ACA & Health Insurance Marketplace in Montana

The Affordable Care Act (ACA) & Health Insurance Marketplace: An Overview A.C. Rothenbuecher, MPH Women s and Men s Health Section

Outline Basics ACA in Montana Role of DPHHS What to tell your clients Resources

ACA Basics Affordable Care Act Under the law, a new Patient s Bill of Rights gives the American people the stability and flexibility they need to make informed choices about their health. Health Insurance Marketplace Website for individuals and small employers to directly compare private health insurance options Can directly compare on the basis of price, benefits, quality, and other factors http://www.hhs.gov/healthcare/rights/index.html; https://www.healthcare.gov/

Important Dates October 1, 2013: Open Enrollment Begins January 1, 2014: Coverage Begins March 31, 2014: Open Enrollment Closes

2014 in 214 words If you have health coverage you like, you can keep it. Children under 26 can stay on a parent s health insurance plan. If you don t have coverage, you can use the new Health Insurance Marketplace to buy a private insurance plan. Pre-existing conditions are covered. So are many preventive services and 10 essential health benefits. Depending on your family size and income, you may get lower costs on monthly premiums and out-of-pocket costs. You may also qualify for free or low-cost coverage from Medicaid or the Healthy Montana Kids (CHIP or Children s Medicaid). Many states are expanding Medicaid to cover more people in 2014. If you don t have coverage in 2014 you ll have to pay a fee. In 2014 it s $95 per adult ($47.50 per child) or 1% of income, whichever is higher. The family max is $285. If you have coverage and want to explore Marketplace plans, you can. But if you have an offer of insurance from an employer, you may not be able to get lower costs on Marketplace insurance based on your income. It depends on whether the insurance you re offered is considered affordable and meets minimum standards. Medicare isn t part of the Marketplace. If you have Medicare, keep it. Marketplace open enrollment starts October 1, 2013. It closes March 31, 2014. Source: https://www.healthcare.gov/blog/2014-in-214-words/

3 Things to Know about The Marketplace 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 Many 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 in the Marketplace present their price and benefit information in plain language Source: HHS ACA Presentation, Ezra Watland, July 2013

10 Essential Health Benefits Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace. Ambulatory patient services (outpatient care you get without being admitted to a hospital) Emergency services Hospitalization Maternity and newborn care (care before and after your baby is born) Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) Prescription drugs Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills) Laboratory services Preventive and wellness services and chronic disease management Pediatric services

MT Insurance Companies Blue Cross Blue Shield of Montana PacificSource Health Plans Montana Health Co-op For rates, visit this website: http://www.csi.mt.gov/consumers/

How does ACA affect Montanans?

Better Options 185,904 (22%) are uninsured Of those uninsured, ~ 135,000 are eligible* 12, 000 young adults in MT can remain on their parents insurance plan As many as 426,361 non-elderly Montanans have some type of pre-existing health condition, including 52,222 children. In 2014, health insurers will no longer be able to charge more or deny coverage to anyone because of a pre-existing condition. Source: http://www.hhs.gov/healthcare/facts/bystate/mt.html#PAGE_4; *Montana CSI and DPHHS Estimate

Better Health Insurance plans are required to provide coverage without cost sharing for a variety of preventive health services Increased funding for community health centers that provide preventive and primary care 17 health centers at 89 sites in MT Special conditions for Native Americans Source: http://www.hhs.gov/healthcare/facts/bystate/mt.html#PAGE_4; http://www.apha.org/advocacy/Health+Reform/ACAbasics/

2014 Marketplace and Medicaid Eligibility

Coverage Gap Federal Poverty Level Health Insurance Marketplace Eligible Tax Penalty if No Health Insurance < 100% Pay full premium for Health Insurance with no subsidy No 101%-138% Health Insurance Subsidy Health Insurance Subsidy Health Insurance, No Subsidy No 139%-400% Yes 401% + Yes

ACA and Medicaid Other ACA reforms to Medicaid that will benefit patients include: People can submit a Medicaid application by mail, in person, by phone, or online and even by fax Electronic data verification - Instead of requiring people to bring in a pile of paperwork, income for most people can be verified electronically

Native Americans The Affordable Care Act contains provisions that apply to enrolled members of federally recognized tribes. These important provisions include: Open enrollment period once each month instead of once per year No co-pays or cost sharing for enrolled tribal members for any marketplace plan for those between 100%-300% FPL between $19,500 and $59,000 for a family of three Eliminates cost sharing for those enrolled in a health plan through the marketplace, regardless of income, when services are provided by the Indian Health Service No penalty for not purchasing health coverage for enrolled members of federally recognized tribes, their descendants, and anyone eligible for Indian Health Service Source: DPHHS Medicaid data. The estimate was compiled by subtracting the July 2013 adult American Indian Medicaid clients group from the 17,000 AIAN Alone or in Combination age 18-64 below 100% FPL as indicated in the U.S. Census Current Population Survey Annual Social and Economic Supplement,2011http://www.census.gov/cps/data/cpstablecreator.html; https://www.federalregister.gov/articles/2013/07/01/2013-15530/patient-protection-and- affordable-care-act-exchange-functions-eligibility-for-exemptions#h-12

DPHHS Mission The mission of DPHHS is to improve and protect the health, well-being, and self-reliance of all Montanans.

DPHHS Role in ACA Make the Medicaid and the Healthy Montana Kids Plan available to eligible Montanans through the federally- facilitated Health Insurance Marketplace. Provide information to clients on the ACA and channels for consumer assistance

Messages to Clients Sign up for Medicaid through healthcare.gov You can get your Affordable Care Act questions answered, or get assistance in completing an application at healthcare.gov. You can also call 1-800-318-2596 and speak with a representative 24 hours a day/7 days a week. Contact a Navigator or Certified Application Counselor (CAC) Source: healthcare.gov

Referral Sites & Resources ACA Navigators Planned Parenthood Great Falls 211 9th Street South Great Falls, MT 59405 P: 406.454.3431 F: 406.454.3433 Rural Health Development DBA Montana Health Network Montana Primary Care Association, Inc. Intermountain Planned Parenthood, Inc. DBA Planned Parenthood The Montana Primary Care Association (MPCA) is an association of community health centers aimed at delivering primary and preventive healthcare to under-served and vulnerable populations. MPCA will use funds to partner with 17 affiliated federally-qualified community health centers, which provide primary and preventive health care services to 100,000 Montanans in 20 counties, to serve currently uninsured Montanans. Funding will be used to train community health center staff to expand current outreach and enrollment assistance activities and to enroll patients into affordable health insurance coverage. Rural Health Development is a non- profit consortium of rural health care providers established in 1990 with a strong network of relationships enabling them to bring value to healthcare through cost savings, research and development of products and services in underserved Frontier communities. Rural Health Development will provide enrollment assistance, through member health care providers, in eastern Montana. Planned Parenthood of Montana (PPMT) will use funds to establish the Montana Marketplace Connection to assist consumers in navigating the Montana Marketplace. Consumers will be able to access assistance from a Navigator by scheduling an appointment or as a walk-in to a PPMT health center, calling a hotline or by video conferencing. Planned Parenthood Helena 211 9th Street South Great Falls, MT 59405 P: 406.454.3431 F: 406.454.3433 Planned Parenthood Missoula 219 East Main Street Missoula, MT 59802 P: 406.728.5490 F: 406.728.5497 Planned Parenthood Heights 100 West Wicks Lane Billings, MT 59105 P: 406.869.5040 F: 406.294.8643 Montana Healthcare Network 11 South 7th Street, Suite 241 Miles City, MT 59301 Phone: (406) 234-1420 Fax: (406) 234-1423 Montana Primary Care Association 1805 Euclid Avenue Helena, MT 59601 Phone: (406) 442-2750 Fax: (406) 449-2460 Email: Lara Salazar Planned Parenthood West 1844 Broadwater #4 Billings, MT 59102 P: 406.656.9980 F: 406.656.9928

Marketplace Resources Operators can provide educational information now, and enrollment assistance after October 1st, in more than 150 different languages, 24/7.

Questions? Jess Rhoades, JRhoades@mt.gov, 444-3666 Bob Runkel, RRunkel@mt.gov, 444-9055 Nancy Clark, nclark@mt.gov, 823-5005 A.C. Rothenbuecher, arothenbuecher@mt.gov, 444-3775