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affordablecare

Page history last edited by aherrera@npl.org 1 year, 7 months ago

 

 

Patient Protection and Affordable Care Act

Laura Saurs - U.S. Government Information Librarian - 973-733-7812 or 973-733-7779

 

Open enrollment for 2019 health insurance: November 1 - December 15

https://www.healthcare.gov

 

For a comprehensive set of links goto the NJ State Library website: http://libguides.njstatelib.org/affordable-care-act

 

Dropping Marketplace Health Insurance coverage for other insurance? 

 

How to Apply:

 

 

Handouts:

 

 

More info:

 

 

 

 

 

 

 


 

 

This section is under construction.

 

 

 

 

 

 

AFFORDABLE CARE ACT PRESENTATION

The yellow book in this picture is the Patient Protection and Affordable Care Act , also known as "Obamacare" in print.  The tall stack of paper consists of regulations related to the Act.  When a patron says "Show me where it says "X" in the law." that issue may actually be covered in the regulations rather than the Act itself.  This is a good representation of the relationship of laws to regulations in general, and shows why it can be difficult to assist patrons in finding the information they need.  

 

This presentation concentrates on a relatively small portion of the Affordable Care Act,the Healthcare Marketplace which opened on October 1, since this is probably what patrons will be asking about in the near future.  The Healthcare Marketplace is for people who don’t have any health insurance or who are unhappy with the insurance they have. If you have insurance through work, Medicare, Medicaid, COBRA, etc. you do not have to participate in the marketplace. 

 

If you have insurance through work, there are some things to know:

 

If your plan existed on or before March 23, 2010 it is considered “grandfathered” (even if you joined it later than that). It must:

 

 

Unlike new insurance policies, Grandfathered plans DON'T have to:

 

Employers are still not required to provide health insurance for employees, but employers with more than 50 employees will have to pay a penalty if they don’t or if the insurance they provide is too expensive.

 

If you have Medicaid you don’t have to sign up for the marketplace.  There are some Medicaid changes that our patrons might want to know about:

 

-States have option to increase Medicaid coverage to adults 19-65 with incomes up to %133 of poverty level.  The Federal government will fully fund this increase for 3 years, then gradually reduce the funding

 

-Medicaid will be expanded in NJ.  Patrons can find out whether they are eligible in October, but coverage may not start ‘til 2014.

 

-All children with incomes up to %133 of poverty level will be covered regardless of whether the state expands medicare.

 

- The income calculation for determining eligibility will be simplified.

 

The Healthcare Marketplace:

 

NJ opted not to create its own marketplace, though it can partner in plan management and promotional activities and establish its own marketplace in the future.

 

Patrons will apply online through the healthcare.gov Web site, not a State of New Jersey site.  They can also apply in person, at  the Department of Child and Family Wellbeing, 394 University Ave., Newark and other locations or by mail.  There will be  forms (in English & Spanish) that patrons can print out to apply by mail.  When applying online, there will be only one form to fill out.  When applying by mail, there is a choice of 3 forms – individual, family, and individual without financial assistance (for those who just want to see the insurance plans and not apply for cost reductions).  Patrons can also call 1-800-318-2596, where someone will walk them through the application process.  Numerous languages will be available from the phone service.  Needless to say, that number will probably be very busy.  People applying in person will be helped by Assistors or Navigators.  Navigators cannot work for or be paid by insurance companies.  No one can choose the plan for the applicant.  Librarians should apply the same practices to giving information about this topic that they use for giving legal or medical information.

 

The marketplace application will be a one-stop-shopping place for healthcare coverage.  Based on the information patrons provide in their applications, they will be notified if they are eligible for federal benefits and will be offered a choice of insurance plans sold by private insurance companies (not by the government). 

 

As we know, a lot of uninsured people can’t afford private insurance. The marketplace application will let patrons know if they qualify for any of several benefits to help with the cost of the marketplace plans. 

 

-Patrons will be informed if they are eligible for Medicare or CHIP. 

-People who must purchase private insurance may be eligible for tax credits and/or cost-sharing if they earn up to %400 of the federal poverty level.  Only income counts in this calculation, not savings or assets. 

-If a person is eligible for the tax credit, it will be paid directly to the insurance company and accounted for on their next tax return. 

-Based on income, a person might also qualify for reduced cost-sharing, which is a discount on out-of-pocket costs such as co-pays and deductibles. 

 

The main function of the marketplace, however, is to offer applicants a choice of private healthcare plans. In New Jersey three companies are selling plans in the marketplace: Horizon Blue Cross Blue Shield of New Jersey; AmeriHealth; and  non-profit Health Republic (formerly the Freelancers Union COOP), which is new to NJ.  Insurance companies have to meet certain requirements to offer plans in the marketplace.    In order to participate in the marketplace, insurance companies must be licensed by the state & in good standing ("Fly-by-night" companies can't participate).  They must offer what are known as “qualified plans.” Qualified Plans must cover 10 essential benefits,* guarantee coverage & renewability regardless of preexisting conditions, and cannot charge higher premiums due to certain factors such as sex or preexisting conditions.  They can charge higher premiums based on age and smoking, but there are limits to how much more can be charged. 

 

 ESSENTIAL SERVICES:

 

  • 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

         

 

 Insurers can offer several levels of coverage, covering varying percentages of a person’s healthcare costs:

 

Bronze: 60%

Silver: 70%

Gold: 80%

Platinum: 90%

 

Plans that cover a greater percentage of the cost would have more expensive premiums. Plan levels of coverage are averages – you might pay more or less depending on your actual health issues in a given year. To participate in the marketplace, each company must offer at least one silver and one gold plan.  The cost-sharing benefit mentioned earlier is available only for silver plans. 

 

There will also be a catastrophic plan option – for people under 30 who can’t afford marketplace plans. (They must obtain a hardship exemption).  It will have a high deductible & low premiums, and pay for 3 primary care visits and preventive care with no out of pocket costs.

 

Through these various methods, it’s anticipated that most people will be able to get insurance which is appropriate to their circumstances.  People who have not arranged insurance by Jan. 1, 2014 will be assessed a fine. If you don’t have insurance in 2014 you will pay a penalty (Espanol) on your 2014 tax return that you fill out in 2015: for uninsured adults it will be %1 of your income or $95 whichever is higher, and 47.50 for each uninsured child, with a maximum of $285 for a family. The feel will rise each year.  The IRS cannot use liens or levies to collect this.  People can get an exemption from the fee if they:

 

  • are uninsured for less than 3 months of the year
  • are determined to have very low income and coverage is considered unaffordable
  • are not required to file a tax return because their income is too low
  • would qualify under the new income limits for Medicaid, but their state has chosen not to expand Medicaid eligibility
  • are a member of a federally recognized Indian tribe
  • participate in a health care sharing ministry
  • are a member of a recognized religious sect with religious objections to health insurance

 

 The marketplace will have limited enrollment periods like the insurance offered by many employers. The initial open enrollment will be a little longer than usual – it will run from October 1,2013 to March 31, 2014.  After that the regular enrollment period will be October 15 to December 7 each year.  During the initial enrollment period, if you enroll by December 15, 2013, coverage must begin by January 1, 2014.  Between January and March 2014, if you enroll between the first and fifteenth of the month, coverage must begin by the first of the following month.  If you enroll in the 2nd half of the month from December 16 to March 31, coverage must begin on the first of the second month after that. There will be special enrollment periods for life events such as having a child, moving to a new state, losing previous health care coverage, gaining or losing eligibility.  A special enrollment period is not available for certain events, such as getting fired or losing your insurance due to non-payment of premiums. You can apply at any time of year for Medicaid & CHIP.

 

Eligibility (Espanol):

 

To sign up for the marketplace you:

-must live in the state or area served by the marketplace (NJ residents can’t use the PA marketplace, etc.)

-must be a citizen or legal non-citizen

-can’t be incarcerated.

 

In order to apply to the marketplace, patrons must

 

-Create an account, for which they will need an email address. 

-Fill out the application. 

 

Many patrons who will be applying to the Marketplace have never had insurance before.  They may not understand common insurance terms like “premium,” “deductible,” and “copay.”  They’ll want to know those before they compare their health plans.  

 

When applying, they should  also have their personal information handy:

 

- Social Security Numbers (or document numbers for legal immigrants)

-Employer and income information for every member of your household who needs coverage (for example, from pay stubs or W-2 forms—Wage and Tax Statements)

-Policy numbers for any current health insurance plans covering members of your household

-A completed Employer Coverage Tool for every job-based plan you or someone in your household is eligible for. (You’ll need to fill out this form even for coverage you’re eligible for but don’t enroll in.)

 

 

Once patrons complete the application, they will be notified whether they are eligible for any of the benefits already described, and receive a list of insurance plans that fit the information they have provided.  The plans must state all costs up front and will be presented in such a way that the patron can easily compare one plan to another.  The patron can search among available plans, choosing one or more plan levels, and filtering results by variables such as the range of premiums the patron is willing to pay or whether the plan covers dental.  The patron can compare up to 12 plans, with 3 plans at a time being displayed side-by-side.  Patrons can get more details about each plan and about the coverage and costs for managing specific conditions such as diabetes.  The patron can then choose a plan, enroll in it, and pay the first month’s premium online or make arrangements to pay some other way. 

 

 

Go back to list of all Newark Public Library Web guides.

 

 

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