affordable care act presentation by community health councils - english

Category:

Documents


0 download

TRANSCRIPT

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    1/26

    The Affordable Care Act:What does it mean for California?

    Community Health Councils

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    2/26

    Community Health Councils

    Works to promote social justice and achieve equity

    in community and environmental resources for

    underserved populations.

    2

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    3/26

    1 out of 5 children and adults in LA County haveno insurance

    Children

    Parents

    Adults without children

    Workers

    Our Neighbors

    Our Friends

    Our Own Families

    The Uninsured

    3

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    4/26

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    5/26

    5

    779,000

    Covered CA

    (with premium assistance))

    460,000Medi-Cal

    970,000RemainingUninsured

    Millions will receive Coverage

    LA County

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    6/26

    Know the Facts Individuals/Families

    In 2014 health insurance is required for Most People

    If you already have insurance through a job, Medi-Cal or Medicare

    you dont have to do anything

    You can be excused if:

    Cannot afford coverage

    Do not file Taxes Your religion does not allow it. Native Americans, Incarcerated

    People and the Undocumented

    6

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    7/26

    More people with coverage means

    lower costs for everyone

    If you do not have coverage,

    you may pay a tax penalty.

    Why is this important?

    Know the facts:

    Penalties start low in 2014 but go up higher every year

    7

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    8/26

    Know the Facts Employers

    Employers with at least 50 full-timeequivalent staff must provide health

    insurance.

    If full time (not part-time) employeesgo into Covered CA, the employermust pay a tax penalty.

    The penalty only occurs if theemployer has 30 or more full timeemployees.

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    9/26

    More Health Coverage Options

    Program Eligibility by Federal Poverty Level

    Household

    Size

    Medi-Cal

    Adults

    Covered California with Premium AssistanceCovered

    California

    no

    Premium

    AssistanceMedi-Cal

    Children

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    10/26

    10

    The paper & online application is simpler.

    Less Documentation and more electronic verification

    Changes start January 1 2014 ~ Healthy Way LA open today

    Adults do not have to have children in Medi-Cal

    Income level goes up

    Former foster youth eligible up to age 26

    Those In Healthy Way LA will become Medi-Cal

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    11/26

    Medi-Cal Benefits Today & 2014

    Medical Coverage - Medically NecessaryAdult &Children

    Adultos y Nios

    Dental & Vision

    Children &Pregnant Woman

    Nios y MujeresEmbarazada

    Dental (preventative, diagnostic, restorationsand full dentures

    Adults

    May 2014

    11

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    12/26

    Covered California Helps make comparing,

    applying for and

    purchasing coverage

    easy.

    Enroll as soon as October

    2013.

    Coverage will start assoon as January 2014

    12

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    13/26

    13

    Whose Eligible?

    Citizen and Lawfully Present Resident

    California Resident

    Household income above 138%

    financial assistance 139% - 400%

    Dont have public coverage (i.e. Medi-Cal)

    Cannot have employer coverage unless

    Health Plan pays less than 60%

    Employees share of premium exceeds 9.5% of

    household income (not dependent share)

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    14/26

    Benefits10 essential health benefits:

    Ambulatory patient services

    Emergency services

    Hospitalization

    Maternity and newborn care

    Mental health & substance use disorder services,including behavioral health treatment

    Prescription drugs

    Rehabilitative and habilitative services and devices Laboratory services

    Preventive and wellness services and chronicdisease management

    Pediatric services, including dental and vision care14

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    15/26

    Premiums

    Based On

    Age

    Household Size

    Region

    Health Plan &Benefit LevelSelected

    Not Based On

    Health Status

    Gender

    Pre-ExistingConditions

    Tobacco Usage

    15

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    16/26

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    17/26

    Bronze Silver* Gold Platinum

    Preventive $ 0 $ 0 $ 0 $ 0

    Primary Care$60

    (3 visits per year)$4 - $45 $45 $25

    Specialty Care $70 $6-$65 $65 $50

    Urgent Care $120 $8 - $90 $90 $50

    Emergency $250 $25 - $250 $250 $150

    Generic Medication 30% $4 - $25 $25 $5

    Lab Testing 30% $6 - $45 $45 $25

    X-Ray 30% $10-$65 $65 $40

    Deductible $5000 $2000 None None

    Maximum Out of pocket

    Individual $6,350 $6,350 $6,350 $4,000

    Family $12,700 $12,700 $12,700 $8,000

    *Sliding Scale co-payments offered at the Silver level based on income17

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    18/26

    Tax Credit Can Change If Family Size Changes You get married or divorced

    You have a baby or adopt achild

    Stop claiming a child on yourtaxes

    Income Changes You get a raise

    You lose your job

    You take a salary cut

    Health Premium Tax Credits

    Take in advance to lower premiums or

    As a credit on your taxes

    Based on family income and size

    Can only get the credit at Covered CA

    18

    http://coveredca.com/
  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    19/26

    Shop and Compare Tool

    Example:

    Family of 4 - $60,000

    (Parents - 40 years old).o Estimated premium:

    $783 per montho Tax credit:

    $374 per montho Family pays:

    $409 per month

    19

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    20/26

    CoveredCA.comBenefitscal.org

    (Medi-Cal & otherSocial Service)

    County Offices

    Service Center

    Covered CA 800-300-1506 County Customer Service Lines

    CertifiedEnrollmentCounselors

    CertifiedInsurance Agents

    (SHOP)

    Enroll Anytime Using Various Ways

    Covered CA: Enrollment Periods

    Year One October 1, 2013- March 31, 2014

    Regular - After Year One October 15 December 7

    Outside Regular Period Within 60 days after a qualifying life-changing event

    One Application for Covered California and Medi-Cal

    Medi-Cal:Enroll Anytime20

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    21/26

    New Consumer Protections

    Free preventive services

    Stay on parents health plan until the age of26.

    Plans cannot deny coverage due to a pre-existing conditions.

    Plans cannot drop coverage or stoptreatment.

    No lifetime or Annual dollar limits

    Plans in and outside of Covered California

    21

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    22/26

    Improving Medicare

    Increased coverage for wellness andpreventative care.

    One free wellness visit per year.

    Covers more preventative services

    Provides discounts on brand name andgeneric drugs while you are in the Part Dcoverage gap.

    Closes the Part D coverage gap by 2020.

    Medicare Beneficiaries DO NOT have to purchase new Coverage

    22

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    23/26

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    24/26

    Emergency/Pregnancy Medi-Cal

    Local program at community/county

    clinics

    Healthy Kids for children 0-5

    Programs Continue for Undocumented

    Immigrants

    24

  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    25/26

    Get Involved!

    Talk with family, friends, and community members

    For more Information:

    Kaiser Family Foundation: healthreform.kff.org

    Health Reform website: www.healthcare.gov Covered California: http://www.coveredca.com/ La Opinion http://www.laopinion.com/lasaludempiezaaqu i Univision Univision.com/saludaqui Telemundo http://www.telemundo52.com/secciones-especiales/asegurate

    25

    Share YOUR Thoughts with Lawmakers

    State:http://www.legislature.ca.gov/

    Congressional: http://www.usa.gov/Contact/Elected.shtml

    (202) 224-3121

    http://healthreform.kff.org/http://www.healthcare.gov/http://www.coveredca.com/http://www.laopinion.com/lasaludempiezaaquhttp://www.telemundo52.com/secciones-especiales/aseguratehttp://www.legislature.ca.gov/http://www.usa.gov/Contact/Elected.shtmlhttp://www.usa.gov/Contact/Elected.shtmlhttp://www.legislature.ca.gov/http://www.telemundo52.com/secciones-especiales/aseguratehttp://www.telemundo52.com/secciones-especiales/aseguratehttp://www.telemundo52.com/secciones-especiales/aseguratehttp://www.laopinion.com/lasaludempiezaaquhttp://www.coveredca.com/http://www.healthcare.gov/http://healthreform.kff.org/
  • 7/27/2019 Affordable Care Act Presentation by Community Health Councils - English

    26/26

    Questions?

    Sonya Vasquez - Community Health Councils

    [email protected] ~ (323) 295-9372

    www.chc-inc.orgwww.facebook.com/CommunityHealthCouncils

    https://twitter.com/chcinc

    http://letsallgetcovered.org/

    26

    mailto:[email protected]://www.chc-inc.org/http://www.facebook.com/CommunityHealthCouncilshttps://twitter.com/chcinchttp://letsallgetcovered.org/http://letsallgetcovered.org/https://twitter.com/chcinchttp://www.facebook.com/CommunityHealthCouncilshttp://www.chc-inc.org/http://www.chc-inc.org/http://www.chc-inc.org/http://www.chc-inc.org/mailto:[email protected]:[email protected]:[email protected]