MNSure PresentationOct 6. 2013

3702 E Lake StMinneapolis, MN 55406

www.sewa-aifw.orgCrisis Line: (952) 912-9100

Agenda • Health Care Directive• Health Insurance Market Place

– What is MNsure?– Who should use MNsure to get insurance?– If my employer offers insurance but it’s too expensive for my budget, can I buy a plan on

MNsure?– How does MNsure affect you?– How does MNsure work?– How can you apply?– How can you get help?– If you use MNsure can you keep your doctor?– How does tax credits work?– What are the different levels of insurance – Bronze, Silver, Gold, and Platinum?

• Next Steps

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Health Care Directive • All legal residents should have insurance starting in Jan, 2014 as required

by law through the Affordable Care Act (also known as Obamacare).• If you do not have health insurance starting in 2014, you will pay a tax

penalty. The penalty will increase over time:– In 2014, it will be the greater of $95 per adult or 1 % of taxable income

per month.– In 2015, it will be the greater of $325 per adult or 2 % of taxable

income per month.– In 2016, it will be the greater of $695 per adult or 2.5 % of taxable

income per month.

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What is MNsure? • MNsure, is the state's new online health insurance marketplace,

sometimes called an exchange. • The Marketplace is a new way to find quality health coverage. It can help if

you don’t have coverage now or if you have it but want to look at other options.

• Minnesota consumers and small businesses with up to 50 full-time employees will be able to obtain health insurance through MNsure.

• The Marketplace will also tell you if you qualify for free or low-cost coverage available through Medicaid or the Children's Health Insurance Program (CHIP).

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Who should use MNsure • Most people will be eligible to purchase health coverage through the

Health Insurance Marketplace. In order to qualify, you must:– Live in the United States, be a U.S. citizen or national, not be currently incarcerated

• MNsure is for:– People shopping for individual, family, or small business coverage. People who’ve

bought such plans through an insurance agent or broker can continue to use an agent. But federal subsidies are only available if your agent or broker is registered to sell on MNsure.

– Tax credits for individuals and family buyers can only be obtained if you purchase your health insurance through MNsure.

– MNsure will also serve as the entry point for enrolling in two government insurance programs: Medical Assistance (Minnesota’s Medicaid program) and MinnesotaCare.

• Does not apply:– Minnesotans who have health insurance through a large employer won't be using

MNsure. – MNsure does not affect people enrolled in Medicare, the government insurance

program for elderly Americans.

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Employer’s insurance is too expensive?

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• Any Minnesota resident can buy insurance on MNsure whether or not your employer offers coverage. But for people who choose MNsure over a workplace plan, there's a relatively high bar to qualify for federal subsidies that bring down the cost of buying insurance on your own.

• If your employer coverage costs less than 9.5 percent of your household income, you could still buy insurance on MNsure but couldn’t take advantage of the law’s tax subsidies.

How does MNsure work?• The website is live as of October 1, 2013 and is designed to offer one-stop

shopping for insurance. • After entering income and other basic information Minnesotans will be

routed either to government insurance programs -- if their income qualifies -- or to commercial plans. MNsure will also let you know if you qualify for tax credits, or other financial help.

• MNsure will allow side-by-side comparisons of commercial plans offered by different companies or with differing levels of coverage. You can decide based on your budget, and health situation as to which plan will work you.

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How to Apply? • Go to the MNsure website http://mnsure.org.• The system will guide you through enrollment step-by-step.

– Create an account• First provide some basic information. Then choose a user name, password, and

security questions for added protection.– Apply for Marketplace coverage

• Enter information about you and your family, including your income, household size, and more. Use this checklist now to help you gather the information you’ll need.

– Pick a plan• Next you’ll see all the health insurance plans and programs you’re eligible for and

compare them side-by-side. You’ll also find out if you can get lower costs on Marketplace coverage.

– Enroll• Choose a health insurance plan that meets your needs and enroll! Coverage starts as soon as

January 1, 2014.

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Need Help? • MNsure toll-free call-center 1-855-3-MNSURE, or 1-855-366-7873. Operators are

available to answer questions in English, Spanish, Hmong and Somali. Callers will also have access to interpreter services in at least 140 other languages.

• The call center is open Monday through Friday, 7:30 a.m. to 8 p.m., and on Saturdays from 9 a.m. to 4:30 p.m., during the open enrollment period, which ends March 31, 2014.

• The state is providing "navigators" and "in-person assisters" to help Minnesotans enroll in the health plans sold on MNsure. You do not need to pay them use to their help. If they ask you to pay, you should call MNsure toll free # and report.

• Certified application counselors will help consumers through the MNsure enrollment process as part of their current jobs at hospitals; clinics; associations and other groups.

• Licensed insurance agents and brokers who complete a MNsure training course will also be able to assist consumers seeking insurance on the marketplace. Brokers and agents also must be registered with MNsure for a client to receive federal tax subsidies if the client is eligible. Agents/brokers must disclose their financial arrangement with insurers to consumers.

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Current doctor? • You can see the networks that are available for each plan before

purchasing a policy and see if your Doctor or clinic is included.

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Tax credits and Cost-sharing reductionsMany people will qualify for new federal subsidies that can help lower health costs, both the premiums and the care itself. When you get coverage through the Marketplace, you may be eligible for:

– Cost-Sharing Reductions, which help lower out-of-pockets costs such as deductibles, co-pays and coinsurance; and

– Advanced Premium Tax Credits, which reduce the amount you pay each month for your insurance premium.

• Both subsidies are available only to qualified individuals who are:– Ineligible for public coverage (Medicaid, Medicare and Children’s Health Insurance Plan)– Unable to get qualified health insurance through an employer

• Any savings are based on your family size and income.

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Cost-sharing Reductions:• In order to take advantage of Cost-Sharing Reductions, you must purchase

a Silver plan on the Marketplace and your modified adjusted gross income (MAGI) must fall below these maximums:Family Size Income

1 Up to $28,7252 Up to $38,7753 Up to $48,8254 Up to $58,8755 Up to $68,9256 Up to $78,9757 Up to $89,0258 Up to $99,075

Note:Your modified adjusted gross income is your household’s adjust gross income plus any tax-exempt Social Security, interest and foreign income.

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Tax CreditsAdvanced Premium Tax Credits are sent directly from the government to your health insurer and are applied to your premium each month. You must apply for this subsidy on the Health Insurance Marketplace. Unlike the Cost-Sharing Reduction, you do not have to buy the Silver plan; however, you still must meet certain income requirements, based on family size:

Family Size Income Range1 $11,490 to $45,9602 $15,510 to $62,0403 $19,530 to $78,1204 $23,550 to $94,2005 $27,570 to $110,2806 $31,590 to $126,3607 $35,610 to $142,4408 $39,630 to $158,520

Note: The amount of tax credit you receive depends on your income; you will pay more for your premiums if your income is near the top of the range and less if your income falls closer to the bottom. If your income falls below the range for your family size, you may qualify for coverage under your state’s Medicaid program.

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Levels of InsuranceComparing health insurance policies is complicated because the coverage can vary so widely from one plan to another. • The federal health care law divides health plans to be sold on health insurance

exchanges such as MNsure into four categories, which named after metals: bronze, silver, gold, and platinum .

• The tradeoff is this: the higher the premiums and the more extensive the coverage, the lower the out-of-pocket costs such as deductibles and co-pays.

1. Bronze plan:Will pay about 60 percent of the cost of the plan's benefits; the consumer pays the rest in deductibles, copays and coinsurance.

2. Silver plan: Will pay about 70 percent of the enrollees' health care costs on average; the consumer is responsible for the remaining 30 percent.

3. Gold plan: Will pay about 80 percent of the costs; the consumer is responsible for the remaining 20 percent.

4. Platinum plan: Will pay about 90 percent of the costs; the consumer is responsible for the remaining 10 percent.

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Terminology & definitions: • Premium: The amount that you and/or your employer pay each month for your family’s plan.

For example, if a plan covers a couple at a rate of $300 per person, per month, the premium is $600 per month.

• Deductible: The amount you must pay each year for any health care you receive before the insurer will pay for your services. If you do not receive any care, you do not need to pay this amount. Often plans with no deductible or a low deductible are more expensive, but you will pay less when you actually get care.

• Copay: A flat-dollar amount that you pay when you receive care. For example, you may be required to pay $20 each time you see a doctor.

• Coinsurance: The percentage of the total charge that you pay when you receive care. For example, you may need to pay 20% of the cost each time you see a doctor.

• Formulary: A list of prescription drugs that your health plan will cover. You may pay more if the drug you take is not on this list.

• Network: All of the health care providers that are associated with your health plan. You generally need to use a provider that is in your network to get your best benefits.

• Out-of-pocket limit: The total amount that you would ever need to pay for care in a year. If you reach this limit, you do not need to pay for any health services you receive until your plan renews the next year. If you do not receive much health care, you may not meet this limit and you would pay less.

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Important dates• October 1, 2013 – Marketplace open enrollment begins• January 1, 2014 – Health coverage can begin• March 31, 2014 – Open enrollment ends\

• Nov 16th – MNSure Enrollment EventOpen Cities Health Center409 N. Dunlap StSt. Paul, MN 55104Ph: 651-251-5942

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Next Steps?

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