Health Insurance MarketplaceNavigating the Changes

Megan Holt, LCSW

Key Points

• I am One of You…

• I Did Not Write This Law…

• I Often Do Not Understand It Either...

• I am Not the Expert…

Primary Payors

• Medicare

• Medicaid

• Private Payors (Insurance)

• Self-Pay / Uninsured

Eligibility & Rules (ACA)

• For the Uninsured Up to 400% FPL

• Qualified Health Plans Must Meet All Essential Elements of ACA

• Subsidized by Federal Government

• States May Choose Medicaid Expansion

• States Must Establish Marketplaces

Essential Health Benefits (ACA)

• Ambulatory Svcs Prescription Drugs

• Emergency Svcs Preventive/Wellness

• Hospitalization Maternity & Newborn

• Rehabilitative & Habilitative Services/Devices

• Pediatric Services (Oral & Vision)

• Mental Health & Substance Abuse Disorder Svcs

Avenues for the Uninsured (ACA)

• Option One:• Insurance – New Marketplace

• Up to 400% FPL

• Subsidized – Income-Based

• Requires at least 2 Providers per County

• Metallic Plans – Must Be Fairly Issued

• Option Two:• Tax Penalty

• Increases Each Year if Remain Uninsured

Avenues for the Uninsured (Ark)

• Medicaid• Traditional Methods (17%FPL or

Below)

• Disabled…

• Medically Frail (Includes SMI)

• Medicaid Expansion• PRIVATE OPTION (up to 138% FPL)

• Insurance Marketplace (ACA)• Exchange Plans (139% - 400% FPL)

Marketplace in Arkansas

• Blue Cross/Blue Shield of Arkansas

• Blue Cross/Blue Shield –Multi-State

• QualChoice

• Ambetter (Novasys)

Will Come Back to These….

Private Option (Arkansas)• Arkansas’s Version of Medicaid

Expansion (But Not Medicaid)

• Childless Adults (19-65) With Incomes ≤138% Federal Poverty Level

• Parents (19-65) With Incomes 17% - 138% Federal Poverty Level (FPL)

• Not on Medicare and Not Disabled

Private Option (Arkansas)• “Purchase” Insurance Plans in the

New Marketplace – Subsidized by Federal Government

• Must be Silver Metallic Plan or Better

• Estimated 225,000 ≤138% FPL Should Enroll

• IMD Exclusion Does Not Apply…so The BridgeWay Can Accept PO Patients

Marketplace in Arkansas

• Blue Cross/Blue Shield of Arkansas

• Blue Cross/Blue Shield –Multi-State

• QualChoice

• Ambetter (Novasys)

Blue Cross Plans Only

Blue Cross PlansQualChoice

Blue Cross PlansAmbetterQualChoice

Blue Cross Plans Only

Blue Cross PlansAmbetterQualChoice

Blue Cross PlansQualChoice

Blue Cross PlansAmbetterQualChoice

Marketplace in Arkansas

• Metallic Plan Options

• Bronze (Covers 60% of Expenses)

• Silver (Covers 70% of Expenses)

• Gold (Covers 80% of Expenses)

• Platinum (Covers 90% of Expenses)

Marketplace in Arkansas

• Outside of Private Option…

• Deductibles and Co-Pays Apply to Most Plans

• Some are as High as $6,500 Individual and $12,000 Family

• Subsidies Only Impact Monthly Premium

Marketplace in Arkansas

• Opened October 1, 2013

• Federal Plans Closed March 31, 2014

• Private Option Remains OPEN

• Coverage Began January 1, 2014

• Expected 500,000 Arkansans are Uninsured• Estimated 225,000+ Will Meet Private

Option or Medicaid Qualifications

Marketplace in Arkansas

• Outreach & Education

• Signing Up…• www.arhealthconnector.org

• 1-855-283-3483

• More Info at www.healthcare.gov

• Certified Application Counselors (CAC)• Several at The BridgeWay

Summary

• Uninsured in Arkansas• Medicaid (Must Qualify)

• Marketplace Insurance Plans

• Private Option (Fully Subsidized)

• ACA (Patient and Government Shared)

• Four (4) Qualified Health Plan Companies in Arkansas• Only 2 (BC/BS) Cover All of Arkansas

• Enrollment Ends March 31, 2014

Summary

• Private Option is Technically Not Medicaid Expansion

(But Uses Federal Dollars the Same Way)

• Private Option “Insurance” Is Accepted at The BridgeWay

• Adult Medicaid Payments to Free-Standing Facilities are Still Denied

Working Together…

• Sign People Up…

• Call Us for Help (501-771-1500)

• Work With State Legislators…

www.TheBridgeWay.com 501-771-1500 1-800-245-0011