COPS/Metro Workshop on the Health Insurance

Marketplace

An Organizing Strategy

COPS/Metro

• A broad-based organization with 33 dues-paying member institutions

• Foster a relational culture among institutions• Develop leadership and capacity to shape the

common good• Organizing Process– Learn issues affecting families– Research possibilities to act– Act to shape public policy – Evaluate & Reflect on our actions, our development

Workshop Topics

• Background on the state of healthcare• What is the Health Insurance Marketplace?• Who can benefit from it?• How does it work?• Small Group Conversations• Next steps

Background

• There are 6.1 million uninsured Texans – 1 million of whom are children– Texas leads the nation

• 390,000 uninsured in Bexar County– This is 23% of the population

Source: Center for Public Policy Priorities www.cppp.org

What is the Health Insurance Marketplace?

• In 2010, the Affordable Care Act (ACA) created the Marketplace (Exchange)

• A one-stop shop to compare plans, benefits, costs

• Provides tax subsidies to make insurance more affordable

What is the Health Insurance Marketplace?

• Benefits include:– Preventive Care covered at 100%–Maternity & Newborn care– Prescription Drugs– Mental health and substance use disorder

services, including behavioral health treatment– Children covered under parents’ plan until age 26– Caps out of pocket expenses

Who Benefits?

Status of Insurance Marketplace?

• Enrollment period: 10/1/13 – 3/31/14• Coverage begins 1/1/14 – So do penalties for those qualified & not covered

• 110,000 residents in Bexar County may qualify• HHS has granted resources to agencies to hire

“Navigators” who can enroll participants– “Certified Application Counselors” can also enroll

Status of Insurance Marketplace?

• Three Navigator agencies in Bexar County– About $1.2 million in federal grants– 22 Navigators

• HHS requires 30 hours of training, including strict privacy protections

• Governor Perry asked TDI to draft tighter regulations for navigators– Additional 40 hours of training; US citizenship

DETAILS ON THE MARKETPLACE

Four Health Plan CategoriesBased on % the plan pays on average

Terms to Know

• Premium: The amount you pay monthly for health insurance coverage

• Deductible: A fixed amount you pay per year before your insurance starts to make payments for covered medical services

• Co-Pay: A fixed amount you pay for each healthcare service.

• Lifetime Cap: The maximum amount your insurance will pay over your lifetime.

Terms to Know

• Out-of-pocket: The amount you pay out of your own pocket for healthcare services.

• Healthcare Navigators,• Application Assisters,• Certified Application Counselors, and• Champions for Coverage: – Different terms for people certified, trained and

knowledgeable to help you understand your health coverage options

What determines my costs?

• Your health insurance cost will be based only on four things:– Age–Where you live– Family Size–Whether you smoke

*Pre-existing conditions will NOT be a factor*

Who can use the marketplace?

• Small businesses

• Families

• Individuals who:– Are US citizens or legal residents– Live in the US– Are not in jail

Who cannot use the marketplace?

• Undocumented residents

• Residents with “deferred action” status (such as DACA)

• People with Medicaid, CHIP or Medicare

Tax credits

• Tax credits will be given on a sliding scale to those who qualify (family size/income)

• People will pay no more than 9.5% of their income in health insurance premiums

• For people who qualify, the government will send money directly to the insurance company.

For more information

www.healthcare.gov

1-800-318-2596

To Enroll

• Beginning October 1, 2013– Online: www.healthcare.gov– By phone: 1-800-318-2596– In person• • •

Documents you need to apply

• Social security card (or document number for legal immigrants)

• Employer and income information for every member of your household who needs coverage (pay stubs, W-2)

• Policy numbers of current health insurance plans covering members of your household

• An Employer Coverage Tool for every job-based plan you or someone in your household is eligible for (even if not enrolled)

What happens if I don't get coverage?

• If you don't have coverage as of 1/1/14 (employer, Marketplace, CHIP, Medicaid or Medicare) you will have to pay a tax penalty

• 2014: 1% of income or $95 per person/year, whichever is higher – The fee for uninsured children is $47.50 per child/year– The most a family would have to pay in 2014 is

$285/year• 2016: 2.5% of income or $695 per person/year,

whichever is higher

CONVERSATIONS

NEXT STEPS

BACKUP SLIDES

Catastrophic Plans

• People under 30 and some people with limited incomes may buy a "catastrophic" health plan. – Will have lower premiums, but high deductible– Protects you from very high medical costs (worst-case

scenarios)– Generally requires you to pay all of your medical costs up

to a certain amount, usually several thousand dollars.• Will include 3 annual primary care/preventive care

visits with no out of pocket costs• People 30 and over who have received a “hardship”

exemption may be able to buy catastrophic plans

*Disclaimer*• COPS/Metro will provide information with

respect to the Affordable Care Act and how it may affect our families

• COPS/Metro will not be engaged in the enrollment process. We can, however, refer families to reputable enrollment agencies who can assist with enrollment

• While our organization accepts contributions for the broad purposes of the organization, we will not accept any contributions stemming from the Affordable Care Act (or any other public funds)

Medicaid Expansion