what athletic trainers need to know about the health care law national athletic trainers’...
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What Athletic Trainers Need to Know about the Health Care Law
National Athletic Trainers’ Association
December 9, 2013, 3:00 pm EST
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Affordable Care Act
Affordable Care Act was passed by Congress in March
2010.
The law extends insurance coverage and provides
additional protections for all consumers.
- Subsidies available to help individuals afford coverage in health
insurance exchanges.
Greater focus on prevention of disease.
The law has been incrementally implemented since 2010.
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Upcoming Changes
A number of major provisions are set to be implemented in
fall 2013 and 2014.
- Health insurance marketplace/state exchanges
- Medicaid expansion
As providers, you have an important role in ensuring that
patients receive accurate information about the changes
taking place.
As consumers of health care, you need to ensure you
receive accurate, timely information in order to make the
choices that best fit your needs.
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If Already Insured…
Benefit from a number of new consumer protections under
the ACA.
- Insurance companies cannot drop coverage if you get sick or if your
health care costs become too expensive.
- Cannot be denied insurance coverage because of a pre-existing
condition.
- No more annual or lifetime coverage limits.
- Coverage for more preventive care services.
- Extends coverage for young adults up to age 26.
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If Already Insured…
All employers were required to send their employees
notices related to the ACA and the availability of coverage
through the exchanges.
Contact your employer to see what, if any, changes can be
expected for the next year.
If your health insurance premiums are too high compared
to your income, you may be eligible for additional cost-
sharing if you purchase a health plan on the exchange.
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If you are an employer …
Beginning January 2015, large employers (more than 50
FTEs) will be required to provide health insurance to their
employees or face a penalty.
- “No Coverage” Penalty ($2,000/FTE/year)
- “Insufficient Coverage” Penalty ($3,000/FTE/year)
Small businesses with less than 25 FTEs making an
average of $50,000 or less may qualify for tax credits.
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If Already a Medicare Beneficiary…
You do not need to purchase health insurance
through the exchanges.
Medicare will now cover additional preventive care
services and an annual wellness examination.
Medicare out-of-pocket prescription drug costs will be
lower.
More focus on quality care
- Accountable Care Organization (ACOs)
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If Not Insured…
The ACA creates new health insurance exchanges
(marketplaces) where health insurance coverage can be
purchased.
- Depending on income, may qualify for additional cost-sharing.
People with low incomes may qualify for Medicaid.
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Health Insurance Exchanges
New health insurance exchanges (marketplaces) for
individuals and small businesses to shop for health care
coverage.
- Offered in every state.
Plan choices and premiums will vary by state.
There are different levels of coverage.
Must sign up between October 1, 2013-March 31, 2014.
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All plans offered in the Exchanges must cover 10 Essential Health Benefits
Doctor visits
Emergency services
Hospital care
Maternity and newborn
care
Mental health and
substance use disorder
services, including
behavioral health
treatment
Prescription drugs
Rehabilitative services and
habilitative services and
devices
Laboratory services
Preventive and wellness
services, and chronic
disease management
Pediatric services, including
oral and vision care
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Coverage Levels
Levels of Coverage Average Plan Contribution Average Individual Contribution*
Bronze 60 percent 40 percent
Silver 70 percent 30 percent
Gold 80 percent 20 percent
Platinum 90 percent 10 percent
*In addition to the monthly plan premium.
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Coverage Levels: Example
4 person household
- Two 44 year olds, 16 year old, 12 year old
Annual household income of $60,000
How does their coverage differ between the different state marketplaces?
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Coverage Levels: Side-by-Side Comparison
Oregon Washington, DC
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Help Paying for Insurance
Starting in 2014,
depending on income,
patients may be eligible
for a subsidy to help
lower out-of-pocket costs
for health insurance
purchased through the
Exchanges
Up to $45,960
Up to $62,040
Up to $78,120
Up to $94,200
Up to $110,280
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Medicaid Expansion
States can choose to expand Medicaid (joint state-federal
program) to cover individuals up to 133% of the federal
poverty level ($15,282 for an individual and $31,322 for a
family of 4).
- Feds pick up 100% of the cost of the new population, phased down to
90% by 2020.
If states choose not to expand, they can keep their
existing Medicaid program.
States have the option to change their minds.
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Medicaid Expansion
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Example
Harold, 30, has a bare-bones health insurance policy through his
employer, and he has limited income. He cares for his mom Betty,
an uninsured 60 year old with a mild hypertension.
- Harold should contact his employer to see what, if any, changes his employer
may make for next year.
- Harold may want to see what plans are available in the health insurance
exchange in his state.
- Harold also may want to explore whether he qualifies for any tax credits or
subsidies to help him afford his premiums.
- Betty should explore her options for more affordable health insurance options
through their state exchange.
• To learn more about the plans available on the exchanges Harold and Betty can go to
healthcare.gov or call 1-800-318-2596.
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When Signing Up, Consider…
What are the deductible (the amount paid out-of-pocket
before benefits kick in) and maximum out-of-pocket costs?
Who is in the network? Does the plan cover preferred
doctor(s) and/or hospital and sites of care?
Does the plan cover necessary prescription drugs? Is the
coverage of those drugs an affordable amount?
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To Sign Up for a Plan, You Will Need …
Social security numbers for every member of the household
who needs coverage
- Or document numbers for legal immigrants
Employer and income information for every member of the
household who needs coverage
- Pay stubs or W-2 forms
Policy numbers for any current health insurance plans
covering members of the household
Information on employer coverage for every job-based plan a
household member is eligible for
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Where to Go for Information on the Exchanges
Official Exchange websites: www.healthcare.gov and
www.cuidadodesalud.gov
24-hour toll-free
call center:
(800) 318-2596
(855-889-4325
TTY/TDD)
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HealthCare.gov – Four Steps to Obtaining Insurance
• Set up an account.
• Fill out the online application.
• Compare your options.
• Enroll!
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Where to Go for Information on Medicaid
For state-by-state
information: http://
www.medicaid.gov/medicaid-chip-program-information/by-state/by-state.html
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Where to Go for Local Assistance
In-person assistance locators:
https://localhelp.healthcare.gov and
https://ayudalocal.cuidadodesalud.gov
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Important Dates
October 1, 2013: Exchanges officially open, consumers can
begin applying and enrolling for coverage.
January 1, 2014: Coverage begins as early as this date;
Medicaid expansion begins in many states.
March 31, 2014: Exchange open enrollment period ends.
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Protection from Scams Keep insurance cards, Social Security cards, and other personal
documentation private and in a safe place.
Know what the new exchanges involve.
- The government will not be calling, sending e-mails, or knocking on doors to
sign people up.
- There is no application fee or charge for enrollment and there are no limited
time offers.
- People with Medicare or insurance through their employer do not need
additional coverage.
Use trusted sources.
Report anything suspicious.
Trust your instincts!
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Questions?
Please submit questions using the chat box on your webinar screen.
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Additional questions?
Please e-mail any additional questions to:
Parie Thorpe
We will compile all questions and will release a Q&A
document a few weeks after this webinar.