Health Care Reform, Health Insurance and Health Care in Houston: An Overview

1. Health Care Reform, Health Insurance and Health Care in Houston: An Overview The Artists Health Insurance Resource Center www.ahirc.org A program of The Actors Fund www.actorsfund.org with funding from The Doris Duke Foundation

2. What’s already happened - 2010 • Children under age 19 with pre-existing conditions can’t be denied coverage. • Young adults up to age 26 can stay on or enroll in their parents’ coverage. • Insurers can’t retroactively cancel the policies of people who get sick. • Insurers can’t impose lifetime dollar limits on medical benefits. • All new plans must cover certain preventive services, such as mammograms, flu shot and tetanus shots, for free.

3. 2010 • Uninsured people with pre-existing conditions may be eligible for coverage through PCIP. Pre-Existing Condition Insurance Plan www.pcip.gov Help for the uninsured with pre-existing medical conditions thru a temporary high-risk pool until January, 2014 Have to be uninsured for 6 months. Monthly Premium Cost: 19-34 $207, 35-44 $249, 45-54 $319, 55+ $444

4. 2011 • Medicare recipients with Part D-drug coverage in the coverage gap or “donut hole” received 50% off drugs. In 2013, you pay 47.5% for brand name and 79% for generic drugs. By 2020, 25% all the time. • Annual wellness visits and certain preventive services are free for Medicare recipients. • Increased funding to Community Health Centers

5. 2014 • Insurers can’t refuse coverage to anyone. • Most people will be mandated to have coverage or pay a penalty. • New insurance marketplaces, called Exchanges, will offer insurance to those who don’t get it elsewhere. • Subsidies will be available to people who buy insurance through an exchange with income less than 400% of the Federal Poverty Level. ($43,320) • Employers with 50 or more employees who don’t offer insurance will be fined.

6. Essential package of benefits: • All new plans will offer at a minimum an essential benefits package which limits out-of-pocket medical expenses. Including: • Ambulatory care • Emergency care and Hospitalization • Maternity and newborn care • Mental health and substance abuse • Prescription drugs • Preventive and wellness services

7. Do I have to have Insurance in 2014? • Yes! • Penalty: increases from $95 or 1% of income in 2014 to $695 or 2.5% of income in 2016. • Exceptions include: Native Americans, those w/religious objections, people who are not legal residents, those who don’t meet tax filing threshold ($9,350 single), people who’ve been uninsured for less than 3 months. Can I keep my current coverage? YES. Plans that were in effect on March 23, 2010 are grandfathered under the law.

8. How Will I Afford Insurance? • If your income is $10,830 - $43,320 (single), you will receive a subsidy to buy insurance through an exchange. • Subsidies will cap the amount you spend on premiums in relation to your total income. • Subsidies will also cap your annual out-of-pocket medical costs. • Example: a person who makes $21,000/yr will have their premiums capped at 6.3% of their income, and their annual out-of-pocket medical costs will be limited to $1,983/yr (excluding premiums).

9. Are There Special Programs For People Under 30? • Under age 30: high-deductible plan option (2014). Prevention benefits and 3 primary care visits are exempt from deductible. • Under age 26: can stay on or enroll in parents’ plan. Applies regardless of living situation, marital status, student status, or financial dependence. Exclusion: if you have access to insurance through an employer.

10. Will There be More Coverage For Preventive Services? • If you have a new policy that began on or after 9/23/2010, you can get certain preventive services for free: • Blood pressure, diabetes & cholesterol tests • Breast, colon & cervical cancer screenings • Vaccines, immunizations & flu shots • HIV & STD testing • Screenings for healthy pregnancies • Well-child visits

11. What’s the small business tax credit? • Available since the 2010 tax year • Employers with fewer than 25 FTE’s employees with average wages of less than $50,000 that purchase health insurance for employees are eligible for the tax credit • To be eligible, employer must offer a group health plan & contribute at least 50% of premium cost • 2010-2013: credit max is 35% of employer contribution (25% for tax exempt/non-profits); will increase to 50% (35% for non-profits) in 2014

12. Small business tax credit • Small business will file Form 8941 when they file income tax returns • Tax exempt organizations will claim the tax credit on a revised Form 990-T www.irs.gov/newsroom/article/0,,id=223666,00.html FAQ: www.irs.gov/newsroom/article/0,,id=220839,00.html

13. Resources & Links • Artists Health Insurance Resource Center: www.ahirc.org • Fractured Atlas www.fracturedatlas.org • Office of Consumer Information and Insurance Oversight: www.hhs.gov/ociio • Federal health care reform website: www.healthcare.gov • Kaiser Family Foundation: www.kff.org

14. How do I get health insurance now? • Employment-related coverage • Purchase private plans • Government-subsidized programs • If you leave/get laid off from a job … COBRA – Continuation of employer benefits for at least 18 months 60 days to decide/elect coverage “Sticker Shock” – guaranteed coverage, but can be expensive. Pay full premium, at group rate.

15. I can afford to buy insurance, but I don’t know what type to get. • Words to Know – HMO, PPO, High Deductible Plan or Catastrophic Coverage. • Choose a carrier & type of policy to meet your needs and your budget. Consider your medical risk and financial limits. • Internet brokers • www.ehealthinsurance.com

16. www.texashealthoptions.com • A State of Texas Resource for Finding Health Insurance Coverage • Consider your medical and financial risk limits • Choose a carrier & type of policy to meet your needs and your budget

17. Texas Health Insurance Pool – Premiums are “Rated Up • www.txhealthpool.com • Schools and Alumni Associations • Chambers of Commerce • Example: Texas Association of Business www.txbiz.org/Insurance

18. Government Programs • Medicaid • Comprehensive • Very low income AND fit one of these categories: pregnant, blind, disabled, 65 or over, 18 or under, or be a parent living with child 18 or under • No premiums • No pre-existing condition waiting periods • 2 month application process • 1-800-252-8263

19. Government Programs for kids • Children’s Health Insurance Program • Must be 18 or younger • Household income below 200% FPL • Must be uninsured for 90 days (some exceptions) • Comprehensive • No premiums, small co-pays • www.chipmedicaid.org

20. I have a special health condition. Are there programs that cover it? • Breast & Cervical Cancer Early Detection Program • Free mammograms for women age 40+ • Free pap smears for women age 18+ • Must go to a participating provider • Must be uninsured and have income under 250% FPL www.dshs.state.tx.us/bcccs/default.shtm • CHIP Perinatal www.hhsc.state.tx.us/chip/perinatal/index.htm

21. I don’t have insurance/I can’t afford insurance. • Free, sliding scale, lower cost clinics • Harris Health System • Gateway to Care • Texas Association of Community Health Centers • Retail Clinics • Minute Clinics • RediClinics

22. I can’t afford my medications • $4 Generics @ Target and Walmart • Costco discount program • Pharmacy Checker www.pharmacychecker.com • Partnership for Prescription Assistance www.pparx.org