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The Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act. The Promise of Health Care Reform. Primary Goal: Health Insurance Coverage for approximately 26 million Americans – over 1 million Illinoisans Right Care, Right Time, Right Setting Better Health. What This Means for Illinois.

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The Patient Protection and Affordable Care Act

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  1. The Patient Protection and Affordable Care Act

  2. The Promise of Health Care Reform • Primary Goal: Health Insurance Coverage for approximately 26 million Americans – over 1 million Illinoisans • Right Care, Right Time, Right Setting • Better Health

  3. What This Means for Illinois • 2013: 1.7 million uninsured Illinoisans • By 2015: • More than 400,000 will gain coverage in the Health Insurance Marketplace • Nearly 350,000 will be covered under Medicaid

  4. What Health Care Reform Does • Establishes Health Insurance Marketplace • Allows states to expand Medicaid effective January 1, 2014 • Illinois opted in under Senate Bill 26 / Public Act 98-104 – signed into law July 22

  5. Options for Consumers • If you already have private insurance, Medicare, Medicaid or VA coverage • Don’t do anything • If you are a legal resident under age 65, earning less than $15,302 (individual) or $31,155 (family of 4) • Enroll in Medicaid • If you earn more than the above limits, up to 400% of the federal poverty level [$45,960 (individual) or $94,200 (family of 4)] • Receive financial help (premium subsidies) and buy insurance in the Health Insurance Marketplace

  6. Health Coverage with Good Benefits • Prescription drugs • Hospitalization • Doctor visits • Preventive care/wellness services • Mental health & substance abuse disorder services • Pediatric services – incl. oral & vision care • NO denials for pre-existing conditions

  7. When & How Do Consumers Sign Up Health Insurance Marketplace: • ILLINOIS Marketplace to be launched by Oct. 1, 2013 • Open enrollment starts Oct. 1, 2013 and ends March 31, 2014 • Create your own account – enter information about you and your family, including income, household size • Review and compare health plans and premiums • Find out if you will receive financial help with premiums • Choose a plan • Coverage begins as soon as Jan. 1, 2014 if you enroll by Dec. 15, 2013

  8. When & How Do Consumers Sign Up New Illinois Medicaid Enrollment Website: ABE or Application for Benefits Eligibility • URL: ABE.illinois.gov • Sign up starting Oct. 1, 2013 • Sign up also available on walk-in basis at Dept. of Human Services offices • Coverage for newly eligible Medicaid population starts Jan. 1, 2014 BOTH Marketplace and Medicaid • Can sign up online, by phone, by mail or in-person with help of “Assister” or “Navigator”

  9. Where Consumers Can Get Help Community–based “Assisters” • In-Person Counselors – outreach, education and enrollment assistance • Navigators – outreach, education and enrollment assistance • Certified Application Counselors (includes hospitals) • All “Assisters” will help consumers apply for Insurance Marketplace coverage and Medicaid

  10. Website Resources • www.HealthCare.gov • www.healthcarereform.illinois.gov • www.EnrollAmerica.org • www.GetCoveredAmerica.org

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