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Health Insurance Marketplace

Health Insurance Marketplace. Navigating 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.

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Health Insurance Marketplace

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  1. Health Insurance Marketplace Navigating the Changes Megan Holt, LCSW

  2. 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…

  3. Primary Payors • Medicare • Medicaid • Private Payors (Insurance) • Self-Pay / Uninsured

  4. 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

  5. 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

  6. 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

  7. 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)

  8. Marketplace in Arkansas • Blue Cross/Blue Shield of Arkansas • Blue Cross/Blue Shield –Multi-State • QualChoice • Ambetter (Novasys) • Will Come Back to These….

  9. 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

  10. 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

  11. Marketplace in Arkansas • Blue Cross/Blue Shield of Arkansas • Blue Cross/Blue Shield –Multi-State • QualChoice • Ambetter (Novasys)

  12. Blue Cross Plans Ambetter QualChoice Blue Cross Plans QualChoice Blue Cross Plans Ambetter QualChoice Blue Cross Plans Ambetter QualChoice Blue Cross Plans QualChoice Blue Cross Plans Only Blue Cross Plans Only

  13. 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)

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. Working Together… • Sign People Up… • Call Us for Help (501-771-1500) • Work With State Legislators…

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

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