Professional Documents
Culture Documents
Todays Agenda
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MHC Who we are Understanding the Problem Understanding the Affordable Care Act Understanding Insurance Exchanges Moving Forward
Who is MHC?
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Member-owned health CO-OP Non-profit organization Home-grown (Helena-based) Funded via federal start-up loans CO-OPs currently approved in 24 states Offering products via the Health Insurance Exchange
Insurance Situation
50 million uninsured Americans 200,000 uninsured Montanans Premiums double in last 10 years 62% of all bankruptcies medically-related
Insurance Situation
Coverage isnt comprehensive Affordability Emphasis on group/employer-provided insurance. Pre-existing condition clause Fear of losing coverage with job loss/change Insurance denied if no continuity of coverage
Exchange = Marketplace Internet-based marketplaces to shop for and buy health insurance Compare apples to apples (tiers of coverage) Determine eligibility for premium subsidies Plans on the exchange must offer Essential Health Benefits 278,000 Montanans could get insurance via the Exchange Congress and their staff will get insurance from the Exchange
Qualified Entity
Agents
Direct Access
Individual Assisted
Eligibility and tax credit validation Tax credit payments Approved tax credit
Health Plans
Individual Contribution
HSA Vendor
Process Flow Money Flow Data Flow
Gold
Metallic Plans
Silver
Bronze
1
22
1
2
1
2
Solutions
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Silver
$1,200 Deductible 70/30 (3,000 out-of-pocket)
Bronze
$2,000 Deductible 50/50 (3,750 out-of-pocket)
Projected Income Unsubsidized annual health insurance premium (adjusted for age) Maximum % of income the person/family must pay for premium (based on income % of poverty level) Amount person/family pays
$34,516
(300% of poverty level)
$7,500
9.50%
$3,279
$4,221
Projected Income Unsubsidized annual health insurance premium (adjusted for age) Maximum % of income the person/family must pay for premium (based on income % of poverty level) Amount person/family pays
$16,107
(140% of poverty level)
$7,500
3.41%
$550
$6,950
Up and running by October 2013 Open Enrollment period for purchasing insurance on the exchange: October 2013 January 2014 Montana will use the Federal Health Insurance Exchange Montana Health CO-OP plans will be on the exchange
Beforeinsurance companies spent as much as 40 cents of every premium dollar on overhead, marketing and salaries. Nowthey must spend 80 cents of your premium dollar on your health care or on improvements to care. If they dont, they must repay the money.
Cannot deny coverage for pre-existing conditions Insurance exchanges allow you to easily compare plans Subsidies for qualified individuals to make premiums affordable New small business tax credits
ACA Subsidies
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Subsidies (advanceable tax credits) to offset monthly premiums for those with income between 100-400% of the Federal Poverty Level (FPL). 65% of Montana families have incomes below 340% of the FPL.
Subsidies At Work
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Family Size 1 2 3 4 5 6
ACA Subsidies
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Subsides will ensure qualifying households pay no more than a specific percentage of income on premiums: Percentage of household income is a sliding scale based on the Federal poverty level (FPL) of the family involved:
Up to 133% FPL: 2.0% of income 133-150% FPL: 3.0% 4.0% of income 150-200% FPL: 4.0% 6.3% of income 200-250% FPL: 6.3% 8.05% of income 250-300% FPL: 8.05% 9.5% of income 300-400% FPL: Capped to 9.5% of income
Businesses with less than 50 full-time employees are exempt from having to offer health insurance to workers.
97% of Montana business have fewer than 50 fulltime employees. 80% of Montana employers have fewer than 10 workers.
with 25 or fewer full-time employees that have average wages under $50K
are eligible for small business tax credit of 35 percent (increasing to 50% by 2014).
Not offering minimum essential benefit coverage -$2,000 per full-time worker (subtracts first 30 full-time workers) Not offering affordable coverage lesser of $3,000 per full-time employee receiving a subsidy or $2,000 per fulltime employee
Income too low to file a federal tax return? Penalties are not meant for you. 2014 $95 per adult and $47.50 per child, up to a family maximum of $285 or 1 percent of family income, whichever is greater
Moving Forward
Stay informed: Will the MT legislature approve federally-funded Medicaid expansion? Will other insurers participate on the exchange? Consider the paradigm shift from group coverage to individual coverage. Do we have ample primary care physicians? Expect a dramatic change in the health care market. Anticipate the possibility of an insurance shift (354,000 Montanans may see an insurance change). Know that there will be fine-tuning and clarification of the ACA. See: www.healthcare.gov
Thank you!
Karen Murphy kmurphy@mhc.coop