ACA Final Presentation

Do you have questions about any of
the following?
Is Obamacare Going to Help Me Pay for My Insurance?
Online Exchanges and Subsidies
Pre-Existing Conditions and Poor Health
Preventive Services
Extending Coverage to Young Adults Under 26
Medicaid Expansion
Penalties
Gender Rating
Essential Benefits Package
Benefits to My Medicare

Do you currently have health insurance?
YES NO

Are you covered by Medicare, Medicaid, CHIP,
TRICARE or other government-funded insurance
programs?
YES NO

Are you a citizen or a legal resident?
YES NO

You are NOT eligible for Obamacare benefits

You may be eligible for tax credits toward your premium,
depending on your income.
You may also be eligible for tax credits toward cost-
sharing reductions, so you would pay less for
deductibles, co-payments, and coinsurance.
You may also be eligible for Medicaid expansion.

Tax credits toward your premiums
To know if you are and by how much, are you
purchasing insurance as a single person or as a
family?
- Single person
- Family

Tax premiums toward cost-sharing
To know how much, are you purchasing insurance as a
single person or as a family?
- Single person
- Family
You are eligible for tax credits toward cost-sharing
reduction
These credits are only eligible to buy the silver plan (one
that covers 70% of the health care costs)

Are you a citizen or have been a legal resident for
more than five years?
YES NO

Am I eligible for tax credits that I can use to lower
the cost of the premium when I buy insurance on
the online exchanges?
Am I eligible for tax credits that I can use to apply
towards cost-sharing, to reduce how much I pay for
deductibles, copayments and/or coinsurance?
If I am eligible for credits/subsidies toward my
premiums, how will I be receiving them?

If I am currently covered by insurance, can I keep it?

Pre-Existing Conditions and Poor Health
My insurance denied me coverage because I have
a pre-existing condition, or because I am in poor
health. Will Obamacare help me?
Before September 23, 2010, my child who had a
pre-existing condition or had poor health, was
denied coverage. But after this date, that was no
longer the case. Why is that?

Preventive Services
Does Obamacare allow me to have preventive
services at no cost?
I am a religious employer and I object to providing
contraceptive services to my employees. How
would Obamacare address my concern?

Extending Coverage to Young Adults Under 26
What if I am under the age of 26, can I stay under
my parents’ plan?

Gender Rating
As a woman, my insurance company charges me
more than it charges a man, despite having similar
health conditions. Will Obamacare do anything
about that?

Essential Benefits Package
What are the essential health benefits that must be
included in health insurance plans starting January,
2014?

Medicaid Expansion
There will be Medicaid expansion in Michigan
because of Obamacare. How do I know that I am
eligible for Medicaid?

Penalties
Is there a penalty if I do not buy health insurance
by March 31, 2014?
What if I lose coverage at some point in 2014, will I
be penalized for not having insurance?

Are you covered by Medicare, Medicaid, CHIP,
TRICARE or other government-funded insurance
programs?
YES
NO

Do you have employer-provided insurance?
YES NO

Does the employer provide coverage for you only, or
your entire family?
- Single Person
- Entire Family

Do you have an employer-provided insurance where
the employer covers at least 60% of the cost AND
where you do not pay more than 9.5% of your income
toward the plan?
YES
NO
I Am Self-Insured

You are NOT eligible for tax credits toward your
premium
You are also NOT eligible for tax credits that could be
used toward cost-sharing reduction, such as reducing
deductibles, coinsurance or copayments

You may be eligible for tax credits toward your
premium, depending on your income
To know if you are and by how much, are you
purchasing insurance as a single person or as a
family?
- Single person
- Family

Single Person
Do you make between $11,490 - $45,960 a year?
YES NO

Family of Four
Do you make between $23,550 - $94,200?
YES NO
Different Size of Family

Single Person
The credit will be in the form of a limit on the percentage
of your income you pay toward premium:
Yearly Income Limit on Premium as
Percentage of Income
$11,490 - $15,281 2% of income
$15,281 - $17,235 3 – 4% of income
$17,235 - $22,980 4 – 6.3% of income
$22,980 - $28,725 6.3 – 8.05% of income
$28,725 - $34,470 8.05 – 9.5% of income
$34,470 - $45,960 9.5% of income
Example

Example
Say you are a single person who earned $29,000 in
2013. Then, when you purchase your insurance on the
online exchanges, your monthly premium cost will be no
more than 8% of your income, which is $193.
This amount will be used to buy the second-lowest-cost
silver plan (a plan that covers 70% of health care costs).
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Say you were going to buy a plan with a premium of
$4,000 on the online exchanges.
Instead of paying $4,000, you will only pay the monthly
premium cap of $193 multiplied by the number of
months in a year:
$193 * 12 = $2,316
You end up saving $3,857 - $2,316 = $1,541
So you got $1,541 of subsidies
Next Page

What if I did not want to purchase the second-
lowest-cost silver plan, can I still get tax credits to
help pay my premium?
Yes you will. In the previous example, you were going to
pay a monthly premium of $193. Say you wanted to buy a
cheaper plan than the second-lowest silver plan, say a less
costly silver plan or a bronze plan (one that covers 60% of
health care costs). Then, you would end up paying less
than $193.
Say the plan you wanted to buy has a premium of $3,200.
What happens now is that you use your tax credits
calculated in the previous page to apply to the new plan.
Next PagePrevious Page

As shown previously, you got $1,541 in subsidies
when you wanted to buy the silver plan. Now you
want to buy the bronze plan that would cost $3,200,
so you end up paying the following premium:
$3,200 - $1,541 = $1,659 (you paid $2,316 before)
You end up paying $1,541 in premiums for a plan that
would have cost you $3,200
More InformationPrevious Slide

If you are still confused
Check out this video
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Family of Four
The credit will be in the form of a cap on the
percentage of your income you pay toward premium:
Aggregate Yearly Income Cap on Premium as
$23,550 - $31,321 2% of income
$31,321 - $35,325 3 – 4% of income
$35,325 - $46,100 4 – 6.3% of income
$47,100 - $58,875 6.3 – 8.05% of income
$58,875 - $70,650 8.05 – 9.5% of income
$70,650 - $94,200 9.5% of income

How many people are in your family?
- Family of two
- Family of three
- Family of four
- Family of five
- Family of six
- Family of seven
- Family of eight

Family of Two
$15,510 - $20,628 2% of income
$20,628 - $23,265 3 – 4% of income
$23,265 - $31,020 4 – 6.3% of income
$31,020 - $38,775 6.3 – 8.05% of income
$38,775 - $46,530 8.05 – 9.5% of income
$46,530 - $62,040 9.5% of income

Family of Three
The credit will be in the form of a cap on the percentage
of your income you pay toward premium:
$16,275 - $21,645 2% of income
$21,645 - $24,412 3 – 4% of income
$24,412 - $32,550 4 – 6.3% of income
$32,550 - $40,687 6.3 – 8.05% of income
$40,687 - $48,825 8.05 – 9.5% of income
$48,825 - $65,100 9.5% of income

Family of Five
$27,570 - $36,668 2% of income
$36,668 - $41,355 3 – 4% of income
$41,355 - $55,140 4 – 6.3% of income
$55,140 - $68,925 6.3 – 8.05% of income
$68,925 - $82,710 8.05 – 9.5% of income
$482,710 - $110,280 9.5% of income

Family of Six
$31,590- $42,014 2% of income
$42,014 - $47,385 3 – 4% of income
$47,385 - $63,180 4 – 6.3% of income
$63,180 - $78,975 6.3 – 8.05% of income
$78,975 - $94,770 8.05 – 9.5% of income
$94,770 - $126,360 9.5% of income

Family of Seven
$35,610- $47,361 2% of income
$47,361 - $53,415 3 – 4% of income
$53,415- $71,220 4 – 6.3% of income
$71,220 - $89,025 6.3 – 8.05% of income
$89,025 - $106,830 8.05 – 9.5% of income
$106,830 - $142,440 9.5% of income

Family of Eight
$39,630 - $52,707 2% of income
$52,707 - $59,445 3 – 4% of income
$59,445- $79,260 4 – 6.3% of income
$79,260 - $99,075 6.3 – 8.05% of income
$99,075 - $118,890 8.05 – 9.5% of income
$118,890 - $158,520 9.5% of income

Do you have an employer-provided insurance where the
employer covers at least 60% of the cost AND where you
do not pay more than 9.5% of your income toward the
plan?
YES NO

You are eligible for tax credits toward cost-sharing
reduction
These credits are only eligible to buy the silver plan (one
that covers 70% of the health care costs)
To know how much, are you purchasing insurance as a
single person or as a family?
- Single person
- Family

Single Person
Without the cost-sharing subsidies, then you would have
paid 70% of the health care costs (silver plan). But, if you
qualify for subsidies, then the health care costs depend
on your:
Yearly Income Health Care Costs
Covered by the Plan
$11,490 - $17,235 94%
$17,235 - $22,980 87%
$22,980 - $28,725 73%
I need more information

Family of Four
Without the cost-sharing subsidies, then you would have paid
70% of the health care costs (silver plan). But, if you qualify
for subsidies, then the health care costs depend on your
income:
Aggregate Yearly Income Health Care Costs
Covered by the Plan
$23,550 - $35,325 94%
$35,325 - $47,100 87%
$47,100 - $58,875 73%
I Need More Information
Different Sizes of Families

Family of Two
qualify for subsidies, then the health care costs depend on
your income:
Covered by the Plan
$15,510 - $23,265 94%
$23,265 - $31,020 87%
$31,020 - $38,775 73%

Family of Three
Without the cost-sharing subsidies, then you would have paid
70% of the health care costs (silver plan). But, if you qualify
for subsidies, then the health care costs depend on your
income:
Covered by the Plan
$19,530 - $29,295 94%
$29,295 - $39,060 87%
$39,060 - $48,825 73%

Family of Five
your income:
Covered by the Plan
$27,570 - $41,355 94%
$41,355 - $55,140 87%
$55,140 - $68,925 73%

Family of Six
your income:
Covered by the Plan
$31,590 - $47,385 94%
$47,385 - $63,180 87%
$63,180 - $78,975 73%

Family of Seven
your income:
Covered by the Plan
$35,610 - $53,415 94%
$53,415 - $71,220 87%
$71,220 - $89,025 73%

Family of Eight
your income:
Covered by the Plan
$39,630 - $59,445 94%
$59,445 - $79,260 87%
$79,260 - $99,075 73%

Additional Information
To find out more about your eligibility for subsidies and affordable
health insurance options, please visit: www.healthcare.gov
If you have any questions that cannot be answered on the website,
then you can contact Consumer Assistance Program
You can also use this link to calculate your subsidy:
http://kff.org/interactive/subsidy/calculator/
You can also call this number for assistance: 1-800-318-2596
(available 24/7) or have live chat here

This is the beauty of the online exchanges, that you can
find at www.healthcare.gov as it does it for you. Once you
enter your information there, such as income and status in
the US, then if you are eligible for tax credits toward your
premiums, the exchanges will arrange that amount to be
paid to the insurance company that you purchased your
plan from, every month.
This is possible as long as you select to receive your
credits upfront. If you have any questions, the website
listed has 24/7 help line. Do not hesitate to use it.

You may be eligible to be covered by Medicaid
expansion
To know if you are, are you purchasing insurance as
a single person or as a family?
- Single person
- Family

You are NOT eligible for Medicaid expansion

Single Person
Do you make up to $15,856 a year?
YES NO

Family of Four
YES NO

Family of two
Do you make between up to $21,403 a year?
YES NO

Family of three
YES NO

Family of five
Do you make up to $38,046?
YES NO

Family of six
YES NO

Family of seven
YES NO

Family of eight
YES NO

You may eligible for Medicaid. You can apply using the
following website:
http://www.benefits.gov/benefits/benefit-details/1221

Absolutely, you can keep your current insurance
If you are self-covered and are not happy with your
insurance, you can always use the marketplaces to
buy insurance and possibly qualify for subsidies to
help you with the cost. Visit www.healthcare.gov for
more information.

Do you satisfy any of the following conditions?
1) I have insurance
2) My income is not more than $10,000 (single), or not more than
$20,000 (family of four)
3) I am in prison
4) I do not reside in the U.S. anymore
5) I belong to the Amish or some other Mennonite sects
6) The cost of premium exceeds 8% of my income even after
employer contributions and federal subsidies
7) I am native American
8) I am an illegal immigrant
YES NO

You do NO have to pay a penalty

You have to pay a penalty
To determine the amount of the penalty, it is important
to note whether you are single or a family:
- Single person
- Family

Single Person
Year Penalty
2014 $95 (adult)/ $47.5 (child), or 1% of income,
whichever is higher
2015 $325 (adult)/ $162.5 (child), or 2% of
income, whichever is higher
2016 and
onward
$695 (adult)/ $347.5 (child), or 2.5% of
income, whichever is higher
The penalty will be paid to the IRS at the time of tax filling

Family (independent of number of children)
Year Penalty
2014 $285, or 1% of income, whichever is
higher
2015 $975, or 2% of income, whichever is
higher
2016 and
onward
$2,085, or 2.5% of income, whichever is
higher
The penalty will be paid to the IRS at the time of tax filling

Not necessarily
Once you lose coverage, you should get on the online
exchanges and purchase insurance. Even if you
could not afford to buy the insurance, you will be
given a period of three months to pay your premiums.
If you do not have insurance for three continuous
months in 2014 (for total of 90 days), then you will
pay a penalty. The penalties can be found here.

Absolutely
Starting January 1, 2014, you will NO longer be denied
coverage because you have a pre-existing condition or
because you are in poor health.
When the online exchanges open on October 1, you will
be able to buy insurance that will no longer deny you
coverage, and the benefits will start on January 1, 2014.
In addition, insurance plans will no longer be able to
charge you more because you have a pre-existing
condition or because you have poor health.

That is one of the benefits of Obamacare.
Since September 23, 2010, one of the many benefits
of Obamacare is to prevent insurance companies
from denying a child coverage because of a pre-
existing condition or poor health.
A child is defined as someone under 19 years old.

Absolutely
One of the benefits of Obamacare is that you can
stay under your parents’ plan UNLESS your parents
are covered by TRICARE, or if you are covered by
your employer.

Absolutely
Since August of 2011, any new plans offered by employers or
private insurance have had to provide coverage, at no cost to you,
for the following preventive services, arranged alphabetically:
1) Annual wellness visits (for adult women)
2) Blood o9opressure screening (for all adults)
3) Breastfeeding support, suppliers and counseling (for adult
women)
4) Cervical cancer screening (for adult women)
5) Colonoscopies (for Medicare beneficiaries)
6) Colorectal and prostate screening (for Medicare beneficiaries)
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7) Contraception (for adult women)
8) Domestic violence screening and counseling (for adult women)
9) Gestational diabetes screening (for adult, pregnant women)
10) HIV screening and counseling (for adult women)
11) Immunizations
12) Mammograms (for adult women at age 40 or above)
13) Pelvic exam (for Medicare beneficiaries)
14) Sexually transmitted diseases counseling (for adult women)
15) Ultrasound for abdominal aortic aneurysm (for Medicare
beneficiaries with a history of smoking)
Previous Page More Information

You do NOT have to provide contraceptive
services to your employees
Religious employers at non-profits (such as religious
colleges) or churches, would not have to pay for birth
control. But their employees would still receive free
access to contraception through a third-party
insurance provider, without incurring any cost to the
employer

Not anymore, starting January, 2014
This practice, known as gender rating, will be banned
starting in 2014. So any insurance plan that you
purchase on the online exchanges, or off the online
exchanges, will be provided to give you coverage that
is the same cost for a man.

Obamacare requires health insurance companies
to have a minimum package of services:
1) Ambulatory patient services (outpatient services in a hospital or a
clinic)
2) Emergency services
3) Hospitalization
4) Maternity and newborn care
5) Mental health and substance abuse disorder services
6) Rehabilitative and habilitative services
7) Laboratory services
8) Preventive services (immunizations, cancer screening)
9) Chronic disease management
10) Pediatric services, including oral and vision care

Free Preventive Services
Since January, 2011, Medicare beneficiaries have no
longer been paying any cost-sharing for the following:
1) Mammograms
2) Clinical breast exams
3) Pap smears
4) Ultrasound for aortic disease
5) Colorectal and prostate screening
6) Bone density screenings
More Benefits

Free Annual Checkups
In addition, since January, 2011, there have been
annual wellness checkups for all Part B enrollees at
no cost to them. Make sure to use these free
services.
MorePrevious

Closing the Coverage Gap
About a quarter of Part D enrollees are in a coverage gap where
they take 100% responsibility for cost-sharing. This is what have
happened since 2012 due to the ACA:
1) Enrollees received a $250 rebate if they had any spending
in the coverage gap in 2010
2) In 2011, enrollees received a 7% discount on generic drugs
that were equivalent to savings of about $604 per enrollee
3) In 2012, seniors got a 50% discount when buying brand
name drugs
4) In the same year, seniors got 14% discount on generic
drugs
5) In 2021, beneficiaries will only be responsible for 25% cost-
sharing instead of the current 100%. This would save
beneficiaries an average of $4,200
Previous More Information

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