New York State of Health

New York State of Health Basics of the Health Insurance Exchange Marketplace Kate Rose Senior Director, Public Policy and Government Relations What ...
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New York State of Health Basics of the Health Insurance Exchange Marketplace Kate Rose Senior Director, Public Policy and Government Relations

What is the NY State Insurance Exchange? “One-Stop Shopping” -- Organized, transparent marketplace designed to help individuals shop for and enroll in health insurance coverage

 Oct. 1 – Exchange opens for business  Compare different insurance options  Check eligibility for programs, like Medicaid  Check eligibility for financial assistance  Calculate the cost  Enroll in a plan

How Do You Access the NY State Exchange?

• • • •

Online: http://nystateofhealth.ny.gov/ By Phone: 1-855-355-5777 (M-F, 8AM-5PM) By Mail: TBD In-Person: TBD Sites throughout the Bronx

Key Dates Open Enrollment October 1, 2013 – March 31, 2014 Effective Date of Health Coverage January 1, 2014 Open Enrollment Year 2 October 15, 2014 – December 7, 2014 **Special Enrollment Periods Available for “Qualifying Events”

Why is the Exchange Important? Federal Affordable Care Act (aka. Obamacare): • Implements a series of health insurance reforms, including the establishment of State-based Exchanges. Goal of the Law: Provide affordable health insurance coverage to more of the uninsured. • 49 million uninsured in U.S. (15%) • 2.2 million uninsured in New York State (13%) • 1.2 million uninsured in NYC (17%) • 185,000 uninsured in Bronx (17%) Source: U.S. Census & American Community Survey, 2011 ACS 1-year estimates.

How Does the Law Help? Increased Coverage and Protection • Insurance Expansion – Medicaid Coverage available for all up to 133% FPL – Subsidized and unsubsidized private coverage available through the Exchange

• Comprehensive Coverage – Must cover 10 categories of “essential benefits” • Consumer Protections and Rights – No preexisting condition exclusions – No rescissions – Protection from high out-of-pocket costs – Adult Children under Age 26 can stay on parents coverage

Why is Health Coverage Important? • Preventive care to keep you healthy – Vaccines, screenings, check-ups • Access to care and support when you are ill, and to keep you from becoming more sick – Diagnosis, treatment, individual care plans • More protection from high, unexpected costs, significant debt or bankruptcy – Emergency care, catastrophic illness In 2013 over 20% of American adults are struggling to pay their medical bills, and three in five bankruptcies will be due to medical bills. https://www.healthcare.gov/why-should-i-have-health-coverage/ http://www.nerdwallet.com

What Does the Law Require? All Individuals Must Enroll in “Minimum Essential Coverage” or Be Subject to a Penalty

Exemptions

Penalties



2014: • $95 (individual), $285 (family) or 1% of income whichever is greater



• • • • • • •

People with household income below the tax filing threshold People who had “hardships” trying to purchase insurance (for example, buying insurance would cause a serious deprivation of food, shelter, clothing or other necessities) Members of certain religious groups who object to having private or public insurance coverage on religious grounds Members of healthcare sharing ministries Incarcerated individuals Undocumented immigrants Low income individuals who can’t afford coverage despite the subsidy Individuals with coverage gaps less than 3 months Native Americans eligible for care through the Indian health service

2015: • $325 (individual), $975 (family) or 2% of income whichever is greater 2016: • $695 (individual), $2,085 (family) or 2.5% of income whichever is greater

What is “Minimum Essential Coverage”? • • •



Employer-sponsored coverage (including COBRA coverage and retiree coverage) Individual market coverage, including a qualified health plan offered by the Health Insurance Marketplace and some plans not on the exchange Government-funded Coverage: Medicare, Medicaid, Children's Health Insurance Program (CHIP), certain types of veterans health coverage administered by the Veterans Administration, TRICARE – State high risk pools for plan or policy years that begin on or before Dec. 31, 2014 (for later plan or policy years, sponsors of these program may apply to HHS to be recognized as minimum essential coverage) Other programs: – Peace Corps volunteer coverage – Non-appropriated Fund Health Benefit Program – Refugee Medical Assistance supported by the Administration for Children and Families – Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014

http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision

Who Can Access the Exchange? Individuals

Small Businesses

 U.S. Citizen, status as a national, or lawful presence in the U.S.  New York Resident, defined as in Medicaid  Uninsured, without access to insurance (i.e. dependent coverage through employer)  Underinsured: Lack access to affordable health coverage (i.e. cost of employer coverage consumes

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