Affordable Care Act Presentation by Community Health Councils - Spanish
Affordable Care Act Presentation by Community Health Councils - English
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Transcript of Affordable Care Act Presentation by Community Health Councils - English
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The Affordable Care Act:What does it mean for California?
Community Health Councils
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Community Health Councils
Works to promote social justice and achieve equity
in community and environmental resources for
underserved populations.
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1 out of 5 children and adults in LA County haveno insurance
Children
Parents
Adults without children
Workers
Our Neighbors
Our Friends
Our Own Families
The Uninsured
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779,000
Covered CA
(with premium assistance))
460,000Medi-Cal
970,000RemainingUninsured
Millions will receive Coverage
LA County
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Know the Facts Individuals/Families
In 2014 health insurance is required for Most People
If you already have insurance through a job, Medi-Cal or Medicare
you dont have to do anything
You can be excused if:
Cannot afford coverage
Do not file Taxes Your religion does not allow it. Native Americans, Incarcerated
People and the Undocumented
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More people with coverage means
lower costs for everyone
If you do not have coverage,
you may pay a tax penalty.
Why is this important?
Know the facts:
Penalties start low in 2014 but go up higher every year
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Know the Facts Employers
Employers with at least 50 full-timeequivalent staff must provide health
insurance.
If full time (not part-time) employeesgo into Covered CA, the employermust pay a tax penalty.
The penalty only occurs if theemployer has 30 or more full timeemployees.
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More Health Coverage Options
Program Eligibility by Federal Poverty Level
Household
Size
Medi-Cal
Adults
Covered California with Premium AssistanceCovered
California
no
Premium
AssistanceMedi-Cal
Children
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The paper & online application is simpler.
Less Documentation and more electronic verification
Changes start January 1 2014 ~ Healthy Way LA open today
Adults do not have to have children in Medi-Cal
Income level goes up
Former foster youth eligible up to age 26
Those In Healthy Way LA will become Medi-Cal
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Medi-Cal Benefits Today & 2014
Medical Coverage - Medically NecessaryAdult &Children
Adultos y Nios
Dental & Vision
Children &Pregnant Woman
Nios y MujeresEmbarazada
Dental (preventative, diagnostic, restorationsand full dentures
Adults
May 2014
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Covered California Helps make comparing,
applying for and
purchasing coverage
easy.
Enroll as soon as October
2013.
Coverage will start assoon as January 2014
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Whose Eligible?
Citizen and Lawfully Present Resident
California Resident
Household income above 138%
financial assistance 139% - 400%
Dont have public coverage (i.e. Medi-Cal)
Cannot have employer coverage unless
Health Plan pays less than 60%
Employees share of premium exceeds 9.5% of
household income (not dependent share)
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Benefits10 essential health benefits:
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health & substance use disorder services,including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices Laboratory services
Preventive and wellness services and chronicdisease management
Pediatric services, including dental and vision care14
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Premiums
Based On
Age
Household Size
Region
Health Plan &Benefit LevelSelected
Not Based On
Health Status
Gender
Pre-ExistingConditions
Tobacco Usage
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Bronze Silver* Gold Platinum
Preventive $ 0 $ 0 $ 0 $ 0
Primary Care$60
(3 visits per year)$4 - $45 $45 $25
Specialty Care $70 $6-$65 $65 $50
Urgent Care $120 $8 - $90 $90 $50
Emergency $250 $25 - $250 $250 $150
Generic Medication 30% $4 - $25 $25 $5
Lab Testing 30% $6 - $45 $45 $25
X-Ray 30% $10-$65 $65 $40
Deductible $5000 $2000 None None
Maximum Out of pocket
Individual $6,350 $6,350 $6,350 $4,000
Family $12,700 $12,700 $12,700 $8,000
*Sliding Scale co-payments offered at the Silver level based on income17
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Tax Credit Can Change If Family Size Changes You get married or divorced
You have a baby or adopt achild
Stop claiming a child on yourtaxes
Income Changes You get a raise
You lose your job
You take a salary cut
Health Premium Tax Credits
Take in advance to lower premiums or
As a credit on your taxes
Based on family income and size
Can only get the credit at Covered CA
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http://coveredca.com/ -
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Shop and Compare Tool
Example:
Family of 4 - $60,000
(Parents - 40 years old).o Estimated premium:
$783 per montho Tax credit:
$374 per montho Family pays:
$409 per month
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CoveredCA.comBenefitscal.org
(Medi-Cal & otherSocial Service)
County Offices
Service Center
Covered CA 800-300-1506 County Customer Service Lines
CertifiedEnrollmentCounselors
CertifiedInsurance Agents
(SHOP)
Enroll Anytime Using Various Ways
Covered CA: Enrollment Periods
Year One October 1, 2013- March 31, 2014
Regular - After Year One October 15 December 7
Outside Regular Period Within 60 days after a qualifying life-changing event
One Application for Covered California and Medi-Cal
Medi-Cal:Enroll Anytime20
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New Consumer Protections
Free preventive services
Stay on parents health plan until the age of26.
Plans cannot deny coverage due to a pre-existing conditions.
Plans cannot drop coverage or stoptreatment.
No lifetime or Annual dollar limits
Plans in and outside of Covered California
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Improving Medicare
Increased coverage for wellness andpreventative care.
One free wellness visit per year.
Covers more preventative services
Provides discounts on brand name andgeneric drugs while you are in the Part Dcoverage gap.
Closes the Part D coverage gap by 2020.
Medicare Beneficiaries DO NOT have to purchase new Coverage
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Emergency/Pregnancy Medi-Cal
Local program at community/county
clinics
Healthy Kids for children 0-5
Programs Continue for Undocumented
Immigrants
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Get Involved!
Talk with family, friends, and community members
For more Information:
Kaiser Family Foundation: healthreform.kff.org
Health Reform website: www.healthcare.gov Covered California: http://www.coveredca.com/ La Opinion http://www.laopinion.com/lasaludempiezaaqu i Univision Univision.com/saludaqui Telemundo http://www.telemundo52.com/secciones-especiales/asegurate
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Share YOUR Thoughts with Lawmakers
State:http://www.legislature.ca.gov/
Congressional: http://www.usa.gov/Contact/Elected.shtml
(202) 224-3121
http://healthreform.kff.org/http://www.healthcare.gov/http://www.coveredca.com/http://www.laopinion.com/lasaludempiezaaquhttp://www.telemundo52.com/secciones-especiales/aseguratehttp://www.legislature.ca.gov/http://www.usa.gov/Contact/Elected.shtmlhttp://www.usa.gov/Contact/Elected.shtmlhttp://www.legislature.ca.gov/http://www.telemundo52.com/secciones-especiales/aseguratehttp://www.telemundo52.com/secciones-especiales/aseguratehttp://www.telemundo52.com/secciones-especiales/aseguratehttp://www.laopinion.com/lasaludempiezaaquhttp://www.coveredca.com/http://www.healthcare.gov/http://healthreform.kff.org/ -
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Questions?
Sonya Vasquez - Community Health Councils
[email protected] ~ (323) 295-9372
www.chc-inc.orgwww.facebook.com/CommunityHealthCouncils
https://twitter.com/chcinc
http://letsallgetcovered.org/
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mailto:[email protected]://www.chc-inc.org/http://www.facebook.com/CommunityHealthCouncilshttps://twitter.com/chcinchttp://letsallgetcovered.org/http://letsallgetcovered.org/https://twitter.com/chcinchttp://www.facebook.com/CommunityHealthCouncilshttp://www.chc-inc.org/http://www.chc-inc.org/http://www.chc-inc.org/http://www.chc-inc.org/mailto:[email protected]:[email protected]:[email protected]