Health Insurance MarketplaceNavigating 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

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

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

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

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)

Marketplace in Arkansas• Blue Cross/Blue Shield of

Arkansas

• Blue Cross/Blue Shield –Multi-State

• QualChoice

• Ambetter (Novasys)

Will Come Back to These….

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

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

Marketplace in Arkansas• Blue Cross/Blue Shield of

Arkansas

• Blue Cross/Blue Shield –Multi-State

• QualChoice

• Ambetter (Novasys)

Blue Cross Plans Only

Blue Cross PlansQualChoice

Blue Cross PlansAmbetterQualChoice

Blue Cross Plans Only

Blue Cross PlansAmbetterQualChoice

Blue Cross PlansQualChoice

Blue Cross PlansAmbetterQualChoice

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)

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

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

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

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

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

Working Together…• Sign People Up…

• Call Us for Help (501-771-1500)

• Work With State Legislators…

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