MHC Farmers Union Presentation

7/29/2019 MHC Farmers Union Presentation

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Its a new world!

Health Care Changes and You


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MHC Who we are

Understanding the Problem Understanding the Affordable Care Act

Understanding Insurance Exchanges

Moving Forward

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Todays Agenda


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Montana Health CO-OP: Who We Are


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Who is MHC?

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 HealthInsurance Exchange


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Health Care: Understanding the Problem


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Health Care Problems

Insurance Situation

50 million uninsured Americans

200,000 uninsured Montanans Premiums double in last 10 years

62% of all bankruptcies medically-related


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Health Care Problems

Insurance Situation

Coverage isnt comprehensive

Affordability

Emphasis on group/employer-providedinsurance.

Pre-existing condition clause

Fear of losing coverage with job loss/change

Insurance denied if no continuity of coverage


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Health Insurance Exchanges & the ACA


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Health Insurance Exchanges

Internet-based marketplaces to shop for and buy healthinsurance

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

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Exchange = Marketplace


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Carrier1

Individual

AgentsEnter

applicantinfo

Determineeligibility/taxcredit level

Calculate anddisplay plansw/tax credit

Select plan/premium

Navigator

HSA Vendor

IndividualContribution

How Does the Marketplace Work?

Auto enroll alleligible for

Medicaid/CHIP Approvedtax credit

Direct Access

Assisted

Tax creditpayments

Eligibility and taxcredit validation

Process Flow

Money FlowData Flow

Eligibility data

Qualified Entity

Carriercollects

premium

Carrierenrolls

member

Carrier 2

Carrier 3

Montana Health Marketplace

Health Plans


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Gold

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Silver

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2

Bronze

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2

Metallic Plans


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Solutions

Open Enrollment/Guaranteed Coverage

Subsidies available via exchange

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Gold Silver Bronze$600 Deductible $1,200 Deductible $2,000 Deductible

80/20(1,500 out-of-pocket)




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Projected Income $34,516(300% of poverty level)

Unsubsidized annual health insurancepremium(adjusted for age)

$7,500

Maximum % of income the person/familymust pay for premium (based on income %of poverty level)

9.50%

Amount person/family pays $3,279

Government tax credit/subsidy $4,221

2014: Subsidies At Work

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*Must purchase from the Exchange/Marketplace to receive subsidy.


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Projected Income $16,107(140% of poverty level)

Unsubsidized annual health insurance premium(adjusted for age)

$7,500

Maximum % of income the person/family mustpay for premium (based on income % of povertylevel)

3.41%

Amount person/family pays $550

Government tax credit/subsidy $6,950

*Must purchase from the Exchange/Marketplace to receive subsidy.


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Up and running by October 2013

Open Enrollment period for purchasing insurance on theexchange: October 2013 January 2014

Montana will use the Federal Health Insurance Exchange

Montana Health CO-OP plans will be on the exchange

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Understanding the Affordable Care Act (ACA)


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Affordable Care Act (ACA)

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Signed into law March 2010

Expand Medicaid

Encourage employers to offer health insurance. Provide premium subsidies Establish health insurance exchanges Strengthen consumer protections

Impose protections to guard against unreasonable rateincreases. Encourage primary and preventive care. Mandate insurance for everyone.


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Insurance companies cannot:

Put a lifetime cap on how much they will pay Cancel coverage by finding a paperwork error.

Deny coverage based on pre-existing conditions

Charge women more for coverage

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Making Health Care AffordablePreventative services are free

Cancer screenings: mammograms & colonoscopies

Vaccinations: flu, mumps & measles

Blood pressure and cholesterol screenings

Tobacco cessation counseling

Depression screening

And more

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Making Health Care Affordable

The 80/20 Rule

Beforeinsurance companies spent as much as 40cents of every premium dollar on overhead, marketingand salaries.

Nowthey must spend 80 cents of your premiumdollar on your health care or on improvements to care.If they dont, they must repay the money.

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Making Health Care Affordable

Starting in 2014

Cannot deny coverage for pre-existingconditions

Insurance exchanges allow you to easilycompare plans

Subsidies for qualified individuals to makepremiums affordable

New small business tax credits

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ACA Subsidies

For qualifying individuals and families withoutemployer-based insurance

Starting in 2014

Subsidies (advanceable tax credits) to offsetmonthly premiums for those with incomebetween 100-400% of the Federal Poverty

Level (FPL). 65% of Montana families have incomesbelow 340% of the FPL.

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Subsidies At Work

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2012 Annual Guidelines Federal Poverty Level

Family

Size

100% 133% 150% 185% 200% 250% 300% 400%

1 $11,170 $14,856 $16,755 $20,664 $22,340 $27,925 $33,510 $44,680

2 $15,130 $20,122 $22,695 $27,990 $30,260 $37,825 $45,390 $60,520

3 $19,090 $25,389 $28,635 $35,316 $38,180 $47,725 $57,270 $76,360

4 $23,050 $30,656 $34,575 $42,642 $46,100 $57,625 $69,150 $92,200

5 $27,010 $35,923 $40,515 $49,968 $54,020 $67,525 $81,030 $108,040

6 $30,970 $41,190 $46,455 $57,294 $61,940 $77,425 $92,910 123,880


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ACA Subsidies

Subsides will ensure qualifying households pay no morethan a specific percentage of income on premiums:

Percentageof household income is a sliding scale based onthe 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

Source: (PPACA 1401, 10105; HCERA 1001; IRC 36B)

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2014: Changes for Employers

Businesses with less than 50 full-time employees areexempt from having to offer health insurance toworkers.

97% of Montana business have fewer than 50 full-time employees.

80% of Montana employers have fewer than 10

workers.

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Small employers offering health insurance

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).

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Penalties for large companies (50+ workers):

Not offering minimum essential benefit coverage --

$2,000 per full-time worker (subtracts first 30 full-timeworkers)

Not offering affordable coverage lesser of $3,000 perfull-time employee receiving a subsidyor$2,000 per full-

time employee

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Penalties for the Uninsured

2015: Insurers mail a Notice of Insurance (similar to W-2)for taxes.

Income too low to file a federal tax return? Penaltiesare not meant for you.

2014 $95 per adult and $47.50 per child, up to a familymaximum of $285 or 1 percent of family income,

whichever is greater

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Moving Forward


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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 toindividual 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

Making the New LawsWork for Montana

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Thank you!

Karen [email protected]

MHC Farmers Union Presentation

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Transcript of MHC Farmers Union Presentation