Get Connected. Get Covered.
The Affordable Care Act (ACA) improves how millions of Americans access health care and makes insurance more affordable. • Marketplace• Medicaid Expansion
Get Connected. Get CoveredYoung Adults in US
Under the Affordable Care Act, up to 16.7 million of America’s 19 million uninsured young adults could be eligible for free or reduced cost coverage through expanded Medicaid (if all states expanded) or tax credits/cost sharing (via the Marketplace).
Status of State Medicaid Expansion Decisions, as of December 11, 2013
WY WI*
WV
WA
VA
VT
UT
TX
TN
SD
SC
RI PA*
OR
OK
OH
ND
NC
NY
NM
NJ
NH
NV NE
MT
MO
MS
MN MI*
MA
MD
ME
LA
KY KS
IA* IN* IL
ID
HI
GA
FL
DC
DE
CT
CO CA
AR*AZ
AK
AL
Implementing Expansion in 2014 (26 States including DC)Seeking to Move Forward with Expansion post-2014 (2 States)Not Moving Forward at this Time (23 States)
Get Connected. Get Covered.
Improved Coverage• No rule out for pre-existing conditions• No lifetime caps• Covered through parents up to age 26 or 30
years old if veteran• Premium equality between genders• 100% coverage of preventive services (no
copays/coinsurance)• Must include Essential Health Benefits
Get Connected. Get CoveredEssential Health Benefits
• Ambulatory patient services• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance use
disorder services• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services• Preventative and wellness
services including chronic disease management
• Pediatric services including oral and vision care
Get Connected. Get Covered.Preventive Care Benefits
1.Abdominal Aortic Aneurysm one-time screening
2.Alcohol Misuse screening and counseling
3.Aspirin use to prevent cardiovascular disease
4.Blood Pressure screening
5.Cholesterol screening
6.Colorectal Cancer screening
7.Depression screening
8.Diabetes (Type 2) screening (high blood pressure)
9.Diet counseling
10.HIV screening
11.Immunization vaccines for adults
12.Obesity screening and counseling
13.Sexually Transmitted Infection (STI) prevention counseling
14.Syphilis screening
15.Tobacco Use screening
Get Connected. Get Covered.
Financial Assistance• Premium Tax Credits– Up to 400% of FPL
• Cost Sharing Subsidies– Up to 250% of FPL
• Medicaid– Up to 138% of FPL
Get Connected. Get Covered.
Individual Responsibility2014 must enroll by 3/31/14 to avoid penalty
– $95 per adult– $47.50 per child (50%)– Or 1% of family income, whichever is greater.
• Paid thru federal income tax
Get Connected. Get CoveredYour Rights Under ACA
• The right to stay on your parents’ family health insurance plan until age 26.
• The right to coverage that cannot be dropped when an unexpected condition or accident makes your care expensive.
• The right to an appeal if coverage for needed care is denied by your insurer.
• The right to information about the cost of insurance and the quality of insurance benefits so that you can choose the plan that works best for you.
• The right to choose your own primary care doctor or pediatrician and to see an OB/GYN without a referral.
• The right to emergency care when and where you need it without huge out-of-pocket network costs.
• The right to a rebate if your insurer spends less than 80% of premium dollars on care.
• The right to free preventive care to keep you healthy and your health care costs down.
• The right to get covered, even if you have a pre-existing health condition.
Source: Illinois Public Interest Research Group
Get Connected. Get CoveredWhat Young Adults are Saying
http://www.youtube.com/watch?feature=player_embedded&v=-ebFKQqhBS4
http://www.youtube.com/watch?v=csgnKOl3sLM&feature=player_embedded
Source: Young Invincibles.org, 2013
Get Connected. Get CoveredWhat Young Adults are Saying
Source: Illinois PIRG, Health Insurance 101 Guide, 2013
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Compare Plans. Determine Eligibility.
Enroll.
What Can I Do on the Marketplace?
Pay Initial Premium.
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For IndividualsMarketplace Plan Compare Sample Monthly Premium Deductible
Out of Pocket Maximum
Copayments/Coinsurance
$x(# enrollees)
$x/yr Family $x/yrFamily
Primary: $xSpecialist: $xGeneric rx: $xER visit: $x
$x/yrIndividual
$x/yrIndividual
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