Navigating Affordable Health CarePersonal Assistance Within Reach... 

Haywood County LibraryOctober 15, 2013

5:00 PM

Jan PlummerHealth Care Navigator Program Coordinator

Mountain Projects, Inc.

Today's Topics

Mountain Project's RoleThe MarketPlacePersonalized assistancePrivacy and ProtectionEligibility and EnrollmentPreparing for an AppointmentContact Information

Mountain Projects Community Action Agency NC Navigator Program: Our Role 

•MPI awarded a grant to implement a Navigator program in the seven counties in WNC• Counties: Clay, Cherokee, Haywood, Graham, Jackson, Swain,

Macon • Local and personal assistance• Community education and partnership agencies• 5.5 employees- covering the 7 counties of WNC-Navigators• Volunteers trained and more needed

The Affordable Care ActProvisions

GOAL: Affordable health care for millions

TOOLS: The Marketplace/An Insurance Exchange

• Shop, compare and purchase insurance based on income and household size.• Medicaid Expansion: NC did not expand

• Individual Mandate beginning 2014/Exemption

• Employer Shared Responsibility: Must offer a plan that meets ACA minimum

essential benefits or pay a fee. (ESRP)

The Affordable Care ActProtections

•Prohibits higher premiums due to health/gender• Extend coverage for dependents up to age 26•Prohibits discrimination against consumers seeking

coverage with pre-existing conditions• Eliminated Insurance Annual Coverage Limits

What is in the Marketplace?

•One stop shopping to determine eligibility for Qualified Health Plans AND...

New tax credits to lower premiumsReduced cost sharing

MedicaidChildren's Health Insurance Program (CHIP)

Review choice of plans and levels of coverage

Transparency, Competition, Choice

Navigator Assistance

• Unbiased, free, impartial• Individuals or Small Employers• Assigned to Counties• Block Times at partner Agencies, i.e. DSS, Mountain Projects• Community Events• Can not go door to door• Refer to state agencies if appropriate• Appointments available

Patti DeridderNC Navigator Program

Clay/Cherokee

Navigator in TrainingMacon

Navigator in Training Graham/Swain

Jane HarrisonRebecca Mathis

NC Navigator ProgramJackson

Jan Shuler Plummer

Volunteers certified in all Counties

How Can a Mountain ProjectsNavigator Help Me?

•Certified to assist through enrollment • Explain insurance terminology; choices; implications•Unbiased, impartial, and free•Privacy/Confidentiality •No rush, no pressure, no affiliation•Resource for questions•May complete on-line or paper applications

Marketplace ConsumersIndividuals

• Need health insurance• Have health insurance they can't

afford• Have dependents or a spouse that

make insurance unaffordable• Employed by a small employer

getting health insurance through the Marketplace

Small Businesses

• Investigate coverage for employees• Explore options via the

Marketplace• Questions about exemptions and

penalties• Have 50 FTE's or equivalent

Eligibility and Enrollment• Started October 1, 2013 • Enroll by December 15,2013 coverage begins January 1, 2014• Ends March 31, 2014• Special Enrollment Periods

October 1 2013

January 1 2014

December 152013

First Month Premium Due

How to PrepareIndividuals

• SSN for Household/Birthdates• Pay Stubs/W2 Tax Information

for 2013/estimate2014• Employer insurance information

(handout)• Additional HH income

information

Employer

• Names of employees with DOB• Expected enrollment• Existing health coverage?• Age of Spouse• Dependent information• Agent may help enroll/explore

Qualified Health Plans Minimum Essential Benefits

• Ambulatory Patient Services• Emergency Services• Hospitalization• Maternity and Newborn Care• Mental Health/Substance Abuse/Behavioral Health Treatment• Prescription Drugs• Rehabilitation: physical or mental• Labs• Wellness/Chronic Disease Management (Asthma, diabetes)• Pediatric Services including dental

Categories of Health PlansThe Four Metal Models

BRONZE: Minimum Essential Benefits/Insurance pays 60% of covered expenses

SILVER: Minimum Essential Benefits/Insurance pays 70% of covered expenses

GOLD: Minimum Essential Benefits/Insurance pays 80% of covered expenses

PLATINUM: Minimum Essential Benefits/Insurance pays 90% of covered expenses

CATASTROPHIC: Meet all QHP requirements but only cover 3 primary care visits annually until deductible is met. Must be under 30 or receive a hardship exemption.

Options to Lower Costs

Premium Tax Credits - Lower monthly premiums/HH income, size, cost of available plans

Cost Sharing Reductions - Limits out-of-pocket costs (deductibles and co-pays)/HH income/size MAY REQUIRE SILVER PLAN SELECTION

Competition in the Marketplace - Blue Cross and CoventryOne

Exemptions toIndividual Responsibility Requirement

Investigate first• Hardships: Homelessness, eviction, foreclosure, utility shut-off, domestic violence

victim, death of close family member, recent bankruptcy, unexpected caretaker expenses, eligibility denials, coverage exceeding 8% of projected annual income, ineligible for Medicaid/no state expansion

Navigators can not assist with the exemption application. (IRS)

• Incarceration Past months• Indian Status Past and Future• Religious Conscience Complete IRS Form 4029• Health Care Sharing Ministry Past months

Personal Assistance

Mountain Projects: 828-452-1447, ext. 115/1-800-627-1548

Toll Free Number: All NC Counties: 1-855-733-3711

Health Insurance Marketplace: 1-800-318-2596www.healthcare.gov