The Marketplace and COBRA:
What employers and employees need to know
Presented by:Emily Brostek, MPH, CHES– Executive Director
Consumers for Affordable Health Care
December 17, 2014
Agenda
• ACA and Marketplace Basics
• The Marketplace & COBRA
• Helping Employees Understand Their
Options
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Our Mission
To advocate the right to quality, affordable health care for every man, woman and child in Maine.
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About Consumers for Affordable Health
Care• Non-profit, non-partisan mission-driven research and advocacy organization based in Augusta (founded in 1988)oConsumer Assistance Program and
HelpLine (1-800-965-7476)oPublic Policy Research and Advocacy
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Marketplace Basics
The Health Insurance Marketplace
The Health Insurance Marketplace helps people without insurance find health coverage
When you apply, you’ll learn if you qualify for:• Lower costs on private insurance plans
based on your household size and family income
• Other programs like MaineCare and the Children’s Health Insurance Program (CHIP)www.mainecahc.org 6
1. Advanced premium tax credits
(APTCs)
2. Cost sharing reductions
(CSRs)
Two kinds of financial help:
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Marketplace Eligibility
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You may be able to get help with the cost of Marketplace plans if…oYou do NOT have access to insurance
at work, or insurance at work is unaffordable AND;
oYou do NOT have access to public insurance like Medicare or Medicaid AND;
oYour household income is between:
Tax Credit Eligibility
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2014 Plans
1 person: $11,490-$45,960
2 people: $15,510-$62,040
3 people: $19,530-$78,120
4 people: $23,550-$94,2002015 Plans
1 person: $11,670-
$46,6802 people: $15,730- $62,9203 people: $19,790- $79,1604 people: $23,850- $95,400
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Financial help is on a
sliding scale.
Who can go to the Marketplace?
• Anyone can purchase a Marketplace plan
Exceptions!Those who get Medicare Part A free
(most people on Medicare)
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These groups won’t usually use the Marketplace
• Medicare recipients
• Medicaid recipients
• Military/veterans • If you have an employer plan (or dependent
coverage through a spouse’s or parent’s plan) unless it’s “unaffordable” or “crappy” www.mainecahc.org 12
• Marketplace plans may be a good option for people who are eligible for COBRA
• Employees need help understanding their options, and when different options are available
Marketplace and COBRA
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• Most people are only able to sign up for a plan on the Marketplace during Open Enrollmento For 2015: November 15, 2014 – February 15, 2015
• Some people qualify for Special Enrollment Periods outside of Open Enrollment if they have certain life events happen to themo Losing another kind of coverage qualifies you for a SEP
Timing Matters!
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• When someone loses their employer-based coverage, they can choose COBRA or the Marketplace
COBRA or Marketplace?
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• If they choose COBRA:o They can’t switch to Marketplace until the next
Open Enrollment periodo They can switch during Open EnrollmentoWhen COBRA expires, they can get a Special
Enrollment Period and sign up on the Marketplace
COBRA or Marketplace?
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• If they choose the Marketplace and forego COBRA:o They have 60 days from when coverage will
end to enroll in a Marketplace plan through a Special Enrollment Period
oDepending on income, they may be able to get financial help on the Marketplace
COBRA or Marketplace?
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• Differences between plans, including:o Costo Total out-of-pocket expenseso Provider networks
• Timing – when is each option available?• Marketplace eligibility – can they get
financial help?o Other coverage availableo Projected income
Helping Employees Understand Their
Options
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• Local help is available to help people understand their options, and apply to the Marketplace
• Find local help:o Enroll207.com oCall our HelpLine at 1-800-965-7476
You Don’t Have to Do It Alone!
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Q & A and Thank You!Consumers for Affordable Health Care
HelpLine: 1-800-965-7476
Web: http://www.mainecahc.org
YouTube: http://www.youtube.com/user/mainecahcchannel
Facebook: http://www.facebook.com/MECAHC
Twitter: @MAINECAHC
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