GET INFORMED Connecting You to the H E A LT H I N S U R A N C E M A R K E T P L A C E
A SPECIAL SECTION FROM THE ARKANSAS INSURANCE DEPARTMENT IN THE ARKANSAS TIMES
Table of Contents Patient Protection pg. 3 how the aca affects you pg. 4 Affordable Care act uniquely suited to benefit arkansas pg. 5 The History of healthcare reform in the U.S. pg. 5
Patient Protection - 3
How the Affordable Care Act Affects you - 4
Affordable Care Act Uniquely Suited to Benefit Arkansas - 5
Health insurance marketplace - 6
Health insurance marketplace pg. 6 FINANCIAL ASSISTANCE pg. 6 data PG. 7
Where to Go For More Check out these reliable sources on the Internet for information about the Patient Protection and Affordable Care Act, including help in calculating the approximate amount of financial assistance you might receive to purchase insurance:
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Get Informed Connecting You to the Health insurance Marketplace
ARHealthConnector.org achi.net
HealthCare.gov
EnrollAmerica.org
How the Affordable Care Act is Already Helping
How the Affordable Care Act Will Help Consumers in the Future
• Children can stay on their parents’ insurance policy until age 26.
Patient Protection
• Insurance companies can no longer deny coverage of a child under age 19 due to health conditions. • Lifetime benefit limits are eliminated, and annual benefit limits on insurance coverage are regulated until 2014.
Patient protection earned top billing when Congress titled the healthcare reform law. The provisions safeguarding patients apply to everyone in the country, not just those who are uninsured.
• Rescinding coverage by insurance companies is prohibited unless due to fraud.
• Coverage can’t be denied to anyone who has a pre-existing condition, such as cancer, diabetes or heart trouble. • No insurance policy for anyone in America can limit annual or lifetime benefits. • Premiums cannot be increased due to gender, health conditions or personal health history. • Premiums can only be increased due to age, geography, and tobacco use.
• Preventive services (such as mammograms, colonoscopies, wellness visits, etc.) are covered at no cost to the consumer.
• Elimination of “donut hole” charges by 2020.
• Rebates on monthly premiums are paid to consumers if the insurance company does not pay enough on health insurance claims ($11 million paid to Arkansas consumers in the first 2 years).
• Primary care physicians will be paid at least 100% of Medicare payment rates for primary care services.
• Eligibility determinations are “real time.”
• Coverage is available for early retirees (age 55-64). • 446,000 Arkansans not enrolled in Medicare Advantage will see decreased premiums. • More than a half-million Arkansans benefit from discounts on Medicare Part D drugs purchased in so-called “donut hole.”
Get Informed Connecting You to the Health insurance Marketplace
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How the Affordable care act affects you
My family is already insured through my employer. Will I be affected?
I have Medicare. Will my benefits cost more or less?
Many insurance policies now cap a person’s lifetime benefits, but the Affordable Care Act (ACA) says they can no longer be capped. The law also removes the annual limits on benefits that your insurance may now impose. Your insurance provider will no longer be able to stop your coverage or raise your premium because of a pre-existing condition. Sons and daughters now can be kept on your insurance until they are 26 years old.
Less. The ACA, starting last year, closes the so-called “donut hole” year by year until it disappears in 2020, saving some seniors more than $1,000 each per year
I run a small business. Must I provide insurance to my employees or else pay a penalty?
If you have fewer than 50 full-time employees or the equivalent of that (100 half-time employees, for example), the law does not require you to provide insurance, nor does I do not have insurance through my work, it levy a penalty for failing to provide it. If and I cannot afford to buy an individual you have 50 or more full-time employees, policy for my family or myself. How will the or the equivalent in part-time workers, you Marketplace help me? must provide quality, affordable insurance for your full-time employees or else you must This fall, the new Health Insurance Mar- pay an additional income tax of $2,000 per Also, your insurance company must give re- ketplace will give you a choice among an ar- full-time employee. The first 30 employees bates if it fails to spend a certain percentage ray of insurance plans that fit your family’s are excluded in calculating the tax. (80%–85%) of the premiums on healthcare needs and your pocketbook—with financial Is absolutely everyone required to have assistance if you meet income eligibility. each year.
My family is insured through an individual policy, which is expensive. Can I switch plans? Your insurance will not be affected, but you may be helped because more insurance plans will be available in Arkansas through the Health Insurance Marketplace created by the ACA. In Arkansas, you can access the Marketplace through the Arkansas Health Connector. The competition among more companies and more plans tends to drive down premiums and out-of-pocket costs. If you see a plan in the Marketplace that is better or cheaper, you may switch to the plan. You will not be eligible for financial assistance unless your family income is no more than 400% of the federal poverty level. 4
insurance or pay the penalty?
Starting Oct. 1, you will be able to shop for an insurance plan online, by telephone, by mail or in person by contacting a qualified insurance agent or visiting one of the many organizations around the state serving as In-Person Assisters, or “guides,” to help you through the enrollment process.
I have no health insurance, but my family and I are in good health. I don’t want to buy insurance. Do I have to?
No. There are a few exemptions, such as if you are in the country illegally or are in prison, or you are a member of a federally recognized Indian tribe or a religious sect that is recognized as conscientiously opposed to health insurance benefits.
I have military insurance (either VA or active military), so will the ACA affect me?
No. Your insurance provides the required You can choose not to buy insurance. Instead, coverage. The same is true of nearly all govyou will pay a penalty to the federal govern- ernment employee insurance programs. ment each year that you and your family are not insured.
Get Informed Connecting You to the Health insurance Marketplace
History of healthcare reform in the U.S. & Arkansas
President Roosevelt ponders including national health insurance in a sweeping social insurance bill that became Social Security, but omits it because of opposition.
1935
President Truman endorses universal health insurance but fails to pass it.
Affordable Care Act Uniquely Suited to Benefit Arkansas
No other state will have as large a share of its population that will be helped by the ACA, no other state will receive quite the economic boost, and few, if any, states will bear as light a load of taxes that pay for the reforms as will Arkansas. Rather than the spending burden many feared, the ACA will produce large savings for the state.
1948
budgets. The government will provide financial assistance on the premiums for families meeting income eligibility. The plans will take effect in January, 2014.
Every year, Arkansas ranks among the unhealthiest five states in the union, based on a variety of measurements such as the number of people with bloodpressure ailments, obesity, diabeThe Arkansas legislature in April tes, smoking, etc. voted to expand Medicaid as called for in the ACA. This was accom- Since more people in Arkansas plished with an approach tailored need insurance and medical care, for the Natural State by covering the Arkansas will experience a large poorest Arkansans through private infusion of federal dollars starthealth insurance plans. The bill, ing in January. With 75 percent of called the Arkansas Health Care Arkansans earning less than 400 Independence Act, overwhelmingly percent of the poverty level, Arpassed and was signed into law by kansas has the highest percentage Gov. Mike Beebe. of its citizens in the nation who are eligible for federal assistance With the Arkansas Health Care In- in paying insurance premiums. dependence Act, our state has positioned itself as a national leader in The impact will go far beyond healthcare reform. No other state that. A major purpose and effect is attempting such a unique ap- of the ACA and the Arkansas proach in implementing the ACA. law is to end unreimbursed care at hospitals, clinics and doctors’ The ACA also establishes a Mar- offices. More patients being covketplace in each state, including ered will infuse much-needed Arkansas, in which insurance resources into those hospitals. companies, starting this fall, will Arkansas’s rural hospitals have offer a range of insurance plans. been struggling with uncompenUninsured people can shop for sated care and they will receive a plan that suits their needs and welcome relief.
1950s
1965
Workplace health insurance grows, primarily in large industries under union agreements.
Congress passes and President Johnson signs a bill masterminded by Rep. Wilbur Mills of Arkansas that establishes Medicare and the joint state-federal Medicaid program.
1971 Under Gov. Dale Bumpers, Arkansas greatly expands health and social services by matching federal funds under Medicaid.
1973 President Nixon outlines a universal health insurance bill to Congress, calling for all employers to buy insurance for their employees. The plan goes nowhere.
1993 President Clinton puts first lady Hillary Clinton in charge of developing a bill to provide health insurance to all. The bill fails.
1997 Arkansas Gov. Mike Huckabee signs a bill to create ARKids First, which expands Medicaid to cover more children.
The Massachusetts Legislature adopts a universal health-care plan proposed by Gov. Mitt Romney and backed by Sen. Edward Kennedy that requires people 2006 to buy health insurance and covers adults under 150 percent of the poverty line through Medicaid.
2010
2013
Gov. Mike Beebe, joined by Democrats and Republicans in the Legislature, signs the Arkansas Health Care Independence Act.
The Patient Protection and Affordable Care Act, based on the Massachusetts model, is signed into law by President Obama.
Get Informed Connecting You to the Health insurance Marketplace
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open enrollment from Oct. 1 through March ple calculations of how much of the pre31. There will be a new enrollment period ev- mium will be borne by the customer and ery year. how much the federal government will pay in the form of tax credits. The Arkansas the health insurance Insurance premiums in Arkansas doubled Insurance Department’s Arkansas Health between 2000 and 2010, the year Congress Connector will help Arkansans enroll in a marketplace enacted the law, while the number of unin- plan that best meets their needs. sured people rose, according to Arkansas Surgeon General Joe Thompson. Every plan must provide at least these 10 essential benefits: outpatient care; emerThis meant that a smaller and smaller part of gency treatment; hospitalization; prescripthe population bought insurance but paid for tion drugs; maternity and newborn care; more and more of the medical costs of people mental health and substance-abuse treatThe “affordable care” half of the Patient Pro- who were uninsured and got charity care ment; rehabilitative and habilitative care; tection and Affordable Care Act is least un- from clinics, hospitals and doctors. laboratory services; preventive and wellderstood in the lengthy law. ness services; and pediatric services in“The idea of the Affordable Care Act is that cluding vision and dental care. Plans may The Affordable Care Act builds on the U.S. you bring everybody in, the good risks and also cover other services. system by making private insurance more af- the bad risks, the well and the sick, and fordable for low- and middle-income families spread the risk over a larger number of peoand by giving strong incentives to buy it. ple,” Thompson said. “That is the only way to Financial Assistance make the health insurance system work.” The incentives are that (1) the government will help you pay the premiums with ad- The goal of the Marketplace is to have a num- Individual plans with total annual premium cost of $5,600 133 150 200 250 300 400 vance tax credits if your family income is no ber of insurance companies offering compet- FPL % Annual Income ($) 15,281 17,235 22,980 28,725 34,470 45,960 more than four times the poverty level (about ing plans, which will hold premiums down Income % for premium 3 4 6.3 8.05 9.5 9.5 $94,000 for a family of four), and (2) most and stretch benefits. Five insurance compa- Consumer payment ($) 458 689 1,448 2,312 3,275 4,366 people who decline to buy insurance will nies indicated to the state Insurance Depart- Subsidy ($) 5,142 4,911 4,152 3,288 2,325 1,234 have to pay a penalty when they file their in- ment in early June that they would each offer come tax returns. medical plans. Four companies plan to offer Family of four with total annual premium cost of $15,700 pediatric dental plans. Other companies have FPL % 133 150 200 250 300 400 Fifty million or so Americans—more than expressed an interest and may enter the mar- Annual Income ($) 31,322 35,325 47,100 58,875 70,650 94,200 500,000 of them in Arkansas—can start ket later. There will be competing plans of- Income % for premium 3 4 6.3 8.05 9.5 9.5 Consumer payment ($) 940 1,413 2,967 4,739 6,711 8,949 shopping on Oct. 1, 2013, in a new Health In- fered in all 75 counties. Subsidy ($) 14,760 14,287 12,733 10,961 8,989 6,751 surance Marketplace for an insurance policy that will fit their families’ needs and budgets. Each company must accept every person who Advance tax credits paid directly to insurance carriers Coverage begins Jan. 1, 2014. applies, regardless of their health or age, and subsidize premiums on plans purchased through the can never stop a person’s coverage if he or Marketplace. Consumers can access the Marketplace on- she becomes ill. line through the Arkansas Health Connector or by contacting insurance agents or In- If a person goes online starting Oct. 1, there Tax credits vary and are based on your income. Person Assisters (guides) by telephone, mail, will be simple descriptions of the benefits or in face-to-face visits. The Marketplace, and costs of each plan and how the insur- The amount you pay depends on where your income falls which will allow people to compare the costs ance company will spend the money. There relative to the 2013 Federal Poverty Level (FPL). and benefits of a number of plans, will offer will be easy comparisons of plans and sim6
Get Informed Connecting You to the Health insurance Marketplace
H E ALTHCAR E R EFO R M BY TH E N UMB ER S
The Affordable Care Act and the Arkansas Health Care Independence Act will help Arkansans get the treatment they need and help hospitals stay in business. This data demonstrates the need and the assistance on the way. Sources: The Rand Corporation, Arkansas Center for Health Improvement, Demos.org, Act 1497 of 2013, and EnrollAmerica.org
TH E U N I N SU R E D I N AR K AN SA S & NATIO NALLY
16.5% of Arkansas residents
report they could not see a doctor due to cost. For those without insurance:
67% Uninsured Americans who have been without coverage for 2 or more years.
78%
26%
Uninsured Americans who don’t know about the new Health Insurance Marketplace.
26% of working-age Arkansans are uninsured.
Adults are more likely to die from trauma or other acute conditions like heart attacks and strokes.
Percent of bankruptcies in the U.S. which are due to medical debt.
Over $338 million TH E I M PAC T O F I N SU FFICI E NT H E ALTH I N SU R AN CE
Adults are more likely to be diagnosed with later-staged cancer due to delays in seeking care.
Estimated amount of uncompensated care costs to Arkansas hospitals in 2010.
62%
47%
Nationally, 47 percent of all indebted households indicated out-of-pocket medical expenses contributed to their credit card debt.
TH E I M PAC T O F TH E AFFO R DAB LE C AR E AC T A 2013 study by the Rand Health Corporation on the economic impact of the ACA in Arkansas predicted that by 2016: At least
$550 Million Annual increase to Arkansas gross domestic product (GDP)
2,300 Lives saved each year
6,200
Cost for Medicaid coverage expansion paid by the federal government, not Arkansas taxpayers. Begins at 100% and will gradually reduce to no less than 90%. Through 2016
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2020 and thereafter
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New jobs created
Up to $67 million annually will be saved in Arkansas because of a reduction of costs for uncompensated care.
Get ready to get Get health
surance coverage ■ Affordable health insurance is coming! ■ Pre-existing conditions can’t keep you out ■ You can finally control your family’s healthcare options ■ Learn how at ARHealthConnector.org
Text “GetIn” to 84700 | Call 855-283-3483