September 28, 2013
“It is all about quality care. … I am encouraging people in my district to go and shop for health care.”
U.S. Health and Human Services will run Georgia’s program HEALTH CARE,
his constituents and the rest of the American people can finally have affordable, quality and accessible health care. “The Affordable Care Act is about securing affordable, quality and accessible health care as a right, not a privilege, for every American; yet it is also about wellness and prevention, economic security and entrepreneurship, the well-being of working families and the strength of the middle class,” he said. Under the Affordable Care Act, also known as Obamacare, no one, including 4.3 million Georgians, can be denied coverage because of a pre-existing condition, and qualified consumers will get help paying for their coverage. Georgia, which stood to receive $1 million in grants for research, planning, information technology development, and implementation of its Health Insurance Marketplace, is one of 36 states that have refused to participate in the program. Because of that refusal, the U.S. Department of Health and Human Services will run Georgia’s plan. On Sept. 25, HHS released a study showing that premiums nationwide will be about 16 percent lower than originally expected and that about 95 percent of the eligible uninsured live in states with lowerthan-expected premiums before taking into account financial assistance. Six out of 10 eligible individuals – who are uninsured today – will be able to find coverage for $100 or less per month along with premium tax Kathleen Sebelius credits and Medicaid coverage. HHS Secretary Kathleen Sebelius said they are excited to see that rates in the Marketplace are even lower than originally projected. “In the past, consumers were too often denied or priced-out of quality health insurance options, but thanks to the Affordable Care Act, consumers will be able to choose from a number of new coverage options at a price that is affordable,” she said. The HHS study report – Health Insurance Marketplace Premiums for 2014 –
Healthcare Marketplace frequently asked questions Open enrollment for the Healthcare Marketplace runs Oct. 1 What if I’m a small-business owner? to March 31, 2014. Businesses with up to 50 employees will have a Small Business Health Options program, or SHOP exchange, that will give What is the Healthcare Exchange? employees more options than they now have. For more informaIt’s a Web site designed to make it easy for people to find health tion, visit http://search.hhs.gov/search?q=SHOP&site=hhshealth coverage. Georgia’s exchange will be run by the federal government care&entqr=3&ud=1&sort=date%3AD%3AL%3Ad1&output=x at http://www.hhs.gov/healthcare/facts/bystate/ga.html. ml_no_dtd&ie=UTF-8&oe=UTF-8&lr=lang_en&client=hhsheal thcare&proxystylesheet=hhshealthcare&btnG=Search Who can use the exchanges? The exchanges are for the uninsured people who will buy their How will it work? own coverage and those whose employer-provided coverage that is Consumers can create online accounts at www.healthcare.gov. too expensive or lacks important benefits. Initial open enrollment Information like income and citizenship status is required. is Oct. 1 through March 31. The exchange will display a list of health plans, premiums and out-of-pocket costs, including deductibles and co-payments. After Who can’t use the exchanges? making a selection, you will be directed to the insurer’s Web site People who are in the country illegally are barred from the to make the payment. exchanges. Most workers at bigger companies that provide health The exchange will determine if you are eligible for Medicaid. If coverage won’t use them. Medicare and Medicaid beneficiaries you are ineligible, it will tell you how much subsidy you can receive aren’t eligible for the exchanges. for a private health plan. In most cases, the government will send subsidies directly to the insurers to pay part of the premium. What if I have a pre-existing condition? Insurance providers are prohibited from discriminating What if I can’t afford the premiums? against you because of a pre-existing condition. On Oct. 1, an The law provides sliding-scale subsidies to help people with estimated 4,324,000 Georgians with a pre-existing health condi- incomes up to four times the federal poverty level – $11,490 (about tion can start to enroll in coverage through the Health Insurance $46,000 for an individual, $62,040 for a couple, and $94,200 for a Marketplace without facing discrimination. family of four) – pay premiums. Additional help with co-payments and deductibles is available for people with incomes up to 250 What kind of plans will I be able to buy? percent of the poverty level ($28,725 for an individual or $58,875 All plans will offer “essential benefits” that include hospitaliza- for a family of four). People who receive subsidies will be required tion, emergency care, maternity and pediatric care, mental health to pay 2 percent to 9.5 percent of their incomes toward premiums, care, and prescription drug coverage. Plans must cover preventive depending on how much money they make. care like flu shots, vaccinations and mammograms at no cost. Insurers will offer four tiers – bronze, silver, gold and platinum – What happens if I don’t buy insurance by March? based on deductibles, co-payments and other costs. You will face a penalty of $95, or 1 percent of your income, Bronze plans have the lowest monthly premiums but higher whichever is greater, for the first year. The fine increases to $695, out-of-pocket costs. or 2.5 percent of income, in 2016.
found that consumers will be able to choose from an average of 53 health plans in the Marketplace and that the vast majority will have a choice of at least two different health insurance companies. Individuals in the 36 states where HHS will fully or partly run the Marketplace will have an average of 53 qualified health plan choices. In Georgia, the average premium for the lowest-cost silver plan will be $304. The lowest cost bronze plan will be $265. Nationally, the average premium for
the second-lowest cost silver plan will be $328 before tax credits, or 16 percent below projections based off Congressional Budget Office estimates. About 95 percent of uninsured people eligible for the Marketplace live in a state where their average premium is lower than projections, and states with the lowest premiums have more than twice the number of insurance companies offering plans than states with the highest premiums. For example, the report shows that a 27-year-old living in Georgia who makes
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$25,000 per year will pay $103 per month for the lowest-cost bronze plan and $145 per month for the second-lowest cost silver plan, taking into account tax credits. For a family of four in Georgia with an income of $50,000 per year, the lowest bronze plan would cost $1,322 per month. In Atlanta, where consumers will be able to choose from among 68 qualified health plans, a 27-year-old who makes $25,000 per year will pay $105 per month, or $2 more, for the lowest-cost bronze plan, and $145 per month for the second-lowest cost silver plan, taking into account tax credits. DeKalb Commissioner Larry Johnson said that he is happy to see enrollment open for the Healthcare Marketplace. “It is all about quality care,” he said Thursday after cutting the ribbon on the new JenCare Medical Neighborhood Center on Larry Johnson Candler Road catering to seniors 65 years and older. “The Marketplace rates are even cheaper than what we first thought. I am encouraging people in my district to go and shop for health care.” Congressman Johnson is hosting an Affordable Care Act Information Event on Oct. 18 at Georgia Piedmont Technical College in Clarkston to help individuals and smallbusiness owners sign up for the Marketplace exchanges. On Oct. 22, Commissioner Johnson is hosting a town hall meeting at Rhema Word Church offering enrolment assistance. The church is at Candler and MCAfee R\roads in Decatur. Health Marketplace Exchange To enroll in the Health Marketplace Exchange, visit www.healthcare.gov or call 1-800-318-2596. State organizations listed at http://go.cms.gov/1a8su1q will be available to provide in-person assistance to consumers to make the enrollment process easy.