Get Covered Kentucky

Get Covered Kentucky Understanding the Affordable Care Act

Welcome Regan Hunt, MPA Executive Director of Kentucky Voices for Health

Introduction Daniel Glaser, MPH Western Kentucky University

Introduction and Overview • Part 1 – The Big Picture: Understanding the Affordable Care Act (A.C.A.) • Part 2 – Gaining Perspective: Kentucky and the A.C.A. • Part 3 – The Nuts and Bolts: Getting Covered with Kynect • Part 4 – Myths, Talking Points & Future Considerations

Introduction and Overview • Live Q&A session immediately following presentation • On Demand recording available at: www.kyvoicesforhealth.org • Questions may be sent to: kvhmedicaidexpansion@gmail.com • Use the subject line: “Get Covered Kentucky Webinar”

Part 1 – The Big Picture: Understanding the Affordable Care Act Question #1: On a scale of one to ten, how would you rate your overall level of comfort explaining the Affordable Care Act to others?

Part 1 – The Big Picture: Understanding the Affordable Care Act • What is the Affordable Care Act (A.C.A.)? • Signed March 23rd, 2010 • Goals: Increase affordability and rate of health insurance; reduce healthcare costs • Most important provisions go into effect over the next six months • Affects insurers, business owners, families and individuals

Major Provisions of the Act • Provisions that Improve the Quality of Coverage • Beginning January 1st, 2014 • Pre-existing Conditions • Health insurers banned from discriminating on the basis of gender or pre-existing medical conditions for all adults / children • Essential Health Benefits • Establishes 10 categories of essential health benefits which all healthinsurance plans must cover

Essential Health Benefits • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care)

Major Provisions of the Act • Provisions that Improve the Quality of Coverage • January 1st, 2014 • Pre-existing Conditions • Health insurers banned from discriminating on the basis of gender or pre-existing medical conditions for all adults / children • Essential Health Benefits • Establishes 10 categories of essential health benefits which all health insurance plans must cover • No Limits on Coverage • Insurance companies prohibited from setting annual or lifetime limits • Preventive Care • Require insurers to provide eligible individuals with free preventive care, no co-pay or deductible

Major Provisions of the Act • Provisions that Improve the Rate of Coverage • Medicaid Expansion • Paid for by Federal Government to expand Medicaid eligibility • States must opt-in • Expanded coverage begins January 1st, 2014 • Health Benefit Exchange • State-by-state basis • Online marketplace for individuals and small businesses • Open enrollment begins October 1st, 2013 • Federal Tax Credits • Subsidies to purchase private insurance via the Exchange • Amount of tax credit based on annual income • Goes into effect January 1st, 2014

Major Provisions of the Act • Provisions that Enforce the Bill • Individual Mandate • Affects any individual / family not covered by their Employer, Medicare, or another private or public insurance program • Must become insured or pay a penalty in 2014 • $95 or 1% of income, whichever is greater • Employer Mandate • Affects businesses with more than 50 full-time employees • Must provide health insurance or pay a penalty in 2015 • $2,000 per uncovered employee

Part 2 – Gaining Perspective: Kentucky and the A.C.A. Question #2: Approximately how many Kentuckians currently lack health insurance? a) 310,000 b) 460,000 c) 550,000 d) 640,000 The answer is d There are an estimated 640,000 uninsured Kentuckians!

Current Health Outcomes in Kentucky • 50th in smoking • 40th in obesity • 43rd in sedentary lifestyles • 41st in diabetes • 48th in poor mental health days • 49th in poor physical health days • 50th in cancer deaths • 49th in cardiac heart disease • 43rd in high cholesterol • 48th in heart attacks • 44th in annual dental visits

Kentucky’s Uninsured Population 640,000 uninsured Kentuckians = 17.5% of population under the age of 65

Analysis of Kentucky’s Uninsured • 308,000 (48% of uninsured) qualify for Medicaid via the Exchange • 332,000 (52% of uninsured) must purchase private insurance via the Exchange

Who is eligible for Medicaid? • U.S. citizens or lawfully present immigrants (After 5 years) • Annual income < 138% of Federal Poverty Line (FPL)

Who is eligible for Federal Tax Credit? • U.S. citizens and lawfully present immigrants • Annual income falls between 138% and 400% of FPL

What about those who do not qualify? • 91.25% of uninsured Kentuckians qualify for Medicaid or at least some tax credit • The other 56,000 people must purchase private insurance or get it from their employer by March 31st, 2014. • They may do so using the Exchange

What about small business employers in Kentucky? • Small businesses are those with 50 or fewer FTEs • No requirement under the A.C.A. for them to cover their employees • Tax incentive for very small businesses, those with 25 or fewer FTEs

Tax subsidies for small business owners • Tax credit amounts may vary based on employee size and average annual wages • To learn more, consult the interactive calculator for Small Business Tax Credits at healthbenefitexchange.ky.gov.

Part 3 – The Nuts and Bolts: Getting Covered with Kynect Question #3: Agree or Disagree: The biggest challenge facing implementation of the A.C.A. is getting uninsured Americans to take the necessary steps to obtain coverage. a) Agree. I think this is the hardest part of implementation. b) Disagree. I think there are greater challenges out there. Thanks for answering!

You must take action if… • You are an adult over the age of 18 -and- • You do not have insurance through either your employer, a government program, or a private plan -or- • You do have insurance, but your current insurance plan does not meet the minimum requirements and is not grandfathered in

Is my current plan grandfathered? • Must have been in existence on March 23rd, 2010 and has stayed the same since then • Note, the status depends on when the plan was created, not when you enrolled in it • Check your plan’s materials: All plans must disclose if they are grandfathered in all materials describing plan benefits

What are the key dates to know? • October 1st, 2013: Open Enrollment on the Exchange begins • January 1st, 2014: Health Coverage can start • March 31st, 2014: Open Enrollment on the Exchange ends

How to get covered with Kynect: • What is Kynect? • Kentucky’s Exchange, similar to Travelocity for health insurance • Online portal to shop for and compare private health insurance plans and enroll in government programs like Medicaid • When does Kynect go live? • October 1st, 2013 • Where can I go to access Kynect? • www.kynect.ky.gov

How does Kynect work? • Step 1: Create a user name and password • Step 2: Submit application for verification of personal information through the national Data Service Hub • Step 3: Shop on the digital marketplace • Step 4: Enroll online

Medicaid, K-CHIP or Tax Credits on the Exchange • Screen 2 will be used to identify those who are eligible for Medicaid, K-CHIP or tax credits

How to compare plans on Kynect? • 4 categories of insurance plans on the Kynect Exchange: • Bronze • Silver • Gold • Platinum • Bronze plans pay a lower premium, but higher out-of-pocket medical costs for care • Platinum plans pay the highest premium, but lowest out-of-pocket costs

Metal Category • Reflects how much your premium costs each month and your portion of out-of-pocket expenses • Metal category does not affect amount of care provided: All plans cover the same essential health benefits • Kynect also offers “catastrophic” plans to people under 30 years old and to some with very low incomes

How to get assistance on the Exchange: • “Kynecters” • Trained in-person assisters • Facilitate enrollment • Offer unbiased advice • Help resolve grievances • Available online, by phone, or in-person • English and Spanish available • Still being trained as we speak. Expected in mid-August… • Visit kynect.ky.gov for more information • Call 1-855-4Kynect (1-855-459-6328)

What happens after open enrollment ends? • Open enrollment lasts until March 31st, 2014 • After that date you cannot use the Exchange unless you qualify for Special Enrollment • Must wait until October of 2014 when enrollment opens again unless you qualify for special enrollment

How to qualify for a Special Enrollment period? • Special enrollment lasts for 60 days after any of the following: • You gain or become a dependent • You gain lawful presence as an immigrant • An enrollment error based on the Exchange is made • There is a one day special enrollment period every month for members of federally recognized Indian Tribes

Kynect for small business owners • Small businesses with 50 or fewer FTEs may also use the Kynect Exchange • Small-business Health Options Program, or S.H.O.P. • Offers private, employer-based plans at the Bronze, Silver, Gold, and Platinum level • Helps qualified businesses calculate their tax credit • No end to the open enrollment period • No unexpected costs • Owners decide their level of contribution to the plan up front and employees pay the difference

Part 4 – Myths, Talking Points & Future Considerations Question #4: In my opinion, the biggest concern most Kentuckians have with the A.C.A. is… a) Its overall cost to the state government b) Its cost to individuals / families c) Its overall effect on the quality of healthcare in Kentucky d) Its effect on the number of healthcare options available e) Other

Myths about the A.C.A. Myth #1: “The Bill has not withstood its legal challenges / has been struck down” • Response: The A.C.A. is the law of the land and the governor has the authority to implement the changes described in the bill Myth #2: “The government is going to make me drop / change my existing coverage” • Response: Most of the 83% of Americans who already have health insurance can and will choose to keep it; Some plans may be phased out because they fail to meet the minimum coverage requirements

Myths about the A.C.A. Myth #3: “Expanding Medicaid will bankrupt Kentucky” • Response: The federal government pays the majority of the cost for expansion; A.C.A. is predicted to generate $802 million in savings and 17,000 new jobs for Kentucky Myth #4: “This Exchange is not private insurance, but ‘Medicaid for the middle class’” • Response: Non-Medicaid recipients using the Exchange will be shopping for private plans offered by private insurers that are competing for their business

Myths about the A.C.A. Myth #5: “The government is going to use my private information against me” • Response: The Exchange comes with built in protections to keep information private; rights still protected by HIPAA Myth #6: Exchange will offer only “Limited coverage options” • Response: There are currently projected to be at least 20 pre-approved options on the Kynect Exchange; full list must be made public by September 1st, 2013

Myths about the A.C.A. Myth #7: “This will lead to high-cost / unaffordable premiums” • Response: Data from other states, like Maryland, contradicts this; Upper-limit on premiums keeps them under 9.5% monthly income Myth #8: “ I have employer-based insurance, so I don’t benefit from the A.C.A.” • Response: Still benefit from coverage of essential health benefits, free preventive care, ban on annual / lifetime limits, new consumer protections, and much more.

Future Concerns about the A.C.A. in Kentucky • Unpopularity / Lack of understanding • Uninsured Kentuckians are more likely to have heard about the negative aspects of the bill than the positive • Shortage of health care providers • Particularly in rural areas with the highest percentage of uninsured who are eligible for Medicaid • Shortage of qualified mental health providers • 1,683 FTE needed to meet the current need

Discussing the A.C.A. in a culturally appropriate manner • Naming: always use official terms when referring to the bill • refrain from nicknames with potentially negative connotations • Framing: frame the discussion through the bill’s positive benefits for the state of Kentucky • more funding, coverage, jobs and healthy people • Focusing: focus discussion on implementation at the local level • keep discussion away from government and focused on people

Discussing the A.C.A. in a culturally appropriate manner • Reassuring: remember that privacy is a concern • reassure your audience that confidentiality is a priority • Including: seek out opportunities to include minorities and English as a second language populations • remember Kynect is available in English, Spanish and offers a language line

Further reading: • healthcare.gov • kynect.ky.gov • kyvoicesforhealth.org • familiesusa.org • Kaiser Family Foundation Calculator

Q & A Period • Live Questions are being answered by: • Erin Hoben, Medicaid Outreach Coordinator, Kentucky Voices for Health • On Demand recording of this webinar available at: • kyvoicesforhealth.org • Additional questions may be sent to: kvhmedicaidexpansion@gmail.com • Use the subject line: “Get Covered Kentucky Webinar”

Thank you for your participation! On Demand recording of this webinar available at: kyvoicesforhealth.org Questions may be sent to: kvhmedicaidexpansion@gmail.com

Get Covered Kentucky