H EALTH C ARE.GOV

1. HEALTHCARE.GOV Affordable Care ActMarketplace Implementation Briefing PA Breast Cancer Coalition Annual ConferenceOctober 5, 2015 Joanne Corte Grossi, MIPP Regional Director U.S. Department of Health & Human Services, Region III Pennsylvania, Delaware, District of Columbia, Maryland, Virginia, West Virginia

2. Affordable Care Act Overview 17.6 million adults gained health insurance since the beginning of open enrollment 2013 through September 12, 2015. 5.4 million young adults gained coverage 12.3 million enrolled in Medicaid & CHIP Uninsured rate dropped to 9.4% - lowest since they began keeping records

3. Affordable Care Act Overview Provides coverage to young adults up to the age of 26 Strengthens Medicare benefits with lower prescription drug costs for those in the ‘donut hole,’ chronic care, and free preventive care Prohibits plans from imposing lifetime and annual limits on the dollar value of benefits, and from rescinding coverage when you get sick

4. Affordable Care Act Overview Rein in insurance premiums rates Prevent denials of coverage, including for pre-existing conditions Make health insurance affordable for middle class families Make health insurance affordable for small businesses with tax cuts

5. Marketplace Implementation Pennsylvania is a Federally Facilitated Marketplace 549,205 Pennsylvanians enrolled during 2014 open enrollment 472,697 Pennsylvanians enrolled during the 2015 open enrollment 479,00 enrolled in Medicaid through Medicaid expansion

6. Marketplace Implementation 15 insurance carriers offering 50 health plans 80 percent of Pennsylvania consumers qualified for an average tax credit of $226 per month 51 percent obtained coverage for $100 or less

7. Actuarial Value • The ACA requires plans inside the Marketplace to meet particular actuarial value (AV) targets • Bronze = 60% AV • Silver = 70% AV • Gold = 80% AV • Platinum = 90% AV • “Metal Levels” will enable consumers to compare plans with similar levels of coverage, promote competition on premiums, and allow plans flexibility to design cost sharing structures

8. Quality Insurance • 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/devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care

9. Open Enrollment • Special Enrollment Period • Qualifying Life Events • Next Open Enrollment: • November 1, 2015 – January 31, 2016

10. From Coverage to Care Understand your coverage – know what services are covered Find a provider – Check your plan’s list of providers Know where to go for care – use ER’s only for life threatening situations Stay healthy with screenings and manage chronic conditions Make an appointment – make sure your plan is accepted by the provider & take your insurance card with you

11. Individual Mandate Penalty • For 2016: • 2.5% of yearly household income or • The higher of $695 per person (up to 3 people or $2,085) • Fee is paid on the federal income tax return you file for the year you don’t have coverage

12. Medicaid Expansion 479,000 Pennsylvanians are newly covered since January 1, 2015 for health insurance with Medicaid expansion 100% federally funded for first three years (2014-2016) Federal funding gradually reduced to 90% in 2020

14. Navigators/CACs in PA • PA Navigators received $3.1 million from CMS • Consumer Health Coalition • consumerhealthcoalition.org (412) 456-1877 • Penn Asian Senior Services • passi.us (215) 572-1234 • PA Association of Community Health Centers • pachc.com (717) 761-6443 • PA Mental Health Consumers’ Association • pmhca.org 717-564-4930 • Public Health Management Corporation • phmc.org (215) 985-2500 • Young Women’s Christian Assn. of Pittsburgh • ywcapgh.org (412) 391-5100

15. Affordable Care Act website –www.healthcare.gov Navigators/CACs - localhelp.healthcare.gov Tax Tools – https://www.healthcare.gov/taxes Affordable Care Act Spanish website – www.cuidadodesalud.gov Resources:

16. Thank you! Contact: joanne.grossi@hhs.gov