G I O V A N N I G O M E Z
R E G I O N A L C O O R D I N A T O R O F O U T R E A C H

What is the Affordable Care Act?
 Signed into law on March 23, 2010 by President
Obama.
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Includes provision for states to create Health
Insurance Marketplaces for individuals, families, and small employers to purchase affordable plans
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Consumers can sign up starting Oct. 1, 2013
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Coverage starts Jan. 1, 2014

What does the ACA do now?
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Extend dependent eligibility to age 26
Children with pre-existing conditions cannot be denied coverage
Elimination of lifetime limits on coverage
Preventive care covered
Implementation of 80/20 rule that requires insurance companies spend at least 80% of premiums on health care

What does the ACA do in 2014?
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Equal premium rates for men and women
No one can be denied because of a pre-existing condition
The extension of Medicaid
The establishment of the Marketplace
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You may qualify for assistance to help with health care premiums and lower your out-of-pocket costs

What is the Marketplace?
 A place where you can review your options and apply for health insurance coverage, knowing the premiums, deductibles, and co-pays ahead of time!
 You can apply at the online marketplace, by phone, or by mail
 Assistance will be available in-person and over the phone if you need it.

How will it work?
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 One Application Process
The Marketplace and ABE

Eligibility for Individuals
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U.S. Citizen;
U.S. National;
Or otherwise lawfully present during the intended enrollment period.
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Not incarcerated
Resident of Illinois

Who is Eligible for Tax Credits?
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Individuals and families with income between 100% to 400% FPL
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Must be US citizens or lawfully present in the US
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Must not be eligible for other “ minimum essential coverage ”
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If your offered insurance at work and it fills all the requirements
Lawfully residing immigrants with incomes below
100% FPL who are not eligible for Medicaid because of their immigration status

Who is Eligible for Tax Credits?
FPL
400%
300%
300%
Marketplace
Unsubsidized
Subsidized
Premiums on sliding scale.
200%
200%
133%
100%
Children
(All Kids)
Pregnant
Women
Parents People w/
Disabilities
Adults w/o
Children

Marketplace Plans
 Must include Essential Health Benefits:
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Ambulatory patient services
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Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services including chronic disease management
Pediatric services including oral and vision care

Marketplace Plans
 Medaled plans:
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Medal level signifies actuarial value, not content, of plan
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Platinum
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Gold
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Silver  Benchmark Plan
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Bronze
 Catastrophic coverage will be available to people under 30 and those who qualify for the individual exemption.

Example: Single Individual
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John
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24 years old
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Income of $22, 980 (200%FPL)
Expected Contribution: 6.3% or $1,448
Plans Covering John
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Gold: $5,200
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Silver Plan: $5,000  Benchmark Plan
Bronze: $4,800
Premium Credits
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$5,000 - $1,448= $3,552
*These are not official prices*

$3,552
$1,848
$3,552
$1,648
$3,552
$1,448
$3,552
$1,248

Eligibility for Individuals
 You could get a break on costs:
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Consumers between 100% and 400% FPL are eligible for tax
subsidies that are applied to premiums.
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Consumers between 100%-250% FPL can receive cost-sharing
reductions.
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Must be enrolled in a silver plan from the marketplace
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Must be eligible for the tax credit
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Both are on a sliding scale.
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Consumers also receive a cap on out-of-pocket spending.

Eligibility for Individuals
 Those who receive employer-provided insurance that meets ACA standards of value and affordability can apply for coverage on the Marketplace, but they are not eligible for tax subsidies.

Who Can Help You Through The Process?
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The IL Assistor Program
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The In-person Counselor program (IPCs) & Navigators
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No Wrong Door Policy
Certified Application Counselors (CACs)
 They will help you every step of the way.

Questions?
 Contact Information
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Giovanni Gomez
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Email: Giovanni.Gomez@illinois.gov