The Health Insurance Marketplace 101
September 2013
The Link Between Health and
Academic Performance
• According to the Centers for Disease Control
and Prevention (CDC), student health is
strongly linked with academic performance.
• The Affordable Care Act increases health care
access for America’s students to help improve
academic achievement and puts them on a
path to success after graduation.
ACA Benefits for Students
• Prohibits insurance companies from refusing
coverage to or limiting the benefits of young adults
because of a pre-existing medical condition.
• Requires insurance plans to cover preventive
services with no copayment.
• Ensures that students will be allowed to stay on
their parents’ health insurance until age 26.
– Already, 3.1 million previously uninsured young
adults have gained coverage through this
provision.
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ACA Benefits for Communities
• College, university and community college campuses are the centers of
our communities. Every family, neighbor, educator, health care provider,
and business knows the importance of well-educated and healthy young
adults for a successful 21st century economy.
The health care law:
• Expands and modernizes community health centers across the country to
serve up to 20 million more patients.
• Brings more primary care providers to our neediest communities by nearly
tripling the size of the National Health Service Corps, which offers loan
repayment and scholarships for serving in areas that most need health
care providers.
• Improves funding for School-based Health Centers and Area Health
Education Centers, which serve the primary care needs of rural and other
underserved communities.
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The Health Insurance Marketplace
 The Marketplace (or Exchange)
• Place for individuals and small employers to
get private health insurance options
• 90% of people who are currently uninsured
will qualify for discounted or free health
insurance
 A new way to get health insurance
• Enrollment starts October 1, 2013
• Coverage begins January 2014
6/30/2016
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Advantages of the Marketplace
 Helps enhance competition in the health insurance
market
 Increases Affordability through premium tax credits, cost
sharing reductions, or public insurance programs
 Ensures Quality though qualified health plans that must
meet basic standards, including quality standards,
consumer protections, and access to an adequate range
of clinicians
 Makes Costs Clear by providing information about prices
and benefits in simple terms consumers can understand,
so they don’t have to guess about costs
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Help to Pay Qualified Health Plan Costs
 Based on family income and size
• Immediate Monthly Premium discount


Family of four with annual income
$23,550* – $94,200* or less
And not eligible for certain other insurance
coverage like Medicaid
• Lower cost-sharing (like copays)

Family of 4 with annual income $58,875*
or less (some other restrictions)
*2013 amounts
Marketplace Establishment
 Each state can choose between:
• State Based Marketplace – State creates and runs its own
Marketplace
• State Partnership Marketplace – State partners with
Federal government to run some Marketplace functions
• Federally Facilitated Marketplace – State has a
Marketplace established and operated by the Federal
government
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Marketplaces
Federally Facilitated Marketplace
Alabama
Alaska
Arizona
Florida
Georgia
Indiana
Kansas
Louisiana
Maine
Mississippi
Missouri
Montana
Nebraska
New Jersey
North Carolina
North Dakota
Ohio
Oklahoma
Pennsylvania
South Carolina
South Dakota
Tennessee
Texas
Virginia
Wisconsin
Wyoming
Total: 26
Conditionally Approved
State Partnership
Marketplace
Arkansas
Delaware
Illinois
Iowa
Michigan
New Hampshire
West Virginia
Total: 7
Conditionally Approved State Based
Marketplace
California
Colorado
Connecticut
DC
Hawaii
Idaho
Kentucky
Maryland
Massachusetts
Minnesota
Nevada
New Mexico
New York
Oregon
Rhode Island
Utah
Vermont
Washington
Total: 18
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Medicaid Expansion
 States have the option to expand Medicaid eligibility to adults
ages 19 – 64 with incomes below 133% of the Federal Poverty
Level
• $15,282/year for an individual, $31,322/year for a family of 4
 100% federal funding for newly Medicaid eligible
• States have no deadline to decide if they are going to expand
 Ensures Medicaid coverage for all children
• With incomes up to 133% of the FPL
 One streamlined application for Medicaid or private health
plans
 Shifts to simplified way of calculating income to determine
Medicaid/CHIP eligibility
• Known as Modified Adjusted Gross Income (MAGI)
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Payments with Your Tax Returns
 In 2014
• If you don’t have a certain level of health coverage
(employer coverage, Medicare, Medicaid, CHIP, TRICARE,
certain VA coverage, an individual policy, or a plan in the
Marketplace) you may have to make a payment with your
tax return

Starting when you file your 2014 Federal tax return in 2015
• Some people may qualify for an exemption
Are all employers required to provide health
insurance in 2014?
 Employers averaging fewer than 50 Full Time
Employees (FTEs) are not required to provide health
insurance coverage
• 96% of all employers in the U.S. have fewer than 50
employees
 Employers with an average of 50 or more FTEs may
be subject to a shared responsibility payment under
certain conditions starting in 2015.
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The Health Insurance Marketplace
• Enrollment October 1st, 2013 – March 31st 2014
• Coverage begins Jan 1st , 2014
0%
133%
Medicaid
Expansion
400%
Private Plans
with Financial
Assistance
FPL
Private Plans
Our goal is to ensure Americans have quality,
affordable health coverage.
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APPLICATION AND ELIGIBILITY
Enroll
(Marketplace)
Submit single,
streamlined
application to
the
Marketplace
Verify and
determine
eligibility
Eligible for
Marketplace or
Medicaid/CHIP
Enroll
•
•
•
•
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Online
Phone
Mail
In-Person
•
Supported
by Data
Services
Hub
(Medicaid/CHIP)
Streamlined, Simplified Implementation
HHS
Paper Application
213
Pages
Online Enrollment
Assistance – It’s Available If You Need It
 Help will be available in the Marketplace
• Toll-free call center - 24/7
 150 languages
 1-800-318-2596 (TTY: 1-855-889-4325)
• Website chat 24/7 (English and Spanish)
• Help in-person
 Navigators
 Other trained enrollment assisters
 Local Community Health Centers, libraries, hospitals and
other locations in local communities
 Agents and brokers
Home Page
Get Insurance tab
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National Snapshot
 41 million eligible uninsured
 17.8 million 18-35 years old
• 58% male
• 26% Latino
• 18% African American
 CBO projects 7 million to
enroll in Marketplaces in
2013-2014.
 HHS has primary
responsibility for outreach in
29 states
 Poverty Level
54%
38%
8%
< 138%
139-400%
400%+
 20% have not graduated
High School
 3.8 million rely on Spanish
 One million rely on some
other language
Reaching the 18 to 35 Year Old Uninsured
Effective
Messaging
 Find a plan that fits your budget
 Health care you can afford and count on when you
need it
 Financial help may be available to lower your
monthly health premium
 All information about what every plan covers and
how much it costs is in one place
Effective
Messengers
 Family - moms, friends, doctors, nurses,
pharmacists.
Media Habits
 91% use internet (but not for health information)
 More likely to watch TV (Galavision, Tres, BET,
MTV, G4, Spike, Oxygen, Style)
Source: CMS and GMMB Market Research
Marketplace.cms.gov
Get the latest
resources to
help people
apply, enroll,
and get
coverage in
2014
05/08/2013
A New Way to Get Health Insurance
Marketplace.cms.gov
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Widgets
Banner/Backdrop
Shop Health Here video
Testimonial video—Barista
Talkers/PowerPoint
Drop-in articles
Op Ed
Postcard for email/list serv sign-up
Consumer “Get Ready” checklist
Collateral brochures
Customizable flyer
PSA/Live Reads
Infographics
Ordering info
Postcards
Collateral brochures
Shop Health Here Video
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Health Insurance Marketplace Key Facts
 6-month open enrollment period begins Oct. 1, 2013
and ends March 31, 2014.
 Coverage begins as soon as Jan. 1, 2014.
 You may be eligible to get lower costs right away to
help you pay for insurance in the Marketplace
(individuals with incomes less than $45,960 or
families of four with incomes less than $94,200).
 For more information, visit HealthCare.gov.
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Be a “Champion for Coverage”
Getting America’s campuses covered begins with YOU!
Let’s create healthier campuses and communities so
students can reach their full potential.
Healthcare.gov
Marketplace.cms.gov
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