SEWA-AIFW MNSure Presentation

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MNSure Presentation
Oct 6. 2013
3702 E Lake St
Minneapolis, MN 55406
www.sewa-aifw.org
Crisis Line: (952) 912-9100
Agenda
• Health Care Directive
• Health Insurance Market Place
– What is MNsure?
– Who should use MNsure to get insurance?
– If my employer offers insurance but it’s too expensive for my budget, can I buy a plan on
MNsure?
– How does MNsure affect you?
– How does MNsure work?
– How can you apply?
– How can you get help?
– If you use MNsure can you keep your doctor?
– How does tax credits work?
– What are the different levels of insurance – Bronze, Silver, Gold, and Platinum?
• Next Steps
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Health Care Directive
• All legal residents should have insurance starting in Jan, 2014 as required
by law through the Affordable Care Act (also known as Obamacare).
• If you do not have health insurance starting in 2014, you will pay a tax
penalty. The penalty will increase over time:
– In 2014, it will be the greater of $95 per adult or 1 % of taxable income
per month.
– In 2015, it will be the greater of $325 per adult or 2 % of taxable
income per month.
– In 2016, it will be the greater of $695 per adult or 2.5 % of taxable
income per month.
SEWA-AIFW Confidential
What is MNsure?
• MNsure, is the state's new online health insurance marketplace,
sometimes called an exchange.
• The Marketplace is a new way to find quality health coverage. It can help if
you don’t have coverage now or if you have it but want to look at other
options.
• Minnesota consumers and small businesses with up to 50 full-time
employees will be able to obtain health insurance through MNsure.
• The Marketplace will also tell you if you qualify for free or low-cost
coverage available through Medicaid or the Children's Health Insurance
Program (CHIP).
SEWA-AIFW Confidential
Who should use MNsure
• Most people will be eligible to purchase health coverage through the
Health Insurance Marketplace. In order to qualify, you must:
– Live in the United States, be a U.S. citizen or national, not be currently incarcerated
• MNsure is for:
– People shopping for individual, family, or small business coverage. People who’ve
bought such plans through an insurance agent or broker can continue to use an agent.
But federal subsidies are only available if your agent or broker is registered to sell on
MNsure.
– Tax credits for individuals and family buyers can only be obtained if you purchase your
health insurance through MNsure.
– MNsure will also serve as the entry point for enrolling in two government insurance
programs: Medical Assistance (Minnesota’s Medicaid program) and MinnesotaCare.
• Does not apply:
– Minnesotans who have health insurance through a large employer won't be using
MNsure.
– MNsure does not affect people enrolled in Medicare, the government insurance
program for elderly Americans.
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Employer’s insurance is too expensive?
• Any Minnesota resident can buy insurance on MNsure whether or not
your employer offers coverage. But for people who choose MNsure over a
workplace plan, there's a relatively high bar to qualify for federal subsidies
that bring down the cost of buying insurance on your own.
• If your employer coverage costs less than 9.5 percent of your household
income, you could still buy insurance on MNsure but couldn’t take
advantage of the law’s tax subsidies.
SEWA-AIFW Confidential
How does MNsure work?
• The website is live as of October 1, 2013 and is designed to offer one-stop
shopping for insurance.
• After entering income and other basic information Minnesotans will be
routed either to government insurance programs -- if their income
qualifies -- or to commercial plans. MNsure will also let you know if you
qualify for tax credits, or other financial help.
• MNsure will allow side-by-side comparisons of commercial plans offered
by different companies or with differing levels of coverage. You can decide
based on your budget, and health situation as to which plan will work you.
SEWA-AIFW Confidential
How to Apply?
• Go to the MNsure website http://mnsure.org.
• The system will guide you through enrollment step-by-step.
– Create an account
• First provide some basic information. Then choose a user name, password, and
security questions for added protection.
– Apply for Marketplace coverage
• Enter information about you and your family, including your income, household
size, and more. Use this checklist now to help you gather the information you’ll
need.
– Pick a plan
• Next you’ll see all the health insurance plans and programs you’re eligible for and
compare them side-by-side. You’ll also find out if you can get lower costs on
Marketplace coverage.
– Enroll
• Choose a health insurance plan that meets your needs and enroll! Coverage starts as soon as
January 1, 2014.
SEWA-AIFW Confidential
Need Help?
•
•
•
•
•
MNsure toll-free call-center 1-855-3-MNSURE, or 1-855-366-7873. Operators are
available to answer questions in English, Spanish, Hmong and Somali. Callers will
also have access to interpreter services in at least 140 other languages.
The call center is open Monday through Friday, 7:30 a.m. to 8 p.m., and on
Saturdays from 9 a.m. to 4:30 p.m., during the open enrollment period, which
ends March 31, 2014.
The state is providing "navigators" and "in-person assisters" to help Minnesotans
enroll in the health plans sold on MNsure. You do not need to pay them use to
their help. If they ask you to pay, you should call MNsure toll free # and report.
Certified application counselors will help consumers through the MNsure
enrollment process as part of their current jobs at hospitals; clinics; associations
and other groups.
Licensed insurance agents and brokers who complete a MNsure training course
will also be able to assist consumers seeking insurance on the marketplace.
Brokers and agents also must be registered with MNsure for a client to receive
federal tax subsidies if the client is eligible. Agents/brokers must disclose their
financial arrangement with insurers to consumers.
SEWA-AIFW Confidential
Current doctor?
• You can see the networks that are available for each plan before
purchasing a policy and see if your Doctor or clinic is included.
SEWA-AIFW Confidential
Tax credits and Cost-sharing reductions
Many people will qualify for new federal subsidies that can help lower health
costs, both the premiums and the care itself.
When you get coverage through the Marketplace, you may be eligible for:
–
Cost-Sharing Reductions, which help lower out-of-pockets costs such as deductibles, copays and coinsurance; and
– Advanced Premium Tax Credits, which reduce the amount you pay each month for your
insurance premium.
• Both subsidies are available only to qualified individuals who are:
– Ineligible for public coverage (Medicaid, Medicare and Children’s Health Insurance Plan)
– Unable to get qualified health insurance through an employer
• Any savings are based on your family size and income.
SEWA-AIFW Confidential
Cost-sharing Reductions:
• In order to take advantage of Cost-Sharing Reductions, you must purchase
a Silver plan on the Marketplace and your modified adjusted gross
income (MAGI) must fall below these maximums:
Family Size
1
2
3
4
5
6
7
8
Income
Up to $28,725
Up to $38,775
Up to $48,825
Up to $58,875
Up to $68,925
Up to $78,975
Up to $89,025
Up to $99,075
Note:Your modified adjusted gross income is your household’s adjust gross
income plus any tax-exempt Social Security, interest and foreign income.
SEWA-AIFW Confidential
Tax Credits
Advanced Premium Tax Credits are sent directly from the government to your health insurer and
are applied to your premium each month. You must apply for this subsidy on the Health
Insurance Marketplace. Unlike the Cost-Sharing Reduction, you do not have to buy the Silver
plan; however, you still must meet certain income requirements, based on family size:
Family Size
Income Range
1
$11,490 to $45,960
2
$15,510 to $62,040
3
$19,530 to $78,120
4
$23,550 to $94,200
5
$27,570 to $110,280
6
$31,590 to $126,360
7
$35,610 to $142,440
8
$39,630 to $158,520
Note: The amount of tax credit you receive depends on your income; you will pay more for your
premiums if your income is near the top of the range and less if your income falls closer to the
bottom. If your income falls below the range for your family size, you may qualify for coverage
under your state’s Medicaid program.
SEWA-AIFW Confidential
Levels of Insurance
Comparing health insurance policies is complicated because the coverage can vary so
widely from one plan to another.
• The federal health care law divides health plans to be sold on health insurance
exchanges such as MNsure into four categories, which named after metals: bronze,
silver, gold, and platinum .
• The tradeoff is this: the higher the premiums and the more extensive the
coverage, the lower the out-of-pocket costs such as deductibles and co-pays.
1. Bronze plan:Will pay about 60 percent of the cost of the plan's benefits; the consumer
pays the rest in deductibles, copays and coinsurance.
2. Silver plan: Will pay about 70 percent of the enrollees' health care costs on average; the
consumer is responsible for the remaining 30 percent.
3. Gold plan: Will pay about 80 percent of the costs; the consumer is responsible for the
remaining 20 percent.
4. Platinum plan: Will pay about 90 percent of the costs; the consumer is responsible for
the remaining 10 percent.
SEWA-AIFW Confidential
Terminology & definitions:
•
•
•
•
•
•
•
Premium: The amount that you and/or your employer pay each month for your family’s
plan. For example, if a plan covers a couple at a rate of $300 per person, per month, the
premium is $600 per month.
Deductible: The amount you must pay each year for any health care you receive before the
insurer will pay for your services. If you do not receive any care, you do not need to pay this
amount. Often plans with no deductible or a low deductible are more expensive, but you will
pay less when you actually get care.
Copay: A flat-dollar amount that you pay when you receive care. For example, you may be
required to pay $20 each time you see a doctor.
Coinsurance: The percentage of the total charge that you pay when you receive care. For
example, you may need to pay 20% of the cost each time you see a doctor.
Formulary: A list of prescription drugs that your health plan will cover. You may pay more if
the drug you take is not on this list.
Network: All of the health care providers that are associated with your health plan. You
generally need to use a provider that is in your network to get your best benefits.
Out-of-pocket limit: The total amount that you would ever need to pay for care in a year. If
you reach this limit, you do not need to pay for any health services you receive until your
plan renews the next year. If you do not receive much health care, you may not meet this
limit and you would pay less.
SEWA-AIFW Confidential
Important dates
• October 1, 2013 – Marketplace open enrollment begins
• January 1, 2014 – Health coverage can begin
• March 31, 2014 – Open enrollment ends\
• Nov 16th – MNSure Enrollment Event
Open Cities Health Center
409 N. Dunlap St
St. Paul, MN 55104
Ph: 651-251-5942
SEWA-AIFW Confidential
Next Steps?
SEWA-AIFW Confidential
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