This PowerPoint contains information we have gathered from state and federal communications.
Although largely accurate, the governing bodies “CAN” and “MAY” change some of what you hear today.
Bottom Line: This is what we know
TODAY.

Exchange Timeline
HEALTHCARE REFORM
Patient Protection & Affordable Care Act (PPACA)
Also-Known-As (AKA) - “OBAMACARE”
1.
March 23, 2010 - Healthcare law enacted.
2.
August 2010 - HHS (Health and Human Services Dept.) started issuing planning grants to states.
3.
July 11, 2011 - HHS issued first set of proposed rules
4.
June 28, 2012 - Supreme Court approves PPACA
5.
October 1, 2013 - Open enrollment begins
6.
January 1, 2014 - Mandatory Exchange coverage begins

PPACA Annual Open Enrollment period (AOE)
• October 1, 2013 till March 31, 2014
• October 15, 2014 till December 7, 2014
• October 15, 2015 till December 7, 2015
• October 15, 2016 till December 7, 2016
NO UNDERWRITING/GUARANTEED ISSUE

Penalties for Individuals under PPACA:
• 2014 – The Greater of $95 or 1% of taxable income
• 2015 – The Greater of $325 or 2% of taxable income
• 2016 – The Greater of $695 or 2.5% of taxable income
• 2017 and beyond - Annual adjustments

Modified Adjusted Gross Income (MAGI)
• The Modified Adjusted Gross Income (MAGI) is calculated by adding back certain items to your Adjusted Gross Income. Your Adjusted Gross Income
(AGI) can be found on line 38 of your Form 1040; line 22 of your Form 1040A; or line 36 of your Form 1040NR. IF YOU HAVE NOT FILED A PRIOR YEAR TAX
RETURN, NO SUBSIDY WILL BE GIVEN!
• The following items must be added to your Adjusted Gross Income (AGI) to calculate your Modified Adjusted Gross Income (MAGI):
 Traditional IRA contributions that were deducted.
 Student loan interest amounts deducted.
 Tuition and fees deducted.
 Domestic production activities deducted.
 Foreign income or housing costs excluded on Form 2555.
 Foreign housing deduction taken on Form 2555.
 Savings bond interest excluded on Form 8815.
 Adoption benefits from an employer excluded on Form 8839.

5
6
3
4
Household
Size
1
2
7
8
Each extra
Person
100% 138% 150% 200% 300% 400%
$11,490 $15,856 $17,235 $22,980 $34,470 $45,960
$15,510 $21,403 $23,265 $31,020 $46,530 62,040
$19,530 $26,951 $29,295 $39,060 $58,590 $78,120
$23,550 32,499 $35,325 $47,100 $70,650 $94,200
$27,570 $38,046 $41,355 $55,140 $82,710 $110,280
$31,590 $43,594 $47,385 $63,180 $94,770 $126,360
$35,610 $49,141 $53,415 $71,220 $106,830 $142,440
$39,630 $54,689 $59,445 $79,260 $118,890 $158,520
$4,020 $5,547 $6,030 $8,040 $12,060 $16,080

Healthnet
2.6 Million are eligible for Premium Subsidies and 2.7 are uninsured in CA, 5.3 total
58 COUNTIES HOSPITAL PHYSICIANS
All regions 300 30,000 Anthem Blue Cross
Blue Shield of CA All regions
13 counties
Kaiser
Alameda Alliance
Contra Costa H.P.
Chinese Community H.P.
Ventura County H.C.P.
LA Care H.P.
Valley Health Plan
Molina Health Care
Western Health
Advantage
Sharp Health Care
All Regions
(except 9)
6 (Alameda)
5 (Contra Costa)
4 (SF) San Mateo
12 (San Luis Obispo,
Ventura)
15 & 16 (LA)
7 (Santa Clara)
3 (Sacto), 15,16,17,19
2,3
19
223
204
35
6
35
4
29
12
10
9
15
7
22,040
44,000
14,219
31,000
5,000
315
176
1,005
993
4,508
3,000
2,600
NETWORK
PPO
EPO (SF 4)
HMO (Santa Clara 7)
PPO
EPO (Monterey)
2,4,5,7,8,9,10,14,
15,16,17,18,19
PPO/HMO (LA)
HMO Santa Cruz,
Monterey,
San Bernito
HMO
HMO
HMO
HMO
HMO
HMO
HMO
HMO
HMO

KE Y B E N E F IT S
Ded uct ib le (if any)
Prevent at ive C are
Primary C are Vis it
Sp ecialt y C are Vis it
Urg ent C are Vis it
Generic M ed icat io n
Lab Tes t ing
X-R ay
Emerg ency R o o m
S i l v e r 7 0 / 3 0
$2 0 0 0 M ed ical Ded uct ib le
No C o s t at leas t 1 yearly vis it
$4 5
$6 5
B ro nz e 6 0 / 4 0
$5,0 0 0 Ded uct ib le fo r
M ed ical and Drug s
No C o s t at leas t 1 yearly vis it
$6 0 - 3 vis it s p er year
$70
$6 0
$2 5
$4 5
4 6 5
$2 50
$12 0
$2 5
3 0 %
3 0 %
$3 0 0
Hig h co s t and infreq uent s ervices like His p it al C are and Out p at ient Surg ery
$2 50
3 0 % o f yo ur p lan' s neg o t iat ed rat e
Imag ing
(M R I, C T, PET Scans )
B rand M ed icat io ns may b e s ub ject t o Annual
Drug Ded uct ib le b efo re yo u p ay t he co p ay
Preferred b rand co p ay aft er Drug Ded uct ib le
(if any)
M AXIM UM OUT-OF-
POC KET FOR ONE
M AXIM UM OUT-OF-
POC KET FOR FAM ILY
$2 50
$2 50 d ed uct ib le t hen p ay t he co p ay amo unt
$50
$6 ,4 0 0
$12 ,0 0 0
4 0 %
$50 -$75 aft er meet ing d ed uct ib le
$50
$6 ,4 0 0
$12 ,8 0 0
G o l d 8 0 / 2 0 P l a t i num 9 0 / 10
No Ded uct ib le
No C o s t at leas t 1 yearly vis it
$3 0
$50
$9 0
$2 0
$3 0
No Ded uct ib le
No C o s t at leas t 1 yearly vis it
$2 0
$4 0
$4 0
$5
$2 0
$50
$2 50
HM O
Out p at ient Surg ery -
$6 0 0
Ho s p it al - $6 0 0 / d ay up t o 5 d ays
PPO - 2 0 %
$2 50
$4 0
$150
HM O
Out p at ient Surg ery -
$2 50
His p it al - $2 50 / d ay up t o
5 d ays
PPO - 10 %
$150
No Ded uct ib le
$50
$6 ,4 0 0
$12 ,8 0 0
No Ded ucct inle
$15
$4 ,0 0 0
$8 ,0 0 0

A nnua l Inc o me - - >
KE Y B E N E F IT S
Ded uct ib le (if any)
Prevent at ive C are
Primary C are Vis it
Sp ecialt y C are Vis it
Urg ent C are Vis it
Generic M ed icat io n
Lab Tes t ing
X-R ay
Emerg ency R o o m
Hig h co s t and infreq uent s ervices like His p it al C are and Out p at ient Surg ery
Imag ing
(M R I, C T, PET Scans )
B rand M ed icat io ns may b e s ub ject t o Annual
Drug Ded uct ib le b efo re yo u p ay t he co p ay
Preferred b rand co p ay aft er Drug Ded uct ib le
(if any)
M AXIM UM OUT-OF-
POC KET FOR ONE
M AXIM UM OUT-OF-
POC KET FOR FAM ILY
$15,8 56 -$17,2 3 5
$19 -$57
No Ded uct ib le
No C o s t
$3
$5
$6
$3
$5
$3
$2 5
10 %
No Ded uct ib le
$5
$2 ,2 50
$4 ,50 0
$17,2 3 5-$2 2 ,9 8 0
$57-12 1
$50 0
No C o s t
$15
$2 0
$3 0
$15
$2 0
$5
$75
15%
$50 t hen p ay t he co p ay amo unt
$15
$2 ,2 50
$4 ,50 0
$2 2 ,9 8 0 -$2 8 ,72 5
$12 1-$19 3
$2 8 ,72 5-$4 5,9 6 0
$19 3 -3 6 4
$1,50 0 M ed ical Ded uct ib le $2 ,0 0 0 M ed ical Ded uct ib le
No C o s t
$4 0
No C o s t
1 Annual Vis it
$4 5
$50
$8 0
$4 0
$50
$2 0
$2 50
$6 5
$9 0
$4 5
$6 5
$2 5
$2 50
2 0 % o f yo ur p lan' s neg o t iat ed rat e
$2 50 t hen p ay t he co p ay amo unt
$3 0
$5,2 0 0
$10 ,4 0 0
2 0 % o f yo ur p lan' s neg o t iat ed rat e
$2 50 t hen p ay t he co p ay amo unt
$50
$6 ,4 0 0
$12 ,8 0 0

A blog post (July 11, 2013) created by Marilyn Tavenner, the Administrator of the
Centers for Medicare and Medicaid Services (CMS), clarifies concerns surrounding Exchange operability after last week’s release of new Affordable Care
Act (ACA) regulations. In the post, Tavenner proclaimed that the Exchanges will be fully operational by the October 1st enrollment deadline. Of chief import,
Tavenner responded to concerns about whether or not the Exchanges will verify an applicant’s submitted income information and if there are safeguards in place to prevent applicants from fraudulently receiving subsidies. Tavenner responded in the affirmative to both, stating that an applicant’s income will be compared against tax filings, social security data, and income reports. Tavenner found that individuals who falsely apply for subsidies will run the risk of receiving a penalty for perjury, and that the Internal Revenue Services (IRS) already has mechanisms in place to recollect subsidies that were overpaid or provide subsidies to those that did not initially receive the correct amount.

www.pnacompany.com
Enrollment
Product type: Health
Product name: OBAMACARE
Comments: Income, Household size, etc.
Kenny Phan (800)810-4762
Email: info@pnacompany.com