Get Covered America
Justine Ceserano
NJ State Director
November 26, 2013
Who Is Enroll America
Enroll America is a non-partisan, not for profit
organization that is committed to enrolling a
maximum number of people in affordable
health coverage through the Marketplace in NJ
Introduction to the Affordable Care
Act aka as Obamacare
The Affordable Care Act was signed into law in
March 2010 and ratified by the Supreme Court
in June of 2012. It is the law of the land
ACA Consumer Protections
With the ACA, insurers can no longer charge
you more in terms of premiums nor deny you
coverage because of:
• Your gender, occupation or credit history
• A pre-existing condition
– And they cannot cancel your coverage if you
become sick
• There limits on cost adjustments for age and
tobacco use
Additional Consumer Protections
• Insurers can no longer put yearly or lifetime
limits on coverage
• Young adults can remain on their parents’
health insurance policy until they rae 26 years
of age
• If insurers don’t spend enough (80%0 to
improve and pay for medical services, they
must return the money to their customers
through rebates
ACA is Already Making a Difference in
Our Lives
Since the passage of the Affordable Care Act:
• 3.1 million young adults have gained coverage
through their parents plans
• 105 million Americans have had lifetime limits
removed from their insurance coverage
• 6.1 million people with Medicare have
received 5.7 billion dollars in drug discounts
Benefits That Must Now Be Included
in your Health Plan
•
•
•
•
•
Doctors’ visits
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance abuse services,
including behavioral health treatment
• Prescription drugs
Benefits continued
• Rehabilitative and habilitative services and
devices
• Laboratory services
• Preventive and wellness services, along with
chronic disease management
• Pediatric services including oral and vision
screening
ACA increases your Access to
Affordable Care
In many cases, you may get preventive services
for free:
• Cancer screenings such as mammograms and
colonoscopies
• Vaccinations such as flu, mumps and measles
• Cholesterol screenings
• Tobacco cessation counseling and
interventions
• Birth control
• Depression screening
For additional included services, visit
healthcare.gov/prevention for a full list
Let’s Get Back to Enroll America
Our Role:
• To provide as much educational and outreach
throughout the state so that residents are
well prepared to enroll
Our Focus
We ARE focused on……
• Outreach and
education to
consumers
• Maximizing health
coverage
enrollment
We Are NOT focused on….
• Medicaid Expansion
• voter registration
• Small Business health
coverage
• In-person assistance
Saturation Location of New Jersey’s
Uninsured
As A Result, Enrollment Will Be A
Challenge
To
Overcome
Many of the uninsured still don’t know about their options
November 2012
78%
of the uninsured don’t
know about the new
health insurance
options
August 2013
43%
of the uninsured don’t
know about the new
health insurance
marketplace options
Enroll America still has work to do, but the uninsured are hearing more
and more about the new options available to them
Source: Enroll America, November 2012
Source: Kaiser Family Foundation, August 2013
Lack of awareness provides opportunity for education with effective messaging
14
Awareness of new health coverage
options is increasing
But many of the uninsured still don’t know
Still
100%
PERCENT OF UNINSURED AWARE
90%
80%
43%
70%
60%
50%
40%
30%
45%
20%
10%
57%
22%
0%
November 2012
Source: Enroll America
June 2013*
August 2013*
*Source: Kaiser Family Foundation
15
Many
Are
Unaware
Consumers want to know their
options
12%
16%
Source: Enroll America, November 2012
69%
16
Four Key Messages to Reach Most Uninsured
All insurance plans will have
You might be able to get
to cover doctor visits,
hospitalizations, maternity
financial help to pay for a
care, emergency room care,
health insurance plan.
and prescriptions. One of these =
top message
for 89% of
population
If you have a pre-existing
condition, insurance plans
cannot deny you coverage.
Source: Enroll America, November 2012
All insurance plans will have
to show the costs and what is
covered in simple language
with no fine print.
State of the State:
Who are the Uninsured?
Over 900,000 uninsured New Jerseyans
The greatest saturation of uninsured is in the
northern counties of the state – Essex, Hudson,
Bergen and in the central part of the state, Middlesex
There are also significant numbers of uninsured in
Mercer County (Trenton), Camden (Camden City),
Atlantic (Atlantic City)
State of the State:
Our Marketplace
New Jersey has opted for a federally facilitated
Marketplace. The Marketplace opened on October 1,
2013 and close on March 31, 2014.
Governor Christie has expanded eligibility criteria for
Medicaid. It is anticipated that approximately 350,000
residents of the state will qualify for Medicaid with
implementation of expansion criteria.
Who Qualifies for Enrollment
• An individual, family or small business not
eligible for coverage through someone or
someplace else (an employer)
• All legal citizens and legally present residents
of the state
• Non-incarcerated individuals
• Members of Congress
Financial
Assistance
Who is Eligible?
• Income <400% of poverty
– 400% of poverty = $44,680 for a single adult, $92,200 for a family of four
• Are immigrants eligible?
– Legal immigrants, yes
– Undocumented immigrants, no
• Refundable, advance-payment federal tax credit (“APTC”)
– Do not have to wait until file taxes to get the tax credit – it can be applied to
the cost the coverage when they enroll
– If taken in advance, tax credit goes directly to health plan consumer chooses
– Pays a portion of consumer’s monthly premium
21
Enrollment Checklist
Before consumers start the enrollment process, they will need to gather:
•
Social Security Numbers (or document numbers for legal immigrants)
•
Employer and income information for every member of your household who
needs coverage (for example, from pay stubs or W-2 forms—Wage and Tax
Statements)
•
Policy numbers for any current health insurance plans covering members of your
household
•
A completed Employer Coverage Tool for every job-based plan you or someone in
your household is eligible for. (You’ll need to fill out this form even for coverage
you’re eligible for but don’t enroll in.) (see
https://www.healthcare.gov/downloads/MarketplaceApp_Checklist_Generic.pdf
for this complete checklist)
4 ways to Enroll
•
Can enroll by phone (800) 318-2596, in person, using paper application or
online at www.healthcare.gov.
•
Give basic info about self and household
 Contact information and who’s applying for coverage
 Income/types of income
 Number of people in household
 Citizenship/immigration status
 If have affordable coverage now
Process will vary from state to state
•
If applying
online or by
phone…
Enter
essential
information
System
pulls
existing
data about
applicant(s)
Supplement
or correct
info, if
needed
Or, enroll in
Medicaid
or CHIP
System
determines
eligibility
23
Pick a plan,
amount of
tax credit to
receive in
advance,
enroll!
By phone
Official Hotline
1-800-318-2596
• 24 hours a day
• 7 days a week
• 150 languages
Online
www. healthcare.gov
Next steps
Next steps
FILL OUT A
COMMIT CARD!
We’ll provide
additional support and
information
Next steps
Get help
from an
in-person
assister
Next steps
GET ENROLLED
Volunteers wanted
• We need your help!
• Everyone has a place in this campaign.
• There is no job too small to make a difference
If you care, then you can help!
Thank you.