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.