Join us as we learn about the benefits of the Affordable Care Act, the ways you can get help paying for insurance, and where you can get help enrolling. (Hint: We can help!)

1. Affordable Care Act Basics
Planned Parenthood
Advocates/Affiliates of Michigan
(PPAM)

2. What is the Affordable Care Act?
Creates new patient protections, new
insurance company regulations, and a
competitive Marketplace for purchasing
health coverage.
Also known as the ACA or Obamacare

3. Enrollment Timeline
2013 Open Enrollment: October 1, 2013 – March 31, 2014
> 1st Phase: October 1 – December 23: Insurance coverage will
begin on January 1st, 2014
> 2nd Phase: December 23, 2013 – March 31st, 2014: Insurance will
begin on a rolling basis based on premium payment
> Open enrollment will begin again November 15th, 2014 –
December 31st, 2014
Note: People can only enroll during open enrollment periods
unless they have a qualifying event

4. Why do we need the ACA?
Nationally: Nearly 48 million uninsured
Michigan: 1.2 million uninsured
Nationally: Significant lack of awareness of eligibility
72% don’t know they are eligible/how the ACA will benefit them

5. Changes to Insurance under Obamacare
Consumer friendly insurance info (EOBs)
No lifetime limits on coverage
Certified health insurance plans (QHPs)
Cannot deny coverage because of pre-existing
conditions.
No more gender rating
Children can stay on their parents insurance
until 26.

6. Major Provisions of the ACA
Essential Health Benefits (EHBs)
Medicaid Expansion
The Marketplace
Tax Credits (APTCs)
Cost-sharing Reductions (CSRs)
Minimum Essential Coverage Requirements (MECs)
Individual Responsibility Requirements

7. Essential Health Benefits
Ambulatory Services (doctors visits, check-ups, etc)
Emergency Services (ER, ambulance, etc)
Hospitalization
Maternity & Newborn Care
Mental Health & Substance Abuse Screenings & Services
Rehabilitative & Habilitative Services
Laboratory Services
Chronic Disease Management
Pediatrics (including pediatric dental & vision)
Preventive & Wellness Screenings
Prescription Drug Coverage

8. Medicaid Expansion
Current:
-Pregnant Women
-Children
-Families
-Elderly
-Blind
-Disabled
Expanded:
-Pregnant Women
-Children
-Families
-Elderly
-Blind
-Disabled
-Childless Adults
•All people with incomes up to 133% FPL 2013: $15,586 (1) $32,499 (4) before taxes
•Michigan: 500,000 newly eligible for Medicaid

9. The Marketplace
Easy, consumer friendly comparison
tools
Requires eligibility to use
 Real-time Eligibility Notices
Medicaid & CHIP Eligibility
Cost Reduction Options
Live Chat Feature
Consumer Assistance –
Navigators, CACs
 Each State has a Marketplace
3 Types:
* Federally Facilitated (FFM) - MI
- State Facilitated (SFM)
- State Partnership (SPM)
www.healthcare.gov

10. Metal Level Plans
SILVER
70/30
BRONZE
60/40
OUT OF POCKET
COSTS
GOLD
80/20
PREMIUMS
PLATINUM
90% Premium/10% Premium
NOTE: As Premiums go up,
Out of Pocket Costs go down
Premiums: monthly costs you pay to have insurance.
Out-of-pocket cost (co-insurance): medical care you pay for after insurance pays covered costs.
Co-pays: fee for service costs you pay for appointments and prescriptions.

11. The Enrollment Process
Insufficient information.
Applicant will need to submit
extra information before
application can move forward.
The individual can apply for coverage
online, in person, by mail, and by phone.
An online application for a single person
can take up to 30-60 MINUTES
MAGIC CURTAIN
Information is entered into the HUB
(IRS, DHS, etc.) to determine eligibility.
Eligibility may be determined in real time
or could take longer.*
An individual comes in
to enroll for health
insurance
Shop and compare
health plans
Enroll in health plan and
potentially pay premium
(individual won’t be covered
until January 1, 2014)
If eligible for federal
premium tax credit, will
start enrollment process
for private plan in the
Marketplace. (May or
may not happen in real
time)
If eligible for Medicaid, receives
Medicaid coverage and starts
Medicaid enrollment process
*The time needed to assess and determine eligibility will
depend on a number of factors, such as the applicant’s
information, type of Exchange, administration of the HUB.

12. Cost Reduction: Tax Credits
Lowers Monthly Premiums
Prorated monthly and payment sent directly to insurance provider
Can use with any plan
Income Based: up to 400%FPL
- $45,960 (1)
- $62,040 (2)
- $94,200 (4)
Consumers can choose amount of APTC to use
If income changes, differences will be reconciled in tax filing (Income goes
up, you will owe money back to the IRS. If income goes down, the IRS will
reimburse the amount you are owed.)
MUST file income tax
Also available for legal immigrants not eligible for Medicaid below 100%FPL

13. Cost Reduction: Cost Sharing Reductions
Reduces out-of-pocket expenses (coinsurance)
Must qualify for APTC to get CSR
Must enroll in Silver Level Plan to use CSR
Income Based & Sliding Scale: below 250%FPL
($58,875 (4))
Example: 100%FPL without CSR = 70/30 coinsurance split
100%FPL with CSR = 94/6 split

14. Individual Responsibility Requirement
FEE (paid when taxes are filed)
Must have QHP with MEC all year
2014: $95/adult or 1% of income (whichever is higher)
2015: $325/adult or 2% of income
Children: 2014 = $47.50
2015 = $162.50
Exemptions are available

15. Fee Exemptions
Available through Marketplace and/or IRS
Exemption Categories:
- financial hardship
- lack of coverage for less then 3 months
- 8% Rule (no coverage available for less than 8% of income)
- income does not meet federal filing threshold
($10,000 for 1 person or $20,000 for family)
- illegal immigration status
- membership in a recognized tribe
- membership in a recognized religious sect that refuses coverage
- incarceration

16. Resources
For Enrollment Assistance
•Call: 1-844-7ENROLL
•Email: 8447ENROLL@ppmchoice.org
State Navigator: MI Consumers for Health Care
http://consumersforhealthcare.org
The Marketplace
www.healthcare.gov or 1.800.318.2596