The Patient Protection and Affordable Care Act

1
The Patient Protection and Affordable Care Act
2
The Promise of Health Care Reform

• Primary Goal Health Insurance Coverage for
  approximately 26 million Americans over 1
  million Illinoisans
• Right Care, Right Time, Right Setting
• Better Health

3
What This Means for Illinois

• 2013 1.7 million uninsured Illinoisans
• By 2015
• More than 400,000 will gain coverage in the
  Health Insurance Marketplace
• Nearly 350,000 will be covered under Medicaid

4
What Health Care Reform Does

• Establishes Health Insurance Marketplace
• Allows states to expand Medicaid effective
  January 1, 2014
• Illinois opted in under Senate Bill 26 /
  Public Act 98-104 signed into law July 22

5
Options for Consumers

• If you already have private insurance, Medicare,
  Medicaid or VA coverage
• Dont do anything
• If you are a legal resident under age 65, earning
  less than 15,302 (individual) or 31,155 (family
  of 4)
• Enroll in Medicaid
• If you earn more than the above limits, up to
  400 of the federal poverty level 45,960
  (individual) or 94,200 (family of 4)
• Receive financial help (premium subsidies) and
  buy insurance in the Health Insurance Marketplace

6
Health Coverage with Good Benefits

• Prescription drugs
• Hospitalization
• Doctor visits
• Preventive care/wellness services
• Mental health substance abuse disorder services
• Pediatric services incl. oral vision care
• NO denials for pre-existing conditions

7
When How Do Consumers Sign Up

• Health Insurance Marketplace
• ILLINOIS Marketplace to be launched by Oct. 1,
  2013
• Open enrollment starts Oct. 1, 2013 and ends
  March 31, 2014
• Create your own account enter information about
  you and your family, including income, household
  size
• Review and compare health plans and premiums
• Find out if you will receive financial help with
  premiums
• Choose a plan
• Coverage begins as soon as Jan. 1, 2014 if you
  enroll by Dec. 15, 2013

8
When How Do Consumers Sign Up

• New Illinois Medicaid Enrollment Website
• ABE or Application for Benefits Eligibility
• URL ABE.illinois.gov
• Sign up starting Oct. 1, 2013
• Sign up also available on walk-in basis at Dept.
  of Human Services offices
• Coverage for newly eligible Medicaid population
  starts Jan. 1, 2014
• BOTH Marketplace and Medicaid
• Can sign up online, by phone, by mail or
  in-person with help of Assister or Navigator

9
Where Consumers Can Get Help

• Communitybased Assisters
• In-Person Counselors outreach, education and
  enrollment assistance
• Navigators outreach, education and enrollment
  assistance
• Certified Application Counselors (includes
  hospitals)
• All Assisters will help consumers apply for
  Insurance Marketplace coverage and Medicaid

10
Website Resources

• www.HealthCare.gov
• www.healthcarereform.illinois.gov
• www.EnrollAmerica.org
• www.GetCoveredAmerica.org