Welcome to the Illinois Health Matters Blog

What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Saturday, December 28, 2013

Consumer Information for January 1, 2014

As the start of coverage for Qualified Health Plans in the Marketplace approaches, the Centers for Medicare and Medicaid Services (CMS) anticipates that some of the newly insured individuals will have questions about how to access healthcare services. CMS has posted information on Marketplace.cms.gov to address questions that consumers may have with the January 1 start of coverage through their selected health plan.

Individuals who have insurance for the first time or have new plans beginning on January 1 are likely to have many questions related to coverage, premiums payments, co-payments, and other issues and may need to reach their individual insurance plan. Below is information for consumers on how to access their health plans as well as education factsheets explaining how health insurance works.

Payments of Premiums
The deadline to sign up for coverage to start January 1st was December 23rd.

We want to remind you that consumers need to pay their premium directly to the insurance company in order to have coverage by January 1, 2014. Consumers can pay when invoiced by the plan, call the issuer to make payment, or pay online if the plan accepts online payment. All consumers have until at least December 31 to pay for coverage effective January 1, although some insurance companies have extended this deadline. Consumers should check with their insurance company to find out when their first premium is due in order for coverage to be effective January 1. Consumers should also confirm with the issuer that their first month’s premium has been received and that enrollment is complete.

Please note that once a consumer selects a plan through the Marketplace, it may take the health plan 48-72 hours to receive and process the enrollment, so please encourage consumers to continue to periodically check back with their selected health plan. The insurance company will also send plan information and an insurance card to consumers who have completed enrollment including payment of the premium.



(Reposted from the Champions for Coverage December 27, 2014 email)

Saturday, December 14, 2013

As Federal Website Improves, GCI Promotes a “Culture of Coverage” Across Illinois

As the federal website continues to improve, Get Covered Illinois today kicked off its first statewide TV advertising campaign, designed to raise awareness of the new state of healthcare that becomes a reality in 2014, with the opportunity to purchase a health care plan through the Illinois Health Insurance Marketplace.

“Now that the federal website has improved, we are shifting from educating consumers to the next phase of encouraging enrollment. We are urging thousands of uninsured residents in Illinois to get covered in this new state of healthcare that we are entering in 2014,” Jennifer Koehler, Executive Director of Get Covered Illinois said. “If you visited GetCoveredIllinois.gov before but didn’t select a plan, come back and try again. With the upgrades to the federal website that were recently put in place, the enrollment system is working much more smoothly. Now is the time to select a plan and get covered.”

In addition to the TV ad launch, Get Covered Illinois is ramping up its outreach efforts for an enrollment push leading up to Dec. 23, the first of a series of key enrollment dates under the federal Affordable Care Act (ACA). Consumers must enroll in a health plan by Dec. 23, and have paid a premium by Dec. 31, in order to have coverage on Jan. 1 through the plans offered on the Illinois Health Insurance Marketplace, which is accessed through healthcare.gov. The full open enrollment period for the Marketplace runs through March 31, 2014.

The Get Covered Illinois advertising campaign is designed to educate those who need insurance on the essential benefits and financial assistance available through the Marketplace, and to drive enrollment for coverage starting as soon as Jan.1. The advertising includes TV, radio, digital and social media, with an emotional connection to reach broader, multicultural populations of Illinoisans to encourage them to take action.

The nearly $1-million TV ad buy includes the eight major-media markets in Illinois, and is targeted to reach Illinois’ uninsured population. The campaign features one 30-second ad that highlights the all-inclusive nature of the new state of healthcare across Illinois; and two 15-second spots: one that highlights the fact that insurers can no longer deny coverage because of pre-existing conditions, and one that features a mom-to-be.

The TV advertising builds on the radio and digital banner advertising that began on Nov. 18 and is similarly targeted at Illinois’ uninsured population.

In addition to the statewide ad push, Get Covered Illinois and its more than 250 community partners are planning about 300 events to drive coverage around the state before Dec. 23. For planned enrollment events in your area, including those on Dec. 14, visit GetCoveredIllinois.gov and click on the events tab.

“We are encouraged that after two months of education and engagement by our more than 1,500 trained and certified Navigators assisting people to enroll across the state, there is steady feedback that residents are successfully buying Marketplace plans,” said Brian Gorman, Director of Outreach and Consumer Education for Get Covered Illinois. “We want to encourage people to sign up starting at our website, or work directly with a Navigator in your area, or call the help desk. All services are free.”

Get Covered Illinois is also further strengthening its Social Media presence to reach the uninsured through Facebook (www.facebook.com/coveredillinois) and Twitter (@CoveredIllinois). GCI recently launched a series of info graphics on social media that feature “30 Days, 30 Benefits.” The 30 pieces describe how the 10 Essential Health Benefits included in all Marketplace plans link directly to the real-life health needs people confront in their daily lives. GCI will also share testimonials of Illinois residents who have successfully enrolled in the Health Marketplace across social channels. These videos highlight what having health coverage will now mean for their lives.

The following is an operations, engagement and enrollment update from Get Covered Illinois >>

The U.S. Department of Health and Human Services (HHS) has released numbers for the first two months of enrollment under the ACA that indicate 67,936 applications on behalf of 124,252 individual people have been completed from Illinois and that 7,043 people have selected a private health care plan through the healthcare.gov website since Oct. 1.

Traffic on the Getcoveredillinois.gov website has remained steady, with 529,650 website visits since Oct. 1 and more than 245,800 users of the screening tool that leads users either to the federal website or the state’s new Medicaid eligibility site, ABE.illinois.gov (Application for Benefits Eligibility). The ABE site has received more than82,000 applications.

GCI encourages uninsured residents to:
  • Visit the website where you can find out if you qualify for a subsidy and compare health plans side-by-side (there is also a Spanish-language version of the website).
  • Sit with a specially trained Navigator at one of the hundreds of partner sites across the state; find a Navigator nearby through the website by entering a zip code. Bi-lingual Navigators are available.
  • Call the help desk at 866-311-1119. Operators are available to help you each day from 8 a.m. to 8 p.m. Spanish-language assistance is available on the phone.
(Published on Friday, December 13 at Get Covered Illinois)

Tuesday, December 3, 2013

ACA Success Story in Southern Illinois

Laura Olmsted, a Certified Application Counselor (CAC), from Shawnee Health Services, had the great pleasure of helping Bill*, a 53 year old from Marion, Illinois, understand what the Affordable Care Act is all about.

Bill is a hardworking self-employed contractor -- making $23,000/year -- who works independent construction jobs, and has not been able to afford health insurance. However, health insurance is something that Bill desperately requires. In the past year and a half, he has suffered not one, but three heart attacks and a broken femur. Mounting medical bills are causing him incredible financial burden, and preventing him from accessing care that he needs.

Luckily, Bill recently met Laura, who helped him to complete an application on Healthcare.gov once he went through the Get Covered Illinois screener. Bill received great news: not only was he eligible for insurance, but he had options, ranging from the low end of paying nothing for a Bronze level or lower end Silver plan, to only $180 per month for a high-end Silver plan after the premium tax credit was factored in.

Laura’s client considered his choices and selected a Silver Multi-State plan through Blue Cross Blue Shield of Illinois where he pays only pocket change - $4.53 per month - for his premium. The plan has a $250 deductible and an out of pocket max of only $2,000 per year. Bill plans to pay for the premiums up front since the price was so affordable.

Should Bill have looked into buying health insurance prior to the enactment of Obamacare (the Affordable Care Act), he would have encountered a very different situation:
  • No certified enrollment specialist would have helped him find and understand his health insurance options;
  • Unless he was connected with an insurance broker, Bill would have had to shop for plans on his own, rather than being able to compare them all in one place;
  • No tax credits or subsidies would be available to help him afford his premium;
  • Bill may have been denied coverage based upon pre-existing conditions; and
  • If Bill did find coverage, prior to Oct. 1 of this year, he likely would have found a plan with higher premiums and without the requisite 10 essential health benefits like the qualified health plan that he recently purchased.
Because of his new options through the Illinois Health Insurance Marketplace, Bill will now be able to receive the health care necessary to get well, and continue living a healthy, productive life in Illinois.
(*Bill is a fictional name to protect the client's anonymity)

Saturday, November 23, 2013

DOI Moves to Allow Consumers to Continue Current Coverage into 2014

Get Coverage Illinois℠
                        The Official Health Marketplace

The Illinois Department of Insurance (DOI) announced on November 22 that it will follow President Obama’s November 14 recommendation and allow insurance companies to renew a number of health plans in the individual and small group markets that do not meet certain Affordable Care Act (ACA) requirements without being penalized. Illinois joins Florida, North Carolina, Ohio, Kentucky, Kansas, Oregon, South Carolina, Colorado, Hawaii and Texas in giving insurance companies the choice to renew existing health insurance policies with current policyholders.

“DOI came to this decision based on the concerns raised by Illinois consumers and the guidance from the U.S. Department of Health and Human Services,” Andrew Boron, Director of the Illinois Department of Insurance said. “Allowing companies to renew current plans gives consumers more time to evaluate their options and will provide a smoother transition into the health care coverage system envisioned by the ACA.”

DOI will immediately work with insurance companies who choose to extend the terminated or cancelled coverage to quickly renew such policies. In step with President Obama’s announcement, policies in effect on Oct. 1, 2013, in the individual or small group market, can be renewed for a policy year starting between Jan. 1, 2014, and Oct. 1, 2014.

According to notifications received by DOI, approximately 185,340 people in Illinois have been advised by insurers so far in 2013 that their coverage has been cancelled or terminated. DOI’s most recent data indicate that more than 476,000 Illinois residents were insured by private individual policies in 2012.

Today’s announcement was made on the same day that federal authorities pushed back the deadline for enrolling in a plan that begins on Jan. 1, from Dec. 15 to Dec. 23. The change gives people eight additional days in which to consider their options.

For Illinois consumers, the ability to renew plans will depend on their insurance company’s decision of whether or not to exercise this option. Consumers should contact their local insurance agent to discuss what options are available to them.

In addition, according to the federal government, any insurance company choosing to renew a non-compliant plan in 2014 should notify consumers that they can purchase coverage through the Health Insurance Marketplace where they may qualify for federal financial assistance, which may include premium tax credits for small employers and other subsidies for individual consumers. This notice should also advise consumers about the protections under the ACA they are foregoing by renewing their current plans including certain Essential Health Benefits that may not be offered through existing plans. Such protections will be required in plans being sold in the Health Insurance Marketplace.

Insurance companies will not be permitted to sell any new plans after December 31, 2013 that do not meet ACA standards. Consumers seeking healthcare coverage should continue to visit http://getcoveredillinois.gov to learn about new health insurance options available through the Marketplace. Those who may consider keeping their current policy should compare it with new plans offered through the Marketplace which cover more benefits, sometimes at a lower cost. DOI is also recommending consumers that have questions regarding differences between a continuation of their current coverage and benefits afforded to them through a plan on the Health Insurance Marketplace to call DOI’s Office of Consumer Health Information at (877) 527-9431.

The following insurers have received approval to offer coverage through the Illinois Health Insurance Marketplace:

Aetna Life Insurance Company
Coventry Health and Life Insurance Company
Coventry Health Care of Illinois, Inc.
Health Alliance Medical Plans, Inc.
Health Care Service Corporation, a Mutual Legal Reserve Company (Blue Cross)
Humana Health Plan, Inc.
Humana Insurance Company
Land of Lincoln Mutual Health Insurance Company

“Making certain that Illinois residents have access to quality affordable health care remains one of our top priorities,” continued Boron. “Today’s actions reinforce our commitment to a culture of coverage.”

Republished from Get Covered Illinois News

Thursday, November 7, 2013

An Illinois Navigator's Experience Finding Lower Premiums in the Marketplace

I decided I might as well enroll myself with a Qualified Health Plan on the Marketplace before I sat down as an In Person Counselor (with a client) so I tried for a few days right after Oct. 1.

Since the site was so slow, I decided to wait until some of the excitement wore off and tried again in mid-October. I sat down after dinner and put in an hour on the computer. I quickly verified my identity, similar to the online process for requesting your free credit report. I answered simple questions about what streets I have lived on, former cities I lived in, etc. They were all multiple choice questions, and I got them all right!

Then I was able to compare the plans for my county and sort them based on certain features: metal, HSA eligible, out-of-pocket costs, etc. At that point there are fewer plans to choose from and I checked off the "compare box" on three that I thought seemed to be a good fit. After looking at the plans, side by side I was able to click on a link with each that took me to the website for each plan so I could do a provider search. I entered my current doctor and to see if my doctor was in-network. This made it pretty easy for me to decide. The pages did load slowly so I folded laundry while they loaded.

Once I enrolled in health coverage, I had to decide to elect or not to elect to access dental. I went through the same process with the dental coverage, but did find that the links did not work for all the dental plans. I eventually decided on a plan and enrolled. Then I put the laundry away while it loaded and waited.

At the end, I got the page where it said my application was complete. I printed out the page along with my application ID# and am excited to let people know that my premiums are going down!

I self-pay for insurance now and will still do so in 2014. I currently pay just over $340 a month for health and dental. Starting in January, I will only pay $185.10 for health and dental. I make too much money for any tax subsidy, so even without assistance I am seeing a huge benefit. I still get to see the same doctor and dentist that I have had since I was a kid and really cannot complain too much. Buying insurance before privately took more time as I would have to research and deal with the insurance brokers and then the underwriters questioning of any of my possible health issues.

I look forward to helping my clients find affordable options on the Marketplace, too.

Joann Boblick
Certified In Person Counselor
La Grange, IL

Tuesday, November 5, 2013

Clearing up the Facts

There has been a lot of confusion about some recent notices to consumers from insurance companies that sell coverage in the individual insurance market, and I’d like to clear up the facts.

Today, more than 3 out of every 4 Americans get insurance from an employer, Medicare, Medicaid, or the Veterans Benefits Administration. Americans who purchase insurance on their own, however, generally buy coverage in the individual insurance market.

Before the Affordable Care Act, coverage in the individual market often was unaffordable, had high co-pays or deductibles, or lacked basic benefits like maternity care, mental health services, and prescription drug coverage. These plans also had high turnover rates, and often were not renewed at the end of a plan year. One study showed that more than half of enrollees in the individual market left their plan within a year.

The health care law is creating new protections for people in the individual market, as well as strengthening employer-based coverage. In the Health Insurance Marketplace, consumers will no longer be charged more because of gender or a pre-existing condition, recommended preventive services will be covered with no additional out of pocket cost, there will be caps on out of pocket costs, and plans will have to offer a basic package of 10 categories of essential health benefits.

Some insurance companies that sell products in the individual market are making changes to their plans. Plans that were in place before the Affordable Care Act passed, and that essentially have not changed - that is benefits have not been cut or additional costs imposed on consumers - are exempt or “grandfathered” out of these basic requirements that ensure quality coverage. Those grandfathered plans can stay the same. Nothing has changed this fact, and that coverage can continue into 2014, so long as both the insurance company and the consumer agree that it will continue.

Some of less than 5 percent of Americans who currently get insurance on the individual insurance market have recently received notices from their insurance companies suggesting their plans may no longer exist. These Americans have a choice – they can choose a plan being offered by their insurer, or they can shop for coverage in the Marketplace. As insurers have made clear – they aren’t dropping consumers; they’re improving their coverage options, often offering plans that are more affordable.

Today, consumers have a choice of an average of 53 qualified health plans in the states where the federal government runs the Marketplace, including those in which it does so in partnership with states. Nearly all consumers live in states with average premiums below earlier estimates. Moreover, half of the people in the individual market today qualify for lower costs on monthly premiums when signing up for coverage through the Marketplace.

While the product is good, there is no denying the online experience on HealthCare.gov must be improved. We will not stop improving the site until every American that wants it has access to quality, affordable coverage.

Importantly, while the team is improving the site, we have opened up new pathways for consumers to apply for coverage through the Marketplace. There are four basic ways to apply for coverage. Sign up by December 15 for coverage that starts January 1, 2014. Enrollment stays open until March 31.

By Kathleen Sebelius, Secretary of Health and Human Services
October 30, 2013 on the HHS.gov blog

Friday, October 25, 2013

Young Invincibles in Illinois

From Visualizing Health Reform,
Illinois Health Matters
Two months ago, Young Invincibles launched our Midwest Regional office here in Chicago. One of the main reasons why we chose to come to Illinois is that it has one of the highest numbers of uninsured young adults. In Cook County alone, over 158,000 19-35 year olds could be eligible for Medicaid and another 190,000 could be eligible for tax credits to make health insurance more affordable. Across the state, 286,000 19-35 year olds could receive Medicaid. Another 345,000 young adults in Illinois could receive tax credits.

Young Invincibles was founded around providing a voice for young adults in the Affordable Care Act (ACA) debate. Since then, we’ve worked hard to educate our generation about the benefits of the ACA, even as we expanded to work on other economic issues that affect young adults. As of October 1st, the launch of the health care marketplaces, we’ve been hard at work with Illinois Health Matters and many other organizations here in Illinois to spread information about the ACA to many uninsured young adults.

To help with that effort, we’re dispelling a few myths about young adults and health insurance that we’ve heard a lot.

Myth #1: Young adults choose not to get health care because they think they’re young and invincible.
This misconception is actually how Young Invincibles got its name! For the most part, our generation does not believe we are invincible, but instead have been shut out of buying insurance because it traditionally had been too expensive for many people. In fact, over 70% of young adults say that health insurance is very important to them. But, many young adults are just beginning their careers and may be working part-time jobs where they aren’t offered health coverage by their employer and can’t afford it on their own. With the ACA, that will change a lot. Now, a majority of uninsured young adults will be eligible for Medicaid or new tax credits to help reduce the cost of health insurance.

Myth #2: Young adults are young and healthy and won’t get sick or injured.
With more accessible health care, we will be able to take care of ourselves. While injuries can come at any time, like a broken finger playing softball or partially collapsed lung from falling on a speaker (both of which are true stories), it’s harder to predict when you’ll get hurt or sick. Coverage offers protections against those catastrophes. Moreover, many preventive services are now covered under the ACA, such as blood pressure tests, cholesterol screenings, HIV screenings, and many common immunizations. By taking advantage of these new, free benefits, you can prevent and treat diseases and conditions before they become a major issue, saving you money and improving your health.

Myth #3: Obamacare and the ACA are two different things. Obamacare is a type of insurance to be purchased.
Many people are still confused by the use of different names for the Affordable Care Act, such as Obamacare and the ACA. The Affordable Care Act, ACA, and Obamacare all refer to the same law.

There is also no government insurance takeover of private insurance. The only government insurance are programs like Medicare and Medicaid. If you buy a plan on the Health Insurance Marketplace, you will be purchasing private insurance, but with new protections and preventive care to ensure that you are buying a comprehensive plan that truly does cover your health care needs.

While these are just some of the common myths and misconceptions out there about the ACA, we still have a lot of work to do to get more information out to the people who need it. Check us out at health.younginvincibles.org to see what resources and information we have available. You can also vote in our video contest! Don’t forget to check us out on Twitter and Facebook, too!

Brian Burrell
Midwest Regional Manager
Young Invincibles

(Posted originally on the YI Blog)

Wednesday, October 23, 2013

Be Covered Illinois Care Fair a Huge Success

On Sunday, October 6th, Be Covered Illinois hosted a Care Fair with many of its partners on Chicago’s southwest side. It was a sight to see! The doors opened at 11:00am, but by 9:45, a line of people stretched outside the building waiting to get in. By the time the event ended at 5:00pm, 5,227 visitors had attended the event. Fifty-two registered In-Person Counselors representing 15 community organizations staffed the enrollment area, the largest gathering of certified navigators yet to be seen in the nation. A big ‘thank you’ and a shout-out to the following agencies for supporting the event with navigators:

• AIDS Foundation of Chicago
• Chicago Childcare Society
• Children’s Home and Aid
• Chinese American Service League
• El Hogar del Nino
• Health Leads USA
• Illinois African American Coalition for Prevention
• Instituto del Progreso Latino
• Lawndale Christian Development Corporation
• Metropolitan Family Services
• Pilsen Wellness Center
• Puerto Rican Cultural Center and Prime Care
• Sinai Community Institute
• The Resurrection Project
• United Way of Metropolitan Chicago

Despite the fact that the federal site – healthcare.gov – was still having difficulties, the resourceful navigators were able to engage attendees in conversations about the law and make hundreds of follow-up appointments with those seeking to enroll in health coverage on the Illinois Health Insurance Marketplace.

In addition to navigators, there were six groups serving as subject matter experts to help answer questions about the new health care law, and 36 organizations that provided information on the resources they provide for communities. The event was supported by almost 200 volunteers, as well as dedicated medical professionals that provided seven different medical screenings, including 527 flu and TDAP vaccines. As a thank you for attending the event, each family left with a bag of healthy groceries, 2,000 bags in all.

The day’s events were a testament to the fact that there is both interest in and the need to secure access to health insurance, and more importantly, health care services for the many people who until now had few healthcare options. With ACA, they will now have many more opportunities to secure access to coordinated, high quality healthcare when they need it.

The Be Covered Illinois Care Fair provided an important opportunity for community organizations to educate attendees about health reform and the health insurance marketplace and how the law can benefit them. People who came were genuinely hungry for knowledge. Knowledge is power, and that Sunday we empowered 5,227 people to have the information they need to gain new access to health care – care that they told us in no uncertain terms – was not only wanted, but desperately needed. As the day wound down, their personal stories and the smiles on their faces were all I needed to confirm that this Be Covered Illinois Care Fair was truly a success.

Words, however, cannot do justice to the positive spirit and collaboration that infused the Care Fair. To get a better sense of that, please take a look at the story that Sarah Schulte of ABC-7 News did on the news that evening.

If you wish to join us as a Be Covered partner organization, request resources or learn more about what we’re doing, please visit: www.becoveredillinois.org

Donna Gerber

Chair, Be Covered Illinois Campaign
Vice President, Community Investments
Blue Cross and Blue Shield of Illinois

Monday, October 21, 2013

How the Affordable Care Act Helps Immigrants

There are at least 40 million immigrants in the United States, accounting for about 13% of our country’s total population. The Affordable Care Act (ACA, also known as ObamaCare) helps immigrants by providing new and strengthening current health insurance coverage opportunities. Below are six important points about the ACA that all immigrants need to understand.

Lawfully present immigrants are eligible to purchase private health insurance plans in the health insurance marketplaces. Every state has made available to its residents access to a state or federal online marketplace where applicants will be provided a range of affordable private qualified health plans for them to enroll in. Essential health benefits, pre-existing conditions, and preventive care will all be covered under these qualified health plans. Open enrollment in these plans is from October 1, 2013, until March 31, 2014. Applicants must have enrolled in and purchased coverage by December 15, 2013, for coverage to start on its earliest date: January 1, 2014.

Lawfully present immigrants may qualify for federal financial help to lower the cost of their monthly premiums and cost-sharing (e.g., co-payments, deductible, co-insurance) to help them afford a private insurance plan through the Marketplaces. Lawfully present immigrants with household income between 100% and 400% of the federal poverty level (FPL) ($45,960 for an individual or $94,200 for a family of four) are eligible for premium tax credits and between 100% and 250% of the FPL ($28,725 for an individual and $58,875 for a family of four) are eligible for the cost-sharing reduction subsidies. The tax credit alone is estimated to provide $2,700 per family that purchases coverage on the Marketplace, reducing premium cost by an average of 32%. To qualify for this federal financial help, applicants cannot be offered affordable health insurance through their job or be eligible for Medicaid.

Most lawfully present immigrants who meet Medicaid program requirements, such as income and state residency, can enroll in Medicaid after they have been in the United States for 5 years or more. Some groups of lawfully present immigrants do not have to wait five years before they may enroll in Medicaid, including refugees, asylees, and pregnant women and children in some states. Immigrants will benefit greatly in states that choose to add the ACA’S new Medicaid eligibility category, which will expand that program to all adults under age 65 with household income of less than 138% of the FPL (about $15,800 for an individual and $32,500 for a family of four). In fact,more than half (52%) of uninsured Hispanics with incomes below this limit reside in states adding the new Medicaid eligibility category. Use of Medicaid does not affect one’s immigration status (public charge decision) unless the Medicaid use is for long-term care such as nursing home care.

Lawfully present immigrants with household incomes of less than 100% of the federal poverty level are also eligible for the private Marketplace coverage and can get help paying premiums and cost sharing if they are ineligible for Medicaid (either because they are not LPRs or because they are LPRs with less than five years of residency).

Undocumented immigrants may not buy health insurance through the Marketplaces, even at full cost. However, until this is remedied, undocumented immigrants need to know that
community health centers, strengthened by ACA funding, will still accept patients regardless of immigration status, emergency rooms will continue to treat undocumented immigrants for free or at very low cost, many hospitals have charity care obligations that essentially provide free care to low-income patients, regardless of immigration status, undocumented immigrants may purchase health coverage through an employer or a spouse’s employer, undocumented immigrants may purchase private health insurance off of the Marketplace, and some state-funded Medicaid programs are open to them regardless of immigration status.

Undocumented immigrants also need to understand that, if they have family members who are U.S. citizens or lawfully present, these family members are required to have health insurance under the law starting in 2014, or face a penalty at tax time, unless they qualify for some exemption. This means that undocumented parents who have lawfully present or U.S. citizen children must ensure that their children have health insurance (through a child-only private Marketplace plan or through Medicaid, for instance). It’s important to remember that only those individuals in a family who are applying for health insurance are required to provide citizenship and immigration status. So undocumented parents applying through the Marketplace for private or Medicaid coverage for their eligible family members will not be asked for a Social Security Number for themselves (only for the applicants).

There is no charge to individuals who receive in-person help in enrolling in Medicaid or Marketplace coverage. The ACA provides federal funding to train and certify in-person consumer assisters to walk individuals through all of their health insurance coverage options. You can find an in-person assister by going to your Marketplace’s website. These assisters cannot and will not charge individuals for this enrollment assistance, including answering questions post-enrollment. Lastly, enrollment information is not shared with immigration agencies for the purpose of enforcement.

Andrea Kovach
Sargent Shriver National Center on Poverty Law

(Reblog from the Shriver Brief)

Tuesday, October 15, 2013

Getting Ready for The Affordable Care Act

Small Organizations in the Wake of the Affordable Care Act 144Understanding the ways in which the Affordable Care Act (ACA) will affect small organizations and change the shape of the health care market isn't easy, especially with the large amount of misinformation that has been spread about the law. To help make the picture clearer, Donors Forum’s Chicago Grantmakers for Effective Organizations hosted a session on Small Organizations in the Wake of the Affordable Care Act.
Stephanie Altman, Health and Disabilities Advocates, Kathy Chan, EverThrive Illinois, and Judith Haasis, Community Health, provided detailed information about what organizations can expect in the new environment and how the coming changes will affect them as individuals and employers.
Two key things nonprofit employers need to know about the ACA:
  • Organizations with fewer than 50 full-time equivalent employees are not required by the law to provide insurance for their employees
  • ACA provides an increased range of options for insuring employees.
The Small Business Health Options Program, or SHOP, can be accessed through healthcare.govand it can connect businesses with fewer than 50 employees to insurance options that might work for them.
Smaller nonprofits can also benefit from available tax credits. Organizations with fewer than 25 employees and annual average wages of less than $50,000 that pay more than 50 percent of the cost of health insurance premiums for their employees, may be eligible for a tax credit equal to 35 percent of their expenses. Organizations must obtain insurance through the SHOP marketplace to get the credit.
The many variables affecting an organization's health insurance decisions are best served by working with an expert. Navigators or assistors have been trained to work with small businesses and individuals to help them connect to benefits for which they might be eligible.
Businesses and individuals can also work with brokers, who can tailor recommendations to them in ways navigators cannot. Brokers are paid by insurance companies, so they will not add to an organization's expenses, and they can help businesses find plans that work for them.
It is important to note that navigators and brokers are prohibited from charging for their services.
The Individual Market
Along with providing possible subsidies for small businesses, the ACA makes significant changes to the insurance market for individuals. Changes from the ACA can be generally grouped into two areas:
  • Changes that affect the quality of insurance policies
  • Changes that provide more access to health insurance
Some of the provisions in the former category have already taken effect, like the provision stating dependents can remain on an insurance policy until they are 26 and the removal of lifetime limits on benefit amounts. Many major provisions, including the health insurance marketplace, are now starting up, with the marketplace accepting applications in anticipation of a launch in January 2014.
Other provisions will take effect at the beginning of 2014. They will describe a basic level of health insurance that all people should be able to access. There will be far fewer variables insurers can use to adjust premiums. Factors that were used in the past, such as gender or pre-existing health factors, cannot be taken into consideration. The only factors that will affect individual prices are age, geography, and tobacco use.
GetcoveredlogoOn the quantity side, the ACA expands Medicaid eligibility in states that opt in to the expansion, including Illinois, while also providing subsidized insurance options through the marketplace for individuals. This presents several possible challenges for organizations.
First, there is already a shortage of Medicaid specialty care providers, and having more individuals using Medicaid could make this shortage more pronounced. For primary care, Medicaid reimbursement rates are being raised to Medicare levels, which should help shortages in that area. Building specialty care capacity will be a challenge.
Another challenge is that as many as 1.5 million state residents will have insurance they didn't have before, and many of them are not familiar with the best ways to make use of access to preventative care. Helping people use their new resources to best improve their health will be important.
While ACA implementation is expected to significantly lower the numbers of uninsured in Illinois, undocumented immigrants are not covered by the ACA.Organizations committed to providing health care to uninsured, low-income individuals will still be needed. They must figure out how to adapt, including whether they should introduce new revenue streams by doing things such as taking in Medicaid patients.
The new environment presented by the ACA will be challenging, but it also presents opportunities for organizations and funders to enhance the health of people throughout the region as they work together.
Resources for individuals and organizations:

Jason Hardy, Member Services Associate, Donors Forum