Everything You Wanted to Know About the ACA and Medicaid Enrollment

 
Everything You Wanted to Know About
                               the ACA and Medicaid Enrollment

                         Health Insurance Marketplace
Beginning in 2014, the Affordable Care Act has a mandate for most individuals to have health insurance
or potentially pay a penalty. Individuals will be required to maintain minimum essential coverage for
themselves and their dependents. Some individuals will be exempt from the mandate/penalty, while
others will be eligible for financial assistance to help pay for the cost of insurance. Minimum essential
coverage is Medicare, Medicaid, Tricare, employer sponsored plans, or plans available on the health
insurance market. It does not include health insurance coverage consisting of excepted benefits like
dental-only plans or Plan First.

Who can apply on the Marketplace?
Individuals who are a U.S. citizen or have lawful presence. Individuals must live in the state
whose marketplace they are applying through and cannot be incarcerated.

Apply Online: Healthcare.gov
Questions? phone: 800-318-2596

When is the open enrollment period?
The first open enrollment period is from October 1, 2013 – March 31, 2014. The next open
enrollment period is from October 15, 2014-December 7, 2014 and will occur annually.

What are the criteria for special enrollment periods outside of open enrollment?
Marriage, change in dependents, loss of an exemption, loss of minimum essential coverage,
change in immigration status, newly eligible for premium tax credits or cost sharing reduction,
gain access to new QHP’s as a result of a permanent move.

Who is considered part of a “household”?
A household is the same as the tax filing unit. If you are married, you must file a joint return for
the coverage year you are requesting tax credits. If you have not filed taxes in previous years
you can still apply for tax credits but must file taxes for the years you are requesting advanced
tax credits.

What information will be needed to apply on the Marketplace?
For all household members you will need name, date of birth, social security number (or
document numbers for legal immigrants), employer and income information, policy numbers for
any current health insurance plan covering members of the household. You should get an
Employer Coverage Tool completed for every job based plan you or someone in your household
is eligible for.
What is a Qualified Health Plan?
Qualified Health Plans will be available on the Marketplace. There will be different levels that
will cover a percentage of costs- premiums, copayments, coinsurance, and deductibles.
Bronze         60%
Silver         70%
Gold           80%
Platinum       90%

Marketplace Qualified Health Plans must have at least the 10 Essential Health Benefits and
cover certain preventive services without charging a copayment or coinsurance, even if you
haven’t met your yearly deductible when services provided within network.

There is also a Catastrophic Plan available for individuals who are under 30 or receive a
hardship waiver. It will include 3 primary care visits until consumers meet plan's deductible.

What are premium tax credits?
A tax credit which can be immediately applied to pay the cost of health insurance premiums.

Who is eligible for a premium tax credit?
Individuals with income between 100-400% of federal poverty level.

[Note: Medicaid expansion should be in effect around April 2014- this will provide Medicaid
coverage to US Citizens/5 year permanent residents with incomes below 138% federal poverty
level.]

Individuals with income below 100% of FPL and are ineligible for Medicaid based on
immigration status (still need lawful presence) may purchase exchange coverage and receive tax
credits.

Is an employee whose employer offers insurance eligible for the premium tax credit?
An employee is eligible for tax credits if their employer insurance offer for single-only
(individual) coverage is unaffordable (more than 9.5% of their W-2 income) regardless of
whether they are actually enrolled in their employer’s plan. If the plan is dropped, this qualifies
as a special enrollment event, so the employee can purchase a QHP (with tax credits) outside
the open enrollment period.

What are cost sharing reductions?
Individuals can receive a reduction in copayments, deductibles and other out of pocket expenses.
If the household income is below 250% of federal poverty level (FPL) and they have selected a
silver plan, you are eligible for the following reductions:
    • 94% reduction with income up to 150% of FPL
    • 87% reduction with income up to 151-200% of FPL
    • 73% reduction with income up to 201%-250% of FPL.
How is income calculated or what is Modified Adjusted Gross Income (MAGI)?
Your Modified Adjusted Gross Income is your adjusted gross income (wages/salary, self-
employment, RSDI, unemployment benefits, spousal support, deduct alimony) plus foreign
earned income and tax-exempt interest.

Not included in the Adjusted Gross Income- child support, veteran's benefits, worker's
compensation, adoption subsidy

Under the Marketplace Exchange, your budget period is projected and annual.

There is NO asset test on the Marketplace.

What is the penalty for not enrolling in a QHP?
In 2014, the penalty will be 1% of income or $95/adult ($285/family), whichever is higher. In
2015, $325/adult ($975/family); in 2016 it will increase to 2.5% of income or $695/adult
($2085/family).

What are some of the exemptions to the penalty?
Marketplace exemptions include: healthcare sharing ministry, incarceration, tribal affiliation,
religious objection and other hardship- premium greater than 8% of income after tax credits,
recent eviction, domestic violence victim, unexpected expense of caring for an ill or disabled
family member.

IRS exemptions include: actual income below filing threshold (in 2012 less than $9,750 for
single person under 65), unlawful presence, no insurance coverage for less than 3 months,
incarceration, healthcare sharing ministry or tribal affiliation.

When will insurance purchased through the marketplace become active?
If enrolled and premium paid by12/15/13 the effective date is 1/1/14.
Thereafter the 1 st -15 th day of the month will be effective the 1 st day of the following month.
The 16th day to the last day of the month will be effective the 1st day of the 2nd following
month. (For example, enrolled and premium paid on 2/15/14 will be effective 3/1/14; if
enrolled and paid on 2/16/14 will be effective 4/1/14.)

If identity cannot be verified online, what forms of identification will be accepted?
The following will be accepted: Identification card, school ID, voter registration card, passport.
Or 2 of the following: birth certificate, social security card, divorce decree, employee ID, high
school/college diploma, property title or deed.

Reasons to request an extension for requested verifications- missing SSA card, missing birth
certificate, inconsistent income, inconsistent address- the Marketplace will ask about time
needed to get missing documents

For what reasons can an individual appeal a decision made by the marketplace?
They can file an appeal if they disagree with the eligibility determination, are denied an
exemption or received an untimely notice of eligibility determination.
What changes should be reported to the marketplace?
A change in income, tax filing unit or relocation.

How does the renewal process work?
A renewal notice will be sent annually. If the individual is satisfied with their health insurance
and have no changes to report, they can reconfirm their enrollment in a QHP. Many details about
the renewal process are unknown.

                             Medicare and the ACA
Will there be changes to Medicare under the ACA?
Yes there will be a few changes.
Preventative benefits will be covered with no cost sharing and it reduces the cost sharing for
prescription drugs.

Are there existing programs to help with Medicare benefits?
Yes, depending on income level.

QMB – Qualified Medicare Beneficiaries provides supplemental Medicaid coverage and pays
monthly Medicare Part B premiums. The income limit is $978 for an individual and $1313 for a
couple.

SLMB (Specified Low Income Medicare Beneficiaries) pays Part B premiums. The income limit
is $1169 for an individual and $1571 for a couple.

The asset limit for QMB and SLMB is $6940 for individual and $10,410 for a couple.

Extra Help Part D Assistance Program provides reduced or eliminated premiums and copays.
The yearly income limit is $17, 235 for individual, $23,265 for a couple. The asset limit is
$13300 for individual and $26580 for a couple.

Contact the Michigan Medicare/Medicaid Assistance Program (MMAP) at 800-803-7174
Medicaid and Medicaid Expansion
Michigan has passed Medicaid expansion but the actual implementation date is still unknown.

The Marketplace should be referring Medicaid eligible people to DHS but remember, from
10/1/13-12/31/13, this will be under the State DHS Medicaid rules in existence now. Beginning
1/1/2014, DHS will begin using new methodology for household size = tax unit and income =
MAGI for Medicaid programs for children, pregnant woman, parents and caretakers.

The citizenship requirement for Medicaid is stricter than the Marketplace. You must be a US
citizen or have at least 5 years with permanent resident card. (There are also MA programs for
refugees, asylees)

Current Medicaid programs
Healthy Kids Medicaid- kids > 1 and pregnant woman- income less than 185%, no asset test
Healthy Kids Medicaid ages 1-19- income less than 150%, no asset test

MI Child- kids coverage income less than 200%, no asset test

Low income parents/caretakers, 19-20 year olds- income less than about 33-37% federal
poverty level for full MA- (income above = deductible/spenddown), asset limit $3000 [This
group eligible for MA under expansion- income to 138%, no asset test and includes adults
ages 19-64 who are not receiving Medicare.]

SSI related Medicaid (aged, blind, disabled) - full Medicaid coverage income at 100% or
below federal poverty level (income above = deductible/spenddown), asset limit $2000/single,
$3000 married. This Medicaid category is expected to remain and is distinct from Medicaid
expansion.

What happens to Maximus?
Maximus has notified qualified agencies that to maintain qualified agency status there will be a
new training session to be certified to submit ACA applications through Maximus, which will
mostly likely continue to be for Healthy Kids, CHIP, MOMS, and Plan First. Available at:
healthcare4mi.com

MAGI Medicaid (aka Expansion/Reform)
Who will be eligible under MAGI Expanded Medicaid?
Individuals who are a U.S. citizen or have a permanent resident card for at least five years.

MAGI related groups- children, pregnant women, parents and caretakers, adult group- 19-64,
not pregnant, not receiving Medicare, former foster care beneficiaries.
Who is considered part of a “household” for MAGI Medicaid?
A household is the same as the tax filing unit.

Income will be Modified Adjusted Gross Income (MAGI):
Your Modified Adjusted Gross Income is your adjusted gross income (wages/salary, self-
employment, RSDI, unemployment benefits, spousal support, deduct alimony) plus foreign
earned income and tax-exempt interest.

Not included in the Adjusted Gross Income- child support, veteran's benefits, worker's
compensation, adoption subsidy

For Medicaid, income is budgeted current and monthly.

There is NO asset test for MAGI Medicaid

How will Medicaid (MA) be managed and what are the benefits?
Most MAGI beneficiaries with be enrolled in a Medicaid HMO with benefits similar to what is
currently available.

Excluded from enrolling in a Health Plan- Plus Care recipients, ESO MA, CSHCS only,
commercial HMO coverage, including Medicare HMO coverage, deductible beneficiaries

Are there child support cooperation rules for MAGI Medicaid?
Yes. There will be child support cooperation rules. However, there will still be exemptions for
good cause such as physical or emotional harm to the individual or child.

Will there be Emergency Services Only Medicaid for MAGI Expansion Medicaid?
Yes. Individuals’ eligible for Medicaid expansion but for their immigration status will receive
Emergency Services Only (ESO) Medicaid.

What changes must be reported for MAGI Medicaid?
Marriage, relocation, birth of children, citizenship, pregnancy, student status and etc.
Monthly Income Limits:
Household       100%      120%          138%             150%          185%         200%       250%        400%
  size      SSI MA/QMB    SLMB      >MA/Tax credit>   HK MA 1-19   HK>1/Pregnant   MI Child     CSR     >Tax credit
   1          $958       $1,149        $1,322          $1,436        $1,771        $1,915     $2,394      $3,830
   2         $1,293      $1,551        $1,784          $1,939        $2,391        $2,585     $3,231      $5,170
   3         $1,628      $1,953        $2,246          $2,441        $3,011        $3,255     $4,069      $6,510
   4         $1,963      $2,355        $2,709          $2,944        $3,631        $3,925     $4,906      $7,850
   5         $2,298      $2,757        $3,171          $3,466        $4,250        $4,595     $5,744      $9,190
   6         $2,633      $3,159        $3,633          $3,949        $4,870        $5,265     $6,581     $10,530

Yearly income:
Household       100%      120%          138%             150%          185%         200%       250%         400%
  size      SSI MA/QMB    SLMB     >MA/Tax credit>    HK MA 1-19   HK>1/Pregnant   MI Child     CSR      >Tax credit

    1        $11,490     $13,788       $15,856        $17,235        $21,257       $22,980    $28,725    $45,960
    2        $15,510     $18,612       $21,404        $23,265        $28,694       $31,020    $38,775    $62,040
    3        $19,530     $23,436       $26,951        $29,295        $36,131       $39,060    $48,825    $78,120
    4        $23,550     $28,260       $32,499        $35,325        $43,568       $47,100    $58,875    $94,200
    5        $27,570     $33,084       $38,047        $41,355        $51,005       $55,140    $68,925    $110,280
    6        $31,590     $37,908       $43,594        $47,385        $58,442       $63,180    $78,975    $126,360
AH private health insurance plans offered on the Health Insurance Marketplace will
offer the same set of essential health benefits. These are minimum requirements but
plans may offer additional coverage. You will see exactly what each plan offers when
you compare them side-by-side on the Marketplace.

    1. Ambulatory patient services
    2. Emergency services
    3. Hospitalization
    4. Maternity and newborn care
    5. Mental health and substance use disorder services, including
       behavioral health treatment
    6. Prescription drugs

    7. Rehabilitative and habilitative services and devices
    8. Laboratory services
    9. Preventative and wellness services and chronic disease management
    10. Pediatric services

    Source:
    https://www.heafthcare.gov/how-can-hsavew
AH Marketplace plans must cover the following list of preventive services without charging you a copayment or
coinsurance. This is true even if you haven't met your yearly deductible and it applies only when these services
are delivered by a network provider. Screenings will be available based on certain criteria and conditions.

     Preventative screenings              I         Preventative screenings               I        Preventative screenings
          for all adults                  I               for women                       I             for children

1. Abdominal Aortic Aneurysm                  1. Anemia screening                             1. Autism screening
   one-time screening
                                              2.   Breast Cancer Genetic Test                 2.   Behavioral assessments •
2. Alcohol Misuse screening and                    Counseling (BRCA)
   counseling                                                                                 3.   Blood Pressure screening
                                              3.   Breast Cancer Mammography
3. Aspirin use                                     screenings                                 4.   Cervical Dysplasia screening

4.   Blood Pressure screening                 4.   Breast Cancer Chemoprevention              5.   Depression screening
                                                   counseling                                 6.   Developmental screening
5.   Cholesterol screening
                                              5.   Breastfeeding comprehensive                7.   Dyslipidemia screening
6.   Colorectal Cancer screening                   support and counseling
7.   Depression screening                                                                     8.   Fluoride Chemoprevention
                                              6.   Cervical Cancer screening                       supplements
8.   Diabetes (Type 2) screening              7.   Chlamydia Infection screening              9.   Gonorrhea preventive medication
9.   Diet counseling                          8.   Contraception                              10. Hearing screening
10. HIV screening                             9.   Domestic and interpersonal                 11. Height, Weight and Body Mass
11. Immunization vaccines                          violence screening and counseling              Index measurements

12. Obesity screening and counseling          10. Folic Acid                                  12. Hematocrit or Hemoglobin
                                              11. Gestational diabetes screening                  screening
13. Sexually Transmitted Infection
    (STI) prevention counseling               12. Gonorrhea screening                         13. Hemoglobinopathies or sickle
                                                                                                  cell screening
14. Syphilis screening                        13. Hepatitis B screening
                                                                                              14. HIV screening
15. Tobacco Use screening                     14. HIV screening and counseling
                                                                                              15. Hypothyroidism screening
                                              15. Human Papillomavirus (HPV)
Source:                                           DNA Test                                    16. Immunization vaccines
https://www.healthcare.gov/what-are-my-
preventive-care-benefits/#part=1              16. Osteoporosis screening                      17. Iron supplements

                                              17. Rh Incompatibility screening                18. Lead screening

                                              18. Sexually Transmitted Infections             19. Medical History
                                                  counseling                                  20. Obesity screening and counseling
                                              19. Syphilis screening                          21. Oral Health risk assessment
                                              20. Tobacco Use screening and                   22. Phenylketonuria (PKU) screening
                                                  interventions
                                                                                              23. Sexually Transmitted Infection (STI)
                                              21. Urinary tract or other infection                prevention counseling and screening
                                                  screening
                                                                                              24. Tuberculin testing
                                              22. Well-woman visits
                                                                                              25. Vision screening
                                              Source:
                                              https://www.healthcare.gov/what-- are-my-       Source:
                                              preventive-care-benef its/#pa rt=2              https:/AAWw.heaithcare.gov/what-are-my-
                                                                                              preventive-ca re-benef its/#pa rt=3
Affordability and Premium Tax Credit Eligibility for Employees and Family Members
                                          (100-400% FPL)

                    Does employee in the family
                                                       1
                   have employer coverage offer?

                                                       Yes

                                             Does employer offer
                                               family coverage?

              No                                                        No,
                                                                   employee-only

                                  Is employee-only                Is employee-only
                                  premium > 9.5% of           premium > 9.5% of
                              household income?               household income?

                           Yes,

         A. Employee                      B. Neither                 C. Employee not
         and family                      employee nor                   tax credit          Yes
        members may                    family members                  eligible, but
         be tax credit                    tax credit                 family members
                                                                                        2
           eligible.   2
                                           eligible.                 may be eligible.

               A

Notes:
   1. This flowchart assumes that plans offered by the employer meet minimum
          value standards (actuarial value of at least 60 percent)..
   2.     Employees and family members who may be eligible for tax credits must meet
          other requirements before fully qualifying, such as having legal residence and
          not having access to government-based plans (Medicaid, Medicare, VA, etc.).
"                 NATIONAL      IMMIGRATION        L A W CENTER         |   WWW.NILC.ORG

                     ion
                                                      MARCH 2013

                                                                  Exempt from individual mandate.
Same access and requirements for affordable coverage
                                                                  Not eligible for Medicare, nonemergency Medicaid,
as U.S.-born citizens.                                            or CHIP.
                                                                  Remain eligible for emergency care under federal law.
Limited federal coverage.                                         Eligible for Emergency Medicaid if low-income.
a Subject to the individual mandate and related tax               Citizen or lawfully present children of undocumented
  penalty (exempt if low-income or meet specific                  parents are eligible:
  exemptions).
                                                                   o To purchase from the state insurance exchange.
• May enroll i n a "qualified health plan (QHP)" from the          o For premium tax credits and lower copayments.
  state insurance exchanges.
                                                                   o For Medicaid or CHIP.
*» Eligible for premium tax credits and lower
                                                                  May seek nonemergency health services at community
   copayments.
                                                                  health centers or safety-net hospitals.
o No waiting periods for enrolling in state insurance
                                                              r

  exchanges or premium tax credits.                               ERlFICATION           REQUIREMENTS

• Eligible for the Pre-Existing Condition Insurance Plan          Only those in a family who are applying for benefits
  (PCIP) and the Basic Health Plan (when available i n a          are required to provide a Social Security number
  state).                                                         (SSN) and their immigration/citizenship status.

• Current federal immigrant eligibility restrictions in           Citizenship or lawful presence must be verified
  Medicaid maintained, including the five-year-or-more            for everyone enrolling in:
  waiting period for most lawfully residing, low-income            o Private health insurance in the state exchanges.
  immigrant adults.                                                o Health insurance premium tax credits.
• Since April 2 0 0 9 , states can choose to provide               o Medicaid and CHIP.
  Medicaid and Children's Health Insurance Program                Status will be electronically verified through:
  (CHIP) benefits to lawfully residing children and
                                                                   o Social Security Administration (SSA) for citizens,
  pregnant women without a waiting period. But in
  states that do not elect this option, these children and         o U.S. Citizenship and Immigration Services (USCIS)
  pregnant women must still wait five years or more                  for non-U.S. citizens via the Systematic Alien
  before they can get affordable health care coverage.               Verification for Entitlements (SAVE) database,
• Citizens of Compact Free Association states who                  o If unable to verify status electronically, enrollees
  reside i n the U.S. remain ineligible for federal                  have an opportunity to provide other documents or
  Medicaid.                                                          to fix the records.
• EXCEPTION: As of August 2012, Deferred Action for               Social Security number of a nonapplicant maybe
  Childhood Arrivals (DACA) grantees are ineligible for           requested to electronically verity household income.
  Medicaid, CHIP, andACAbenefits.                                 If unavailable, other proof of income can be provided.
                                                                  Information about immigration status maybe used
UNDOCUMENTED             IMMIGRANTS
                                                                  only to determine an individual's eligibility.
No federal coverage.
• Not allowed to purchase private health insurance at             This explanation of how immigrants are included in health care
  full cost i n state insurance exchanged).                       reform is per provisions in the Affordable Care Act of 2010 (ACA)
                                                                  (encompassed in the Patient Protection and Affordable Care Act
• Not eligible for premium tax credits' or lower                  (Pub. Law No. 111-148) as amended by the Health Care and
  copayments.                                                     Education Act of 2010 (Pub. Law No. 111-152)).

               Los ANGELES (Headquarters)                                         WASHINGTON, D C

             3435 Wilshire Blvd., Suite 2850                                      1444 Eye Street, NW, Suite 1110
                     Los Angeles, CA90010                NATIONAL                 Washington, DC 20005
                               213 639-3900              IMMIGRATION              202 216-0261
                            213 639-3911 fax             LAW CENTER               202 216-0266 fax
The Path to Health Care Coverage Under the AfFordafole Care Act, in 2014
                                                                                                                           in States that Adopt the Medicaid                            Expansion
                                                                                      Are you age £5 or older?     ygg
                                                                                       (Or otherwise entitled       ^^,1        Eligible for
                                                                                      to Medlars,   e.g. reee/ve                Medicare
This flow chart provides a high-level picture ofthe ways that                                  SSDI.)
people wili obtain health coverage in 2014 under the Patient
Protection and Affordable Care Act (ACA). It is intended as
an overview ofthe pathways to coverage: while individuals
                                                                                                                                                                                                                                                                    Ineligible for Medicaid
may follow thefiow chart and determine possible options,                                                                                                                                                                HO                                   HO                                    NO
                                                                                                                                                                                              Coverage available                   Family Income less.             but m e e t £ H ! P standard.
it is pot intended-to be comprehensive for that purpose.                                                                                                                                       trough patents?                       thanlSPSSFPL?                 (In (vilchigan/e'qual to or
Rather, it is offered as a way to look ahead and better                                                                                                                                                                                                            lesjuian2ut)KofFPL)?
understand tlie many pathways to coverage that will exist in
2014, specifically in states that adopt the ACA's expansion of                                                                                                                                                                        YES
Medicaid eligibility.
                                                                                                                                                                  Uninsured
                                                                   1                                                       Is available premium >E%                (Penalty)
Exemptions from Individual Mandate                                                                                                                                                                                                    Eligible for
                                                                                        •;Doyou choose to                   ofln«me,orareyou                                                     YES
- Exemptfrom filing Income tax                                                           remain uninsured?                  otherwise exempt Tram                                                                                     Medicaid'
- Incarcerated
                                                                                                                             individual mandate?                  Uninsured
                                                                                                                                                                 (No Penalty)
• Member of an Indian tribe
                                                                                            HO                                                  YES
. Those with short coverage gaps and hardships
. Member of religious sect exempted from paying Social
                                                                                                                                                                                                     Choose             YES
  Security, Medicare, payroll, and self-employment taxes                                                           YES                                                                                                             Covered under
                                                                                         Are you less than 26                                                                                option to be on parent's
• Lack access to affordable coverage (as defined in ACA                                       yeareold?                                                                                              policy?
                                                                                                                                                                                                                                   parent's policy
  Sect. 1302)
• Undocumented immigrants
                                                                                                                                                                                                   HO

 CHIP—Children's Health Insurance Program                                                                                                                                                        Choose option.         YEI
                                                                                                                                                                                                                              \J   Buy catastrophic-only
                                                                                                                                                                                             to buy rataitrophk-on!/
 FPL-r-Federa! poverty level                                                                                                                                                                                   1
                                                                                                                                                                                                                              *^         insurance
                                                                                                                                                                                                   insurance?
 SSDi—Social Security Bisabllity Income
                                                                                                                                                                                                          NO
 1
          Option to buy catastrophic-only coverage is available for individuals who
          are exempt from the individual mandate due te hardship or lack of access
          to affordable coverage.                                                                                                                                                             Is available premium on                                         HO
                                                                                                                               •Is health coverage,       NO                            HO
                                                                                                                                                                                               the Individual market               Income equal to or less
 2
          Child-only plan; are available for those under age 21                                                                                                -Income less uian1395i
                                                                                                                                                      1
                                                                                                                            available to you through                                           more than'fiSS of your                tliarciOOSSorFPL?
                                                                                                                                                                        FPL?
 '        Employers with over 200 full-time employees must auto-enroll employees                                                                1
                                                                                                                                 an employer!                                                        income?
          in coverage. Employees may opt out to obtain coverage elsewhere or
          remain uninsured-(wlth possible penalty).
 " Legal immigrants in U.S.
Y£5

                                                                                                WO                          I: available premium            \i available premium NO. Jl available premium
                                                                      Income less than 13954,
                                                                                                                          equal to or hut than B5£        between 8X and 9'5% oF     mora than'9.55£:oFyour-
                                                                          .' FPL? 7                                           of your income?                   yourincomc?"                Income?

                                                                         YES                                                  YES                             Y5-S                         YES

                                                                                                               NO         Income equal lo or feu
                                                                                                                                                     no   Income equaltoor]HI          Income equal toorlesi
                                                                                                                            -iHan'40Q3SFPL?

                                                                                                                              YES                             YE

                                                                                                                            Doeiemployerplan                 Doeiemployerplan
                                                                                                               YES         coverfiOJformore of              cover iOK or more of.
                                                                                                                            your, share ofhealth             your share ofhealth
                                                                                                                          expenses (on average}?           expenses (on average)?

                                                                                                                              MO

                                                                                                                                                                                         Option to accept
                                                                                                                                                                                       employer coverage
                                                                                                                                                            Option toaccept             QR/fauy coverage
                                                                                                                           Option to accept
                                                                                                                                                          employer.coyerage.             on Exchange and
                                                                                                                          employer coverage
                                                                          . Option to                 Option to accept                                     OR buy coverage               receive;p/emiurn
                                                                                                                           OR buy coverage
                                                                       accept employer               employer coverage                                       on Exchange'or \             tax credits (and
                                                                                                                            on Exchange and
                                                                        .coverage (and                ORbuy coverage                                        individual market             . cost-sharing,
                                                                                                                          . receive premium >
                                                                       receive premium                 on Exchange or                                       without premium,                 subsidies If
                                                                                                                             tax credits (and
                                                                      assistance subsidies            individual market                                   tax credits OR buy              income equal to
                                                                                                                               cost-sharing
                                                                       if state offers) OR            without premium                                       catastrophic-only,           or less than 250%
                                                                                           4
                                                                                                                          subsidies if income
                                                                      enroll in Medicaid                  tax credits                                      insurance* OR opt                     4
                                                                                                                                                                                            FPL) OR buy
                                                                                                                             equal to or less
                                                                                                                                               4             out of coverage.            catastrophic-only
                                                                                                                            than 250% FPL)                                                           s
                                                                                                                                                             without penalty            insurance OR-opt
                                                                                                                                                                                          outofcoverage
                                                                                                                                                                                         without penalty

© Cental'for HeiiliJicarefiesafirclifitTraiwformatiori,January 2013
WWwdirfcorR/ACAflowdiart                                                                                                                                                                                 Page 2 of
HEALTH CARE COVERAGE IS REQUIRED IN
                          2014. ARE YOU COVERED?

WHAT YOU NEED TO KNOW:
 Starting Oct 1, there is a new way to find Health Insurance, called the Health
  Insurance Marketplace (also called an Exchange) at HealthCare.gov.
 All insurance plans will cover doctor visits, hospitalizations, preventative care,
  maternity care, emergency room care, and prescriptions.
 If you have a pre-existing condition, insurance plans cannot deny you coverage or charge you
  more.
 Financial help may be available so you can find a plan that fits your budget.
 All insurance plans will show the costs and coverage in simple language with no fine print.
 Act Now: Health Insurance enrollment will be open Oct 1, 2013 until March 31, 2014.
  Coverage will be available starting as early as Jan 1.

       See your options and enroll online at HealthCare.gov or Cuidadodesalud.gov
                   or call 1.800.318.2596. For local help, see other side.
HEALTH CARE COVERAGE IS REQUIRED IN 2014.
                 ARE YOU COVERED?

GET LOCAL HELP:
Casa Latina                                                           UMHS Regional Alliance for Healthy Schools
734.926.4656 ● 4925 Packard Rd, Ann Arbor ● Appointment only          734.998.5795 ● Appointment only ● UMHS-RAHS@umich.edu
Spanish available                                                     Translation services available
Packard Health
734.971.1073 ● 3174 Packard Rd, Ann Arbor ● Appointment only ● Call   Washtenaw Health Plan
and ask for Jennifer Green                                            555 Towner, Ypsilanti ●Walk-in ●Mon-Fri 9am-4pm
                                                                      734.544.3030 ● whp.ewashtenaw.org ● Spanish available
Shelter Association of Washtenaw County
Robert J. Delonis Center, 312 W Huron St, Ann Arbor ●734.662.2829     Washtenaw County Community Support
M-F 8am-5pm ● Appointment only                                        and Treatment Services
                                                                      734.544.3050 ● Mon-Fri 9am-5pm
St. Joseph Mercy Health System
855.753.4726 ● www.stjoeshealth.org/aca                               Regional Navigator — Center for Family Health
                                                                      407 N Jackson St (Wheelchair access: 505 N Jackson St), Jackson
University of Michigan Health System                                  Walk-in and appointments ● Mon-Fri 8am-5pm ● 517.788.8809
877.326.9155 ● Mon-Fri 9am-8pm                                        Translation services available
www.uofmhealth.org/newoptions ● PFC-Counselors@med.umich.edu

                                                      You can also see your options, enroll anytime on your own or get live
                                                         chat assistance at HealthCare.gov or by calling 800.318.2596.
Health Care Coverage is                                                          Health Care Coverage is
                        required in 2014.                                                                required in 2014.
                        Are you covered?                                                                 Are you covered?

WHAT YOU NEED TO KNOW:                                                           WHAT YOU NEED TO KNOW:
 Starting Oct 1, there is a new way to find Health Insurance,                    Starting Oct 1, there is a new way to find Health Insurance,
   called the Health Insurance Marketplace (also called an                          called the Health Insurance Marketplace (also called an
   Exchange) at www.HealthCare.gov.                                                 Exchange) at www.HealthCare.gov.
 All insurance plans will cover doctor visits, hospitalizations,                 All insurance plans will cover doctor visits, hospitalizations,
   preventative care, maternity care, emergency room care, and                      preventative care, maternity care, emergency room care, and
   prescriptions.                                                                   prescriptions.
 If you have a pre-existing condition, insurance plans cannot de-                If you have a pre-existing condition, insurance plans cannot de-
   ny you coverage or charge you more.                                              ny you coverage or charge you more.
 Financial help may be available so you can find a plan that fits                Financial help may be available so you can find a plan that fits
   your budget.                                                                     your budget.
 All insurance plans will show the costs and coverage in                         All insurance plans will show the costs and coverage in
   simple language with no fine print.                                              simple language with no fine print.
 Act Now: Health Insurance enrollment will be open Oct 1, 2013                   Act Now: Health Insurance enrollment will be open Oct 1, 2013
   until March 31, 2014. Coverage will be available                                 until March 31, 2014. Coverage will be available
   starting as early as Jan 1.                                                      starting as early as Jan 1.

                                 You can see your options, enroll, or get live                                    You can see your options, enroll, or get live
                               chat assistance anytime at HealthCare.gov or                                     chat assistance anytime at HealthCare.gov or
                                                    by calling 800.318.2596.                                                         by calling 800.318.2596.
Health Care Coverage is                                                              Health Care Coverage is
                              required in 2014.                                                                    required in 2014.
                              Are you covered?                                                                     Are you covered?
GET LOCAL HELP:                                                                      GET LOCAL HELP:
Casa Latina 734.926.4656 ● 4925 Packard Rd, Ann Arbor ● Appointment only ●           Casa Latina 734.926.4656 ● 4925 Packard Rd, Ann Arbor ● Appointment only ●
Spanish available                                                                    Spanish available
Packard Health 734.971.1073 ● 3174 Packard Rd, Ann Arbor ● Appointment               Packard Health 734.971.1073 ● 3174 Packard Rd, Ann Arbor ● Appointment
only ● Call and ask for Jennifer Green                                               only ● Call and ask for Jennifer Green
Shelter Association of Washtenaw County ● Robert J. Delonis Center, 312              Shelter Association of Washtenaw County ● Robert J. Delonis Center, 312
W Huron, Ann Arbor ● 734.662.2829 ● M-F 8am-5pm ● Appointment only                   W Huron, Ann Arbor ● 734.662.2829 ● M-F 8am-5pm ● Appointment only
St. Joseph Mercy Health System 855.753.4726 ● www.stjoeshealth.org/aca               St. Joseph Mercy Health System 855.753.4726 ● www.stjoeshealth.org/aca
University of Michigan Health System 877.326.9155 ● M-F 9am-8pm                      University of Michigan Health System 877.326.9155 ● M-F 9am-8pm
www.uofmhealth.org/newoptions ● PFC-Counselors@med.umich.edu                         www.uofmhealth.org/newoptions ● PFC-Counselors@med.umich.edu

UMHS Regional Alliance for Healthy Schools 734.998.5795 ● Appointment                UMHS Regional Alliance for Healthy Schools 734.998.5795 ● Appointment
only ● UMHS-RAHS@umich.edu ● Translation services available                          only ● UMHS-RAHS@umich.edu ● Translation services available

Washtenaw Health Plan 555 Towner, Ypsilanti ●734.544.3030                            Washtenaw Health Plan 555 Towner, Ypsilanti ●734.544.3030
Walk-ins ● M-F 9am-4pm ● whp.ewashtenaw.org ● Spanish available                      Walk-ins ● M-F 9am-4pm ● whp.ewashtenaw.org ● Spanish available

Washtenaw County Community Support and Treatment Services                            Washtenaw County Community Support and Treatment Services
734.544.3050 M-F 9am-5pm                                                             734.544.3050 M-F 9am-5pm

Regional Navigator — Center for Family Health 407 N Jackson St                       Regional Navigator — Center for Family Health 407 N Jackson St
(Wheelchair access: 505 N Jackson St), Jackson ●Walk-ins and appointments            (Wheelchair access: 505 N Jackson St), Jackson ●Walk-ins and appointments
M-F 8am-5pm ● 517.788.8809 ● Translation services available                          M-F 8am-5pm ● 517.788.8809 ● Translation services available

                                     You can see your options, enroll, or get live                                        You can see your options, enroll, or get live
                                   chat assistance anytime at HealthCare.gov or                                         chat assistance anytime at HealthCare.gov or
                                                        by calling 800.318.2596.                                                             by calling 800.318.2596.
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