Ahirc Nashville Ppt

8/3/2019 Ahirc Nashville Ppt

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Monday November 14, 2011

Presented by: Jim Brown

National Director of Health Services

The Actors Fund

[email protected] x265
mailto:[email protected]:[email protected]


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Children under age 19 with pre-existingconditions cant be denied coverage.

Young adults up to age 26 can stay on or enrollin their parents coverage.

Insurers cant retroactively cancel the policiesof people who get sick.

Insurers cant impose lifetime dollar limits onmedical benefits.


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Uninsured people with pre-existingconditions may be eligible for coveragethrough PCIP.

Pre-Existing Condition Insurance Planhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-

plan/tn.htmlHelp for the uninsured with pre-existing medical conditions thru a

temporary high-risk pool until January, 2014
http://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.htmlhttp://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/tn.html


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Medicare recipients in the coverage gap ordonut hole will receive 50% off drugs

Annual wellness visits and certain preventive

services will be free for Medicare recipients.

Increased funding to Community Health Centers


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Insurers cant refuse coverage to anyone. Most people will be mandated to have coverage or

pay a penalty.

New insurance marketplaces, called Exchanges, will

offer insurance to those who dont get it elsewhere. Subsidies will be available to people who buy

insurance through an exchange with income lessthan 400% of the Federal Poverty Level. ($43,320)

Employers with 50 or more employees who dontoffer insurance will be fined.


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All new plans will offer at a minimum anessential benefits package which limits out-of-pocket medical expenses.

Including: Ambulatory care

Emergency care and Hospitalization

Maternity and newborn care

Mental health and substance abuse Prescription drugs

Preventive and wellness services


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If your income is below $43,320 (single), youwill receive a subsidy to buy insurance throughan Exchange.

Subsidies will cap the amount you spend onpremiums in relation to your total income.

Subsidies will also cap your annual out-of-pocket medical costs.

Example: a person who makes $21,000/yr will have theirpremiums capped at 6.3% of their income, and their annualout-of-pocket medical costs will be limited to $1,983/yr(excluding premiums).


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Under age 30: high-deductible plan option

(2014). Prevention benefits and 3 primary

care visits are exempt from deductible.

Under age 26 on family plan as mentioned.


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If you have a new policy that began on or after9/23/2010, you can get certain preventiveservices for free:

Blood pressure, diabetes & cholesterol testsBreast, colon & cervical cancer screenings

Vaccines, immunizations & flu shots

HIV & STD testing

Screenings for healthy pregnanciesWell-child visits


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Available beginning 2010 tax year

Employers with fewer than 25 FTEs employees withaverage wages of less than $50,000 that purchase

health insurance for employees are eligible for thetax credit

To be eligible, employer must offer a group healthplan & contribute at least 50% of premium cost

2010-2013: credit max is 35% of employercontribution (25% for tax exempt/non-profits); willincrease to 50% (35% for non-profits) in 2014
http://www.irs.gov/newsroom/article/0,,id=223666,00.htmlhttp://www.irs.gov/newsroom/article/0,,id=223666,00.html


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Artists Health Insurance Resource Center:www.ahirc.org

Office of Consumer Information and Insurance

Oversight: www.hhs.gov/ociio Federal health care reform website:

www.healthcare.gov

Kaiser Family Foundation: www.kff.org
http://www.ahirc.org/http://www.hhs.gov/ociiohttp://www.healthcare.gov/http://www.kff.org/http://www.kff.org/http://www.healthcare.gov/http://www.hhs.gov/ociiohttp://www.ahirc.org/


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Employment-related coverage Purchase private plans Government-subsidized programs

If you leave/get laid off from a job COBRA Continuation of employer benefitsfor at least 18 months60 days to decide/elect coverageSticker Shock guaranteed coverage, butcan be expensive. Pay full premium, at grouprate.


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Colleges & Universities Alumni Associations

Association Plans

Chambers of Commerce
http://www.texashealthoptions.com/http://www.texashealthoptions.com/


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Words to Know HMO, PPO, HSA, High

Deductible or Catastrophic Coverage

Choose a carrier & type of policy to meetyour needs and your budget.


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http://www.ehealthinsurance.com/http://www.ehealthinsurance.com/


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Householdsize Annual income Monthly income1 $10,830 $9032 14,570 1,214

3 18,310 1,5264 22,050 1,838


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http://www.tn.gov/tenncare/forms/tenncareoverview.pdf
http://www.tn.gov/tenncare/forms/tenncareoverview.pdfhttp://www.tn.gov/tenncare/forms/tenncareoverview.pdf


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http://www.tn.gov/tenncare/tenndercarehttp://www.tn.gov/tenncare/tenndercarehttp://www.covertn.gov/index.htmlhttp://www.covertn.gov/index.html


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http://www.covertn.gov/index.htmlhttp://www.covertn.gov/index.htmlhttp://www.covertn.gov/index.htmlhttp://www.covertn.gov/index.html


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http://www.covertn.gov/web/cover_kids.htmlhttp://www.covertn.gov/web/cover_kids.html


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http://www.covertn.gov/web/cover_rx.htmlhttp://www.covertn.gov/web/cover_rx.html


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$4 Generics @ Target and Walmart

Pharmacy Checker

www.pharmacychecker.com

Partnership for Prescription Assistance

www.pparx.org
http://www.pharmacychecker.com/http://www.pparx.org/http://www.pparx.org/http://www.pharmacychecker.com/


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http://www.covertn.gov/web/pcip_chart.pdfhttp://www.covertn.gov/web/pcip_chart.pdfhttp://www.covertn.gov/web/pcip_chart.pdfhttp://www.covertn.gov/web/pcip_chart.pdf


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Sliding-scale clinics Health Center Program: ask.hrsa.gov/pc

Vine Hill Clinic

http://www.uchshealth.org/clinics

United Neighborhood Health Services 10 locations

http://www.unitedneighborhood.org

Siloam Health Care Centerhttp://www.siloamhealth.org/
http://www.uchshealth.org/clinicshttp://www.uchshealth.org/clinicshttp://www.unitedneighborhood.org/http://www.unitedneighborhood.org/http://www.siloamhealth.org/http://www.siloamhealth.org/http://www.siloamhealth.org/http://www.unitedneighborhood.org/http://www.uchshealth.org/clinics


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ADAP HIV+ or AIDS Medications

1-800-525-2437

The National Breast & Cervical CancerProgram Participating providers

Income: up to 250% of FPL http://health.state.tn.us/BCC/index.htm
http://health.state.tn.us/BCC/index.htmhttp://health.state.tn.us/BCC/index.htmhttp://health.state.tn.us/BCC/index.htm


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Dental discount plans and dental insurance

Dental schools Meharry Medical College School of Dentistry

http://www.mmc.edu/education/dentistry/patientcare.html

Negotiate with your dentist

Many of the Community Clinics have low-cost or free dental clinics for people withlow incomes.
http://www.mmc.edu/education/dentistry/patientcare.htmlhttp://www.mmc.edu/education/dentistry/patientcare.htmlhttp://www.mmc.edu/education/dentistry/patientcare.htmlhttp://www.mmc.edu/education/dentistry/patientcare.html

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