This document summarizes key aspects of healthcare reform in the United States, including changes taking effect in 2014. It outlines elements like the individual mandate requiring health insurance, subsidies for low-income individuals and families, coverage of pre-existing conditions, open enrollment periods, and the roles of licensed insurance agents versus navigators in assisting with plan selection and enrollment. The reform will lead to major rate increases for individual plans, so the document advises working with a licensed agent to find an affordable plan on or off the new insurance exchanges.
2. What does it mean for you?
Understanding the impact of Healthcare Reform
3. Objectives : Healthcare Reform
Healthcare Law pass in March 2010
Preventive Services law changed in September 2010
Change in benefits for Individual plans in 2014
Non-grandfather vs. grandfather plans
Pre-existing condition law starting Jan 2014
Open enrollment period
Rates Increase 40-100% for Individual Plans
Subsidy and how to qualify ( 1.2 million will qualify)
Penalty for not buying qualified health insurance (QHP)
Insurance Carriers participating in North Carolina exchange
Licensed Insurance Agents
Navigators (20 hours training ) No licensed or Error & Omission Insurance required
5. Pre-existing condition rule in 2014
Kids with pre-existing conditions cannot be turned down for insurance (2010)
Adults with Pre-existing conditions can not be turned down for major medical health insurance
( 2014)
Guaranteed Access to health insurance in all 50 states (2014)
Jan 1, 2014 All pre-existing conditions, medicine, and treatment covered
6. Mandated Insurance changes : Essential Benefits
:
• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care
7. Open Enrollment:What you need to know to get
started?
• October 1- March 31st (6mos ) 1 st year only
• Tax Return filed with IRS for year (2012)
• Federal application for Subsidy
• Health application for Insurance
• Licensed Insurance Agent Navigator ( New position created by Federal Government )
8. LicensedAgent vs. Navigator :Who can I trust?
• 40 hours of classroom required with state exam of 70%
• 24 C.E. credits required every 2 years
• Error & Omission Insurance
• Background Check
• Receive ongoing training from various carriers and new products on a monthly basis
• No-fee for using licensed insurance agent
• Customer Advocate
9. Licensed Agent vs. Navigator :What is a Navigator and
what is there roles?
• 20 hours of training and must pass exam
• (Reduced from 30hrs because not enough time to train before Oct 1)
• Not Licensed
• E& O Insurance not required
• Fee charged by Exchanged for plans purchased that helps pay for Navigator
• Little to no experience with health insurance or insurance in general
• Limit product knowledge (Cannot discuss any plans or carriers outside of the exchange)
10. Ways to handle the huge rate increase coming for Individual
plans?
Have a strategy for getting the right insurance plan (On and Off exchange)
Know what your needs are and how to determine the right plan
Find a licensed Independent Agent or Agency to work with (Don’t go alone)
Shop Insurance Carriers
Customer Reviews of agents past customers (Look for someone with the heart of a teacher)
11. Recap of Changes in Healthcare in 2014
Open Enrollment- Don’t Wait!
$1.2 millions subsidy individual and families in North Carolina
All pre-existing conditions will be covered
Choosing a LicensedAgent or Navigator