ACA Outreach & Enrollment in AANHPI Communities: Explaining Health Insurance

Coordinator: Welcome and thank you for standing by. At this time all participants will be in a listen-only mode until the question and answer session. At that time if you would like to ask a question you may press Star 1 on your touch-tone phone. Today’s call is being recorded. If you have any objections you may disconnect at this time. Now I would like to turn the call over to Charlene Kazner Charlene Kazner: Hello everyone, thank you very much for participating in this training webinar. My name is Charlene Kazner and this webinar is sponsored by the Substance Abuse and Mental Health Services Administration, SAMHSA. I will be the presenter for the webinar In April of this year we conducted a needs assessment on the outreach and enrollment efforts related to the Affordable Care Act, or ACA, for the Asian-American and Native Hawaiian and Pacific Islander communities The assessment involved 22 community-based organizations from nine states Based on the needs assessment we learned that the demand for in-language in-person certified navigators is very high while resources are very limited. This webinar will provide guidance to community-based organizations’ non-ACA-certified staff on how to explain health insurance and accessing health care to the community. By the end of the webinar you will be able to understand how to explain the value of having health insurance, understand how to explain the value of preventive healthcare and understand how to describe the practical steps for using health insurance to access care There will be Q&A following the presentation The value of having health insurance – – I’m sorry, I lost – – Pardon me. More eight million Americans enrolled in health insurance through the marketplace. 7.9% are Asian-American, 0.1% are Native Hawaiian and Pacific Islanders In addition over 4.8 million are covered by states through the Medicaid and the Children’s Health Insurance Program Why is having health insurance so important? Health insurance helps you to get access to quality healthcare for physical health, mental health and substance abuse. How insurance covers medical care cost, protection from high, unexpected expenses and preventive care and treatment sooner avoiding serious illness and higher cost What is health insurance? Health insurance is a contract between you and your insurance company. You buy a plan and the insurance company agrees to pay some or all of your medical cost. Did you know that an average three-day hospital stay is $30,000 and fixing a broken leg can cost up to $7,500. The value of preventive healthcare; what is preventive healthcare? Preventive healthcare is the most important step you can take to manage your health. It focuses on preventing illnesses, injuries or medical conditions before they actually happen. It extends to people with chronic conditions Many of the top risk factors leading to illness and premature death are preventable. Many Asian-Americans and Native Hawaiian and Pacific Islanders are not familiar with how to access United States or western healthcare system and seek medical help only when they are sick or hurt. Many choose to skip routine examinations and screenings which can prevent serious illness and higher cost Cancer screenings are especially important to Asian-Americans and Native Hawaiian and Pacific Islanders who are less likely to undergo mammograms, pap tests and colorectal screenings Those who smoke habitually smoke more cigarettes a day than any other group. When they are admitted for substance abuse treatment 64% reported alcohol as a problem. Preventive care services detect health problems at an early stage when there is a greater chance for a full recovery. Some of the preventive healthcare services available are screening, immunizations, regular check-ups, routine physicals, colonoscopies, mammograms, Pap smears and counseling Please check for a detailed list of covered preventive care services for adults, women, children and also Medicare Steps for using health insurance to access care. Many Asian-Americans and Native Hawaiian and Pacific Islanders have health insurance

for the first time through the Affordable Care Act. Many do not know how to use their health insurance; they depend on navigators, community health workers, medical staff educators, enrollee counselors, family members, friends and others to help them. They tend to seek medical help only when they are sick and many times in the late stages of an illness. These next steps will help Asian-Americans and Native Hawaiian and Pacific Islander communities to understand and use health insurance to access quality care Here are the 10 essential health benefits Every plan sold in the marketplace will include these benefits: Outpatient care, emergency services for things such as heart attack or broken bones, hospital stays, baby care, mental health, substance abuse, prescriptions, disability care, any lab tests, preventive services and dental and vision for children What are the healthcare plans? There are four different healthcare plans that consumers will have to sign up for, health maintenance organization, or HMO, consists of in-network doctors, specialists and hospitals who provide all the services for these members. The members must receive their referral from the primary care physician before seeing other doctors The plan does not cover out-of-network services except for emergencies. An exclusive provider organization, or EPO, members do not need a referral from a PCP to receive in-network services. The plan does not cover out-of-network services except for emergencies The point of service, or POS, members can visit any in-network provider without a referral Members need a referral to visit an out-of-network provider at a much higher cost. The preferred provider organization, or PPO, members can visit any provider without a referral. Members do not need a referral to visit an out-of-network provider but it will cost more What are the categories of insurance plans? There are four different categories. First is the Bronze Plan; the insurance will pay 60%, the consumer will pay 40%. The monthly payments are lower but there are higher out-of-pocket costs when you receive medical services. The Silver Plan the insurance will pay 70%, the consumer pays 30%. There are higher monthly payments than a Bronze Plan but lower out-of-pocket costs than the Bronze Plan when you receive medical services The Gold Plan the insurance will pay 80%, you pay 20%; higher monthly payment than the silver plan but lower out-of-pocket cost than the Silver and the Bronze Plan when you receive medical care. The Platinum Plan is the highest of all for the monthly payment. The insurance will pay 90% and the consumer will pay 10% This plan has the lowest out-of-pocket cost when you receive medical care How do I get health insurance? You can go online to or you can call 1-800-318-2596 You can also fill out an application that is available at and mail it on, or you can go to for the list of sisters by state. Locally you can go the libraries, community health centers, hospitals and faith-based organizations How do I get help paying for insurance? The amount of tax credits and cost sharing reductions you get depends on your income and family size. If your income falls between 100% and 400% of the federal poverty level you will receive a tax credit that can be applied towards your health premium. In order to get premium assistance you must enroll through the marketplace Premiums can be applied to any of the health plans whether you select the Bronze, the Silver, the Gold or Platinum. As this chart shows a single individual with income ranging from $11,490 to $45,960 and a family of four with income ranging from $23,550 to $94,200 will receive a tax credit If your income is at or below 138% of the federal poverty level you may be eligible for Medicaid. You may receive your premium assistance in three ways; in advance, you may choose to have your assistance sent directly to the health plan you select lowering your monthly premium payment. The insurer will bill you for the rest of the premium. When

you file your taxes you may pay the full price of your premium payment each month and receive your tax credit in full as part of your tax return in the form of a tax refund. Or from an advance in sum when you file your taxes You may choose on a sliding scale to have some of your premium assistance sent to the health plan each month lowering your monthly premium payments and the rest of your premium assistance sent to you as a tax refund when you file your tax return. Here are some health insurance definitions. Premium: This is the amount you pay for your health insurance plan Deductible: Amount you have agreed to pay for health services before your insurance plan starts paying. As an example if the plan you have has a $1,000 deductible the insurance plan pays nothing until you have paid $1,000 for services Co-insurance: This is a percent of the cost for the covered healthcare services that you are responsible for. A co-payment: A fixed amount that you pay for a specific covered healthcare service. This is usually paid at the time of service. When you go to a doctor’s visit you would pay $15 at the time of the visit, and this amount varies. The most you will – Out-of-pocket maximum: This is the most you would pay during a policy period — which is usually one year — before your health insurance starts to pay at 100% What is in and out-of-network? In-network are facilities, providers and suppliers your health insurer has contracted with to provide healthcare services. Contact your insurance company to find out which providers are in-network If a provider is out-of-network it may cost you more to see them. Always check with your provider and insurance company before making an appointment so you will know how much you have to pay. Out-of-network: A provider who doesn’t have a contract with your health insurer or plan to provide services to you Remember you will pay more to use them Networks can change so always check with your provider each time you make an appointment so you know exactly how much you will have to pay for medical services. Your insurance card: After enrolling in health insurance every enrollee will receive an insurance card Your insurance card is proof that you have insurance; carry it with you at all times Your insurance card will show the plan type that you signed up for, the member’s name, member’s number, the group number, any co-pays for PCP or specialist and emergency room, your member service phone number where you can contact your insurer at any time, the prescription group number and your co-pay for prescriptions whether they are generic or name brand Explanation of benefits: After each visit for medical care services you will receive an explanation of benefits. This is not a bill; it’s just an explanation of what will be covered for your medical service. It lists the service description, your provider charges, allowed charges, what is going to be paid by the insurer, what you owe, any remark that the insurance company would like you to know, and it’ll also list the name of the payee in case there was any overpayment on the claim and who to send the reimbursement to Where can I go for care? Primary care providers work with their patients to ensure they get the right preventive services, manage their chronic conditions and improve their health and well-being. Some places may offer services and support that vary based on the needs of the community they serve. You can find a PCP and private medical groups and practices, ambulatory care centers and outpatient clinics, generally qualified health centers, community clinics and free clinics. Also school-based health centers, urban Indian clinics and tribal health centers and Veterans Affairs medical centers and outpatient clinics How do I know if my provider is in-network? Call your insurance company, look at their Web site. Check your membership handbook Let them know if you are looking for something in particular. Do you want a provider who speaks a language other than English? Do you want a provider who can accommodate your mobility or functional impairment? If you already have a provider you like and want to keep, call their office and ask if they accept your coverage

You will have to pay more to see a provider out of your network so always ask your plan if you need prior authorization before you visit your provider. If you don’t get pre-authorization you may be charged for things your health plan would have paid for How do I pick a provider? Call the provider’s office, ask them questions. Do they accept your health coverage? Do they accept new patients? Is the office close to your home or work? Is it convenient for you to get there? Does your provider speak your language or is there an interpreter available to help you? Do they have accommodations for limited mobility or functional impairment? Which hospital or hospitals does the provider work with? Is the office staff respectful and helpful? Sometimes it takes more than one visit to decide if a provider is the right one for you. It is very important that your provider meets your needs. Your provider should be one that you can work with, trust and feel comfortable talking to. Here is a case scenario: Mental health and substance abuse disorder services including behavioral health treatment is now covered by the Affordable Care Act The stigma, shame and embarrassment of mental illness keeps many Asian-Americans and Native Hawaiian and Pacific Islanders from seeking help Kim, a 38-year-old divorced mother of two has a successful job with no health insurance For the past eight months she has worried constantly about losing her job and the ability to provide for her family. She felt depressed, anxious, restless, tired and tense and has difficulty concentrating and conveying very simple things which is out of the ordinary for her. With no health insurance and the stigma and shame of mental illness she felt she had nowhere to go She and her family now have health insurance through the ACA marketplace. With health insurance Kim was able to seek help from her PCP who helped her get mental health assistance. She was diagnosed with generalized anxiety disorder and is currently in therapy and doing very well. How do I fill a prescription? What is a prescription? A prescription is an instruction written by a medical practitioner that authorizes a medicine or treatment for a patient. Once you get a prescription from your provider you may fill your prescription in three different ways You may go to a local pharmacy. Your health plan may require you to use certain pharmacies Your health plan may not pay if you do not use these pharmacies so be sure that you get those pharmacies from your insurance company Mail-order pharmacy; the prescription is sent to the mail-order pharmacy or phoned in by the provider. It may cost less but will take longer to get to you. It is best used for long-term medicines for chronic illness Or you can go on the internet to online pharmacies This can be used for long-term medicine and medical supplies. The insurance Web site has directions for filling or transferring your prescription. Avoid any Web site that claims a doctor can prescribe medicine without seeing you. How do I appeal if my insurance does not pay? If you are charged for tests or services you think your coverage should have paid keep the bill and call the phone number on the back of your insurance card right away. The insurance companies have call and support centers to help plan members What are the penalties? Starting in 2014 the flat penalty for an adult if $95, 50%, or $47.50 for those in the household that are under 18, or 1$ of the household income. In 2015 it increases to $325 per adult or 50% under 18 for $162.50 in 2016, and $696 for adults and 50% would be $347.50. After 2016 the increase is based on the cost of living So as you see as time goes on it gradually increases What are the exemptions? The exemptions for not enrolling in health insurance are if you

are uninsured for less than three months in the year. The lowest price coverage available to you would cost more than 8% on your household income. You don’t have to file a tax return because your income is too low. You’re a member of a federally-recognized tribe or eligible for services through an Indian health services provider. You’re a member of a recognized healthcare sharing ministry. You’re a member of a recognized religious sect with religious objections to insurance including Social Security and Medicare. You’re incarcerated, either detained or jailed. You are not lawfully present in the United States, and hardship Go to to see an extensive list of at least 14 that qualify for an exemption under hardship How do I report a change? You must report a change if you get married or divorced, have a child, adopt a child or place a child for adoption, have a change in income, get health coverage through a job or Medicare, Medicaid, change your place of residence, have a change in disability status, gain or lose a dependent, become pregnant, changes that may affect your income or household size, change in tax filing status, change in citizenship or immigration status or incarceration or release from incarceration, change in status as an American-Indian/Alaska Native or tribal status and any correction to your name, date of birth or Social Security number You can report these changes in two ways, online at, select report a life change and log into your account, or you can contact the marketplace at 1-800-318-2596 Do not report these changes by mail and it is very important to report these changes within 60 days from the life-changing event Where can I go for help? The Asian-American and Native Hawaiian and Pacific Islander communities include many, many ethnic groups. This page lists a few in-language resources on where to go for help, English, Chinese, Bengali and Tongan If there are any questions on the webinar presented today please feel free to call either one of us, Juliet Bui, Perry Chan, Suhaila Khan, myself, Charlene Kazner, or Domin Chan at the e-mail addresses listed. Now we will take any questions that you have. Thank you very much for your participation Coordinator: Thank you. At this time we will begin the question and answer session. If you would like to ask a question you may press Star 1 on your touch-tone phone. Please unmute your phone and provide your first and last name clearly when prompted. To withdraw your question press Star 2, and once again if you would like to ask a question please press Star 1 and record your name. One moment to see if we have any questions. Currently there are no questions in the queue Charlene Kazner: There are no questions? Coordinator: Yes, there are no questions Charlene Kazner: Thank you very much. I hope this webinar was informative for you and you can take this information on to your communities Thank you so much for joining us today. Have a wonderful evening Coordinator: Thank you for your participation This concludes today’s conference and you may disconnect at this time