HEALTH INSURANCE MARKETPLACE TOOLKIT
The Health Insurance Marketplace Is Here
A consortium of the Pennsylvania Mental Health Consumers’ Association (PMHCA), the Mental Health Association in Pennsylvania (MHAPA), and Mental Health America of Westmoreland County (MHAWC) received a grant from the U.S. Department of Health and Human Services to develop a Health Insurance Marketplace Navigator Program to help mental health consumers across Pennsylvania navigate the Health Insurance Marketplace. These Navigators provide information about the Marketplace and give enrollment assistance to people, particularly those who want behavioral health services to be covered by their health insurance. The Navigators are employed by The Advocacy Alliance, PMHCA, MHAPA, and MHAWC.
We need your help to spread the word about the Marketplace and the Navigator Program. Using the communications in this toolkit, please inform your networks, stakeholders, and community about the Marketplace. Help us ensure that no one who is eligible for insurance is left out, left behind, or left on the sidelines of the Marketplace.
This toolkit provides messages for consumer-focused communications. It is designed to help us reach the more than 222,000 people across the state who use or need behavioral health services in their insurance plans, particularly those who experience serious mental illness or serious psychological distress.
Table of Contents
Key Messages
The Health Insurance Marketplace 3
Healthcare.gov 3
Health Plans Offered on the Marketplace and How to Apply for Coverage 3
Enrollment Timing and Key Dates 4
The Health Insurance Marketplace Navigator Program 4–5
The Health Care Law (Affordable Care Act) 5
The Health Care Law in Pennsylvania 5
The Health Care Law and Mental Health and Substance Use Disorder Services 6
The Health Care Law and Preexisting Conditions 6
The Health Care Law and Medicaid and CHIP 6
The Health Care Law and Tax Credits 6
Web Copy 7
Newsletter Article 9
E-mail Copy 11
Social Media Messages 12–13
Website Badges 14
Appendix A
Resources and Information about the Health Care Law and Health Insurance
Marketplace 15
Appendix B
Health Insurance Marketplace Navigator Program Brochures and Flyers 16
Appendix C
Health Insurance Marketplace Navigator Program Letter to Community Orgs 17
Key Messages
The Health Insurance Marketplace
· The Health Insurance Marketplace can help millions of Americans—individuals, families, and small businesses—easily find health insurance that fits their budgets and meets their needs.
· The Marketplace gives Americans who are uninsured, or who buy their own coverage, a whole new way to shop for coverage.
· The best source for the latest and most accurate information about the Marketplace is Healthcare.gov or, for Spanish-speaking consumers, Cuidadodesalud.gov.
· Thanks to the Marketplace, for the very first time, consumers can go to one place to search for health coverage options; get accurate, easy-to-understand information on different plans; and make apples-to-apples comparisons of private insurance plans. They can get comprehensive information about benefits and quality, side by side with facts about price, before making a choice.
Healthcare.gov
· The website offers resources, videos, and checklists—and live web chat 24/7 in English and Spanish—to help individuals and families enroll in the Marketplace.
· Consumers can call the U.S. Department of Health and Human Services at 1-800-318-2596 to speak with a trained customer service representative 24/7. English- and Spanish-speaking representatives are available, and there is a language line to assist callers in more than 150 additional languages.
· Some states have state-based Marketplaces. In Pennsylvania, consumers use healthcare.gov to apply for coverage, compare plans, and enroll.
Health Plans Offered on the Marketplace and How to Apply for Coverage
· Every health insurance plan in the Marketplace offers essential health benefits, including doctor visits, preventive care and wellness services, hospitalization, prescriptions, and mental health and substance abuse disorder services, including behavioral health treatment. Plans must also treat everyone fairly; discrimination against people with preexisting conditions is banned. Coverage starts as early as January 1, 2014, if you complete your application and pay the first premium paid by December 15, 2013.
· No matter where consumers live, they need only fill out a single application on the Marketplace to choose from the health plans available in their area; learn if they’re eligible for programs like Medicaid or the Children’s Health Insurance Program; or find out if they qualify for lower costs on monthly premiums or out-of-pocket costs.
· To apply for insurance consumers will need the following: name, birth date, social security number, and income information for all family members needing coverage.
Key Messages (cont’d)
Enrollment Timing and Key Dates
· Open enrollment—the period when people can enroll in a plan in the Marketplace—is from October 1, 2013 to March 31, 2014. After that, open enrollment will always be from October 15 to December 7 for coverage the following year (for example, open enrollment for 2015 will be from October 15 to December 7, 2014). Consumers may also qualify for special enrollment periods outside of open enrollment if they experience certain events. Consumers can submit an application for health coverage outside of the Marketplace, or apply for Medicaid or CHIP, at any time of the year.
· Four key dates for Marketplace enrollment are:
o October 1, 2013: Marketplace open enrollment started
o December 15, 2013: Last day to sign up and pay for coverage that starts on January 1, 2014
o January 1, 2014: Health coverage can start
o March 31, 2014: Open enrollment ends
The Health Insurance Marketplace Navigator Program in Pennsylvania
· Health Insurance Marketplace Navigators play a vital role in helping people determine their eligibility for insurance and enroll in an affordable coverage program. They also provide outreach and education about the Marketplace.
· Navigators are trained to help people understand the Marketplace structure and to help them complete eligibility and enrollment forms.
· The Advocacy Alliance, MHAWC, MHAPA, and PMHCA provide Navigators who can help people who use or need behavioral health services figure out which coverage and plans they qualify for and help them enroll.
· The Advocacy Alliance, MHAWC, MHAPA, and PMHCA’s Navigators cover Western Pennsylvania (MHAWC), Central Pennsylvania (PMHCA), and Eastern Pennsylvania (The Advocacy Alliance).
· This Health Insurance Marketplace Navigator Program is made possible through a consortium of the Pennsylvania Mental Health Consumers’ Association, the Mental Health Association in Pennsylvania, and Mental Health America of Westmoreland County. The project described was supported by Funding Opportunity Number CA-NAV-13-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
Key Messages (cont’d)
· Consumers can call 1-855-274-5626 (toll free) to make an appointment or speak with a Navigator. Or they can locate a Navigator who serves a specific county in the list below. Language interpreter services are available. The TTY number for people who are deaf or hearing impaired is 1-877-962-5593.
o Western Region Navigators. Counties served are Allegheny, Armstrong, Beaver, Butler, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Venango, Warren, Washington, and Westmoreland. E-mail or call 1-855-274-5626 (toll free).
o Central Region Navigators. Counties served are Adams, Bedford, Blair, Cambria, Centre, Clinton, Columbia, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Lycoming, Mifflin, Montour, Northumberland, Perry, Snyder, Somerset, Union, and York. E-mail or call 1-855-274-5626 (toll free).
o Eastern Region Navigators. Counties served are Berks, Bradford, Bucks, Carbon, Chester, Delaware, Lackawanna, Lehigh, Luzerne, Montgomery, Monroe, Northampton, Philadelphia, Pike, Schuylkill, Sullivan, Susquehanna, Tioga, Wayne, and Wyoming. E-mail or call 1-855-274-5626 (toll free).
The Health Care Law (Affordable Care Act)
· The health care law is already making a difference in the lives of millions of Americans. Since the law was passed:
o 3.1 million young adults have gained insurance through their parents’ plans.
o 105 million Americans have had lifetime limits removed from their insurance coverage.
o 6.1 million people with Medicare received $5.7 billion in prescription drug discounts through 2012, and $2.1 billion was returned to consumers in 2011 because their health plans did not spend at least 80% of premium dollars on care or quality improvements.
The Health Care Law in Pennsylvania
· Because of the health care law, the 88% of Pennsylvanians who have insurance have more choices and stronger coverage than ever before. And for the 12% of Pennsylvanians who don’t have insurance, or Pennsylvania families and small businesses who buy their coverage but aren’t happy with it, new options are now available.
Key Messages (cont’d)
The Health Care Law and Mental Health and Substance Use Disorder Services
· The new health care law is increasing access to mental health and substance use disorder services. Plans on the Health Insurance Marketplace must cover mental health and substance use disorder services.
· New protections are included in the law. Because of the law, health plans must now cover preventive services like depression screening for adults and behavioral assessments for children at no cost. And starting in 2014, most plans won’t be able to deny coverage or charge more due to preexisting health conditions, including mental illnesses.
The Health Care Law and Preexisting Conditions
· Starting in 2014, being sick won’t keep consumers from getting health coverage. Insurance companies can’t turn people down or charge more because of a preexisting condition. And once consumers have insurance, insurance companies can’t refuse to cover treatment for preexisting conditions. Coverage for preexisting conditions begins immediately. This is true even if consumers have been turned down or refused coverage due to a preexisting condition in the past.
· The only exception for covering preexisting conditions is for individual health insurance plans that consumers purchase themselves, not through an employer (also known as grandfathered plans). These do not have to cover preexisting conditions. Consumers who have one of these plans can switch to a Marketplace plan during open enrollment and immediately get coverage for preexisting conditions. (Note: The health care law defines a grandfathered plan as a group health plan that was created—or an individual health insurance policy that was purchased—on or before March 23, 2010.)
The Health Care Law and Medicaid and CHIP
· The Marketplace will tell consumers whether they qualify for Medicaid or the Children’s Health Insurance Program (CHIP). If consumers qualify for Medicaid or CHIP, their coverage can begin immediately. They can also apply for either of these programs at any time.
The Health Care Law and Tax Credits
· The amount of financial help available through the new tax credit is based on income and family size, to ensure that coverage is affordable for everyone. The Kaiser Family Foundation calculator helps people see how much help they and their family will get under the law. It’s available at http://kff.org/interactive/subsidy-calculator/.
· Tax credits are available to anyone earning between 100% and 400% of the Federal Poverty Level (100% FPL = $11,490 for an individual, or $23,550 for a family of 4; 400% FPL = $45,960 for an individual, or $94,200 for a family of 4). And out-of-pocket costs (what people pay for things like copays, coinsurance, and annual deductibles) will also be limited based on income, protecting people from potentially devastating medical costs if they or their loved ones get a serious illness.
Web Copy
The Health Insurance Marketplace is a new way to find health coverage that fits your budget and meets your needs. With one application, you can see all your options and enroll. Every health insurance plan in the new Marketplace offers essential health benefits, such as doctor visits, preventive care and wellness services, hospitalization, prescriptions, and mental health and substance use disorder services, including behavioral health treatment. Compare plans based on price, benefits, quality, and other features important to you before you make a choice.
Once you’ve decided on a plan, you can enroll directly in the Marketplace and make a premium payment by December 15, 2013 for coverage that begins on January 1, 2014. (Open enrollment for 2014 closes on March 31, 2014.)
Apply and Enroll
Visit Healthcare.gov. You can also call the Marketplace at 1-800-318-2596 for more information. TTY users should call 1-855-889-4325. Coverage starts as soon as January 1, 2014.
To apply for insurance you will need the following: name, birth date, social security number, and income information for yourself and all family members needing coverage.
Get Help from Health Insurance Marketplace Navigators in Pennsylvania
Navigators can help you understand how the Marketplace works and complete eligibility and enrollment forms. In Pennsylvania, The Advocacy Alliance, the Mental Health Association in Pennsylvania, Mental Health America of Westmoreland County, and the Pennsylvania Mental Health Consumers’ Association offer Navigators who are trained to help people who use or need behavioral health services.
Call 1-855-274-5626 (toll free) to make an appointment or speak with a Navigator. Or locate one who serves your county in the list below. Language interpreter services are available. The TTY number for people who are deaf or hearing impaired is 1-877-962-5593.
· Western Region Navigators. Counties served are Allegheny, Armstrong, Beaver, Butler, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Venango, Warren, Washington, and Westmoreland. E-mail or call 1-855-274-5626 (toll free).
· Central Region Navigators. Counties served are Adams, Bedford, Blair, Cambria, Centre, Clinton, Columbia, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Lycoming, Mifflin, Montour, Northumberland, Perry, Snyder, Somerset, Union, and York. E-mail or call 1-855-274-5626 (toll free).
· Eastern Region Navigators. Counties served are Berks, Bradford, Bucks, Carbon, Chester, Delaware, Lackawanna, Lehigh, Luzerne, Montgomery, Monroe, Northampton, Philadelphia, Pike, Schuylkill, Sullivan, Susquehanna, Tioga, Wayne, and Wyoming. E-mail or call 1-855-274-5626 (toll free).
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This Health Insurance Marketplace Navigator Program is made possible through a consortium of the Pennsylvania Mental Health Consumers’ Association, the Mental Health Association in Pennsylvania, and Mental Health America of Westmoreland County. The project described was supported by Funding Opportunity Number CA-NAV-13-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.