Getting Ready for the Health Insurance Marketplace: Behavioral Health Treatment Providers



making sure that individuals with mental health and substance use conditions have health care coverage is a major priority for mental health and substance abuse treatment providers and the substance abuse and mental health services administration Samsa the new health insurance marketplace will provide opportunities for people without health insurance to sign up for the first time beginning in October 2013 for coverage beginning as soon as January 1st 2014 Samsa has teamed up with national organizations whose members and affiliates interact with these individuals every day our goal is to help you let patients clients and community members know about their new health insurance options explain the benefits of enrolling in one of the new plans provide basic assistance in helping them apply and connect them with trained assisters in their communities as needed this toolkit will provide you with resources to learn more about health insurance explain it to your patients and clients their families and community members and get ready for the health insurance marketplace our organization is participating in one of five different coalition's with which Samsa is working Samsa is working closely with the Centers for Medicare and Medicaid Services CMS to coordinate and disseminate materials with current information on the marketplace and on enrollment we are partnering with many different national provider organizations who have local members or affiliates working together to reach our patients and clients the toolkit is divided into three main sections first we describe the health care law how it works and how it is important for mental health and substance abuse treatment providers and their patients and clients then we explain how you can use the health insurance marketplace to get information about and to apply for health coverage finally we provide a wealth of communication materials and ideas to help you get the word out about who will benefit from this new coverage before we begin we will provide a brief overview on how to navigate through this information the toolkit has several features you can use to get the most out of the materials we will share besides the main presentation screen there is a dock of widgets you can use to access the resources described in each slide move back and forth within the presentation and see a transcript of the narration you can also share with others through social media channels the next few slides show how to navigate the toolkit this is your presentation screen you can use the media player in the top right corner shown here to pause and start the program if you minimize that window it is available in the dock below just click the blue icon to reopen to the left of the presentation is one of several resource lists here you will find links and documents available as part of this toolkit there are many resources so only the first resource list is showing now there are more below in the dock as shown in the green icons pictured with a folder click on one of those icons to see additional resources as they are discussed during the session to the right of this window is the chapters dialog box if you want to jump to a particular section you can click on the title of that section to advance the presentation to that point again you can minimize this window and open it again from the dock below when you need it other widgets available in the dock include this icon that provides instructions on how to order printed CMS materials a transcript that is synchronized with the presentation so you can read along and icons that provide links to make it simple to share this presentation on social media sources many Americans are currently uninsured or underinsured when key parts of the health care law also known as the Affordable Care Act take effect in January 2014 Americans will gain access to quality health insurance about 25 million will be newly insured thanks to the health care law this includes a significant number of individuals with mental or substance use disorders which studies show make up nearly 25% of all uninsured people the Center for Medicare and Medicaid Services known as CMS has prepared an overview of the health care law and the health insurance marketplace for partners and stakeholders that you might find useful we've included it as resource 1 if you would like to learn about statistics and characteristics of uninsured people with behavioral health conditions in your state or local area click on resource to the health care law expands access to health insurance by preventing the most common abuses by health insurance companies starting in 2014 the health care law will prohibit health insurers from charging more or denying coverage to people because of pre-existing conditions a chronic illness or condition previous treatment for an illness injury or other condition or occupation it will also prohibit denying coverage due to age charging women more for insurance or charging individuals higher premiums due to their health status the health care law requires most insurance policies in the individual and small group markets including all qualified health plans sold through a marketplace to offer a comprehensive package of items and services known as essential health benefits ehb essential health benefits must include items and services in 10 specified categories including mental health and substance use disorder services resource three describes each state's essential health benefits according to a recent report by Health and Human Services office of the assistant secretary for planning and evaluation which is available as resource for there are forty seven and a half million Americans without health insurance and twenty five percent of uninsured adults have a mental health or substance use disorder or both additionally around one-third of those with health coverage through the individual market have no coverage for substance use disorder services nearly twenty percent lack coverage for mental health services and many that do have coverage for these services are not provided comparable benefits with other medical services the Affordable Care Act will expand mental health and substance use disorder benefits and parity protections for 62 million Americans because of the new health care law there will be a significant increase in the number of individuals with mental and substance use disorders who are able to access the mental health and substance use services they need in their report ASPI estimates that thirty two point 1 million americans will gain access to coverage that includes mental health and/or substance use disorders that comply with federal parity protection and an additional 30 point four million americans who currently have some mental health and substance abuse benefits will benefit from federal parity the health care law will accomplish this by improving consumer access to mental and substance use services new health insurance plans must offer coverage in certain essential health benefits categories which include mental health and substance use disorder services providing comparable coverage new parity regulations will provide coverage for behavioral health services comparable to other chronic health conditions like diabetes asthma and hypertension establishing new consumer protections no individual can be denied coverage the because their mental or substance use disorder is deemed a pre-existing condition this is critical for the individual seeking or in recovery the healthcare law creates a new way to get health insurance the health insurance marketplaces a health insurance marketplace provides a way for individuals and families to identify the best coverage for their needs and to see if they qualify for a premium discount also known as a tax credit or cost-sharing or for public coverage options such as Medicaid the new marketplace will provide detailed information about health plan prices benefits and quality in clear plain language this way individuals will be able to make meaningful comparisons between plans and get a clearer picture of what they'll be paying and what they'll be getting before they make a choice individuals will be able to use a single streamlined application for coverage under a qualified health plan that will determine if they qualify for premium discounts also known as tax credits and cost-sharing reductions to lower their out-of-pocket costs in the plan the application will also show whether they may be eligible for programs such as Medicaid and the Children's Health Insurance Program chip qualified health plans are offered in four categories called the bronze silver gold and platinum levels all marketplace insurance plan categories offer the same set of essential health benefits the category you choose affects how much your premium costs each month and what portion of the bill you pay for benefits such as prescription medications the health-care law requires that within a health insurance marketplace insurers must offer at least one silver and one gold plan the marketplace application can be filled out and submitted online by phone through the mail or person there are many ways to get help in finding the best health care coverage resources are available for people who have questions or need help applying these include a toll-free call center that's open 24 hours a day seven days a week individuals can ask a trained customer service representative questions about the marketplace and the enrollment process customer assistance is provided in more than 150 languages other resources that will be available to help people include a website with health plan comparison tools and live chat services such as the navigator program will provide in-person assistance with the process of enrolling and using health insurance community-based organizations like ours and other third party assistors also will play a large role in helping people apply for health insurance coverage the health-care law permits licensed agents and brokers to help people enroll through the marketplace if the state allows it it's important to note that some of these assistance resources such as the marketplace call centers websites and navigators will be unbiased and impartial while others such as the insurer zone websites and call centers and agents and brokers who contract with them will not resource 5 is a fact sheet that provides a brief message directing individuals to the marketplace call center to get help and information regarding the marketplace the message includes the call center phone number and is duplicated in 26 different languages to assist with widespread distribution resource 6 describes other types of consumer enrollment assistance including navigators and other trained and certified assistance personnel as we get closer to October we will provide you with more detailed information about the assistance process and how your organization will be able to help the new premium discount or tax credit available through the marketplace generally available to individuals and families with annual incomes between 100 and 400 percent of the federal poverty level that's eleven thousand four hundred and ninety to forty five thousand nine hundred and sixty dollars for an individual and $23,550 for a family of four in 2013 who do not have access to certain other types of minimum essential coverage people who qualify can use the premium discount to lower their monthly marketplace health plan premiums starting in 2014 the payment goes directly to the insurance company the premium discount will make health coverage more affordable in addition to the premium discounts some people will qualify for cost-sharing reductions which apply to deductibles coinsurance and co-payments an applicant must one have an annual household income that is less than or equal to two hundred and fifty percent of the federal poverty level twenty eight thousand seven hundred and twenty five dollars for an individual and fifty eight thousand eight hundred and seventy five dollars for a family of four in 2013 to meet the requirements to enroll in a health plan through the marketplace and receive the premium discount and three enroll in a silver-level plan through the marketplace certain American Indians and Alaskan Natives who purchase health insurance through the marketplace do not pay any cost sharing if their annual income is under three hundred percent of the federal poverty level roughly thirty four thousand four hundred and seventy dollars for an individual and seventy thousand six hundred and fifty dollars for a family of four in 2013 in Alaska those numbers are forty-three thousand fifty dollars for an individual and eighty eight thousand three hundred and twenty dollars for a family of four there are four basic steps involved in the enrollment process first an individual must a marketplace account second starting in October they will complete a marketplace application they will then see all plans and programs for which they are eligible and we'll find out if they are eligible for premium discounts or cost-sharing reductions after comparing plans side-by-side the third step is to pick a health plan the fourth and final step in the enrollment process is to enroll in the chosen plan with coverage starting as early as January 1st 2014 resources 7 & 8 are English and Spanish versions of the infographic in this slide which can be handed out to patients and clients to inform them of the basic steps for enrolling through the marketplace resources 9 and 10 are English and Spanish versions of the marketplace application checklist which provides a short list of the details that need to be gathered before applying for coverage the way the health insurance marketplace will be implemented differs by state states are able to choose whether they want to run their own marketplaces or have the federal government run their marketplace either with or without some state involvement states also may be expanding Medicaid coverage to 133 percent of the federal poverty level every state must offer a comprehensive package of items and services known as essential health benefits essential health benefits must include items and services within at least 10 categories including mental health and substance use disorder services to learn more about the health care law and how the marketplace will operate in your state click on resource 11 this toolkit consists of easy to use materials currently available and located in one place for your convenience so you can pick and choose what works best for your organization this includes articles fact sheets and brochures digital and web content videos posters and postcards events and outreach tools and a glossary of terms most commonly used all of these materials are available free of cost for you to download print use on your website or incorporate in your social media strategies such as Facebook and Twitter outreach many materials for consumers are available in Spanish along with Korean Vietnamese Russian and many more languages in this next section we're going to walk you through what is available as we progress throughout the materials you will notice a resource number on the lower left of most slides these correspond to the numbers in the resource lists and any time you may click on the resource list button to access and download the materials directly a file will be available with the entire toolkit for you to access and download these materials also can be found on marketplace.cms.gov the toolkit has been prepared for you and your organization to disseminate materials throughout your community and directly to your consumers and their families you may use any and all if possible of the materials the materials have been designed to align with outreach efforts that your organization may be planning or already doing such as posting updates in monthly e-newsletters or blogs presenting at national and local conferences conducting training webinars with your staff to update them on the latest information about the health care law and using educational materials during one-on-one sessions with consumers and family members the materials can be printed for distribution or posted on your website or Facebook sites CMS also will be providing printed copies of some of the materials if you are interested in being notified when these materials can be ordered register at the web address provided in the CMS materials ordering widget now let's see what is available for you to use articles are available with content that can be used in your newsletters and on your websites some examples include postings of what's new for creation of a health care reform corner to provide updates you may want to include information in your newsletters or emails about how to prepare for what's coming in October this article explains how the health insurance marketplace will help individuals obtain quality and affordable health insurance it also provides details about the enrollment process as well as where to go for more information about the marketplace and enrollment general and customized versions for special populations are available in both English and Spanish click on resources 12 through 19 to view the different versions of this article this article provides more information about the health insurance marketplace including how the marketplace makes it easier to find and obtain insurance and what marketplace health plans must cover it directs individuals to the website healthcare.gov and to the new toll-free marketplace

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