Getting Ready for the Health Insurance Marketplace: Consumer, Family, Peer & Recovery CBOs

“Making sure that individuals with mental
health and substance use conditions have health care coverage is a major priority for consumer,
family, peer, and recovery community organizations and the Substance Abuse and Mental Health
Services Administration (or SAMHSA). 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 1, 2014.”
“SAMHSA has teamed up with national organizations whose members and affiliates interact with
these individuals every day. Our goal is to help you let consumers, their families, 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 consumers, their
families, and community members; and get ready for the Health Insurance Marketplace.”
“Our organization is participating in one of five different enrollment coalitions with
which SAMHSA is working. SAMHSA is working closely with the Centers for Medicare and
Medicaid Services (CMS) to coordinate and disseminate materials with current information
on the Health Insurance Marketplace and on enrollment.”
“Here are our coalition partners.” “Their national organizations’ and local
members or affiliates are all working together to reach consumers and families to educate
them about the health care law in preparation for coverage expansion.”
“The toolkit is divided into three main sections. First we describe the health care law, how
it works, and how it is important for consumer, family, peer, and recovery community organizations
and their consumers and family members. Then we explain how you can use the Health Insurance
Marketplace to get information about and apply for health coverage. Finally, we provide a
wealth of communication ideas and materials 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.” How Do I Use the Toolkit?
“The toolkit has several features that 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 that you
can use to directly 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 re-open.”
“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.”
“The other icons available in the dock include this icon that provides instructions on how
to order printed CMS Materials; a transcript of this presentation 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.”
Understanding How the Health Care Law Helps “Now that you are familiar with how to use
the toolkit, let’s review how the Health Care Law will help millions of Americans.
” “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
2. ” “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
ten specified categories including mental health and substance use disorder services.
” “Resource 3 describes each state’s Essential
Health Benefits. According to a recent report by HHS’ Office of the Assistant Secretary
for Planning and Evaluation (available as Resource 4), there are 47.5 million Americans
without health insurance and 25 percent of uninsured adults have a mental health or substance
use disorders or both. Additionally, around one-third of those with health coverage through
the individual market have no coverage for substance use disorder services, nearly 20
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. These facts have been
a major concern for consumer, family, peer, and recovery community organizations.”
“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, ASPE estimates that 32.1 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 30.4 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 comparably to other chronic health conditions like diabetes, asthma and
hypertension.” “Establishing new consumer protections-
No individual can be denied coverage because their mental or substance use disorder is
deemed a “pre-existing condition. This is critical for the individuals seeking or in
recovery.” Using the Health Insurance Marketplace
“The Health Care Law creates a new way to get health insurance: Health Insurance Marketplaces.
A Health Insurance Marketplace provides a way for individuals and families to identify
the best coverage for their needs, and 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.”
“A 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 they can get a clear 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
like 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 online, by phone, by mail or in 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, where 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, and programs like the Navigator program, which provides in-person assistance
with the process of enrolling and using health insurance.”
“Community-based organizations, like ours, and other third party assistors will also
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 is important to note that some of the
assistance resources, such as the Marketplace call centers, websites and Navigators will
be unbiased and impartial, while others like the insurers’ own websites and call centers,
as well as 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 is a fact sheet that describes other types of consumer enrollment
assistance, including Navigators and other trained and certified assistance personnel.”
“The new premium discount (or tax credit) available through the Marketplace is generally
available to individuals and families with annual incomes between 100% and 400% of the
Federal Poverty Level or $11,490-$45,960 for an individual and $23,550 – $94,200 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 will go 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 copayments. An applicant must: 1) have an
annual household income that is less than or equal to 250% of the Federal Poverty Level
which is $28,725 for an individual and $58,875 for a family of four in 2013; 2) meet the
requirements to enroll in a health plan through the Marketplace and receive the premium discount;
and 3) enroll in a silver-level plan through the Marketplace.”
“Certain American Indians and Alaska Natives who purchase health insurance through the
Marketplace do not pay any cost-sharing if their annual income is under 300 percent of
the Federal Poverty Level, roughly $34,470 for an individual and $70,650 for a family
of four in 2013 (in Alaska, $43,050 for an individual and $88,320 for a family of four).”
“There are four basic steps involved in the enrollment process. First, an individual must
create 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 will 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 1, 2014.” “Resources 7-8 are English and Spanish versions
of the infographic in this slide, which can be handed out to consumers and family members
to inform them of the basic steps for enrolling through the Marketplace. Resources 9-10 are
English and Spanish versions of the Marketplace Application Checklist (referenced in the infographic),
which provides a short checklist of the information that needs to be gathered to apply 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% 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 user disorder services. To learn more about the
health care law and how the Marketplace will operate in your state, click on Resource 11.
You can also click on the map in the slide, which will open a webpage that allows you
to click on specific states to learn more.” “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 (widgets), 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. At 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” “The toolkit has been prepared just 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 on 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, website
postings of “what’s new” or for creation of a “health care reform ‘corner’”
to provide updates.” “You may want to include articles 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 information 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 12-19
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 plan must cover. It directs individuals
to and to the new toll-free Marketplace call center to obtain more information
about how to get insurance through the Marketplace. For the full version of this article, click
Resources 20-21; for a shortened version that can be used for drop-ins, click Resources
22-23. Both versions are available in English and Spanish.”
“These fact sheets and brochures are helpful products that can be used by your staff when
working one-on-one with consumers and their family members, distributed at local community
events or health fairs, and attached to listserv emails. They provide basic information on
the benefits of enrollment, what health insurance is, and how this insurance can make health
care more affordable. They can be easily downloaded. In the next few slides, we’ll show you what’s
available for different groups of individuals and in different languages. Printed copies
of several items are available free through CMS. Use the CMS ordering widget in the dock
to learn which are available and how to order them. ”
“This brief brochure explains the benefits of Health Insurance Marketplace and describes
what steps consumers can take to prepare before open enrollment begins in October. It is available
in many different languages. Also, customized versions have been created for Alaska Natives
and American Indians. Click on Resources 24-36 to access the brochures. You may be able to
order printed copies of this brochure from CMS. Click on the CMS widget on the dock to
learn how.” “As a companion piece to the previous brochure,
the Value of Health Insurance provides an introduction to what health insurance does,
how much it costs and how it helps individuals pay for health care. The brochure is available
in numerous languages and as in the earlier brochure, customized for Alaska Natives and
American Indians. Click on Resources 37-49 to access these brochures. You also may be
able to order printed copies of this brochure from CMS.”
“These fact sheets provide a quick, easy to understand overview of why different groups
of individuals should consider applying for health insurance. Easy to print, they are
available in both Spanish and English. They can be put in racks or on desks throughout
your locations or handed directly to consumers and family members when you meet with them.
Click on Resources 50-64 to download these fact sheets.”
“This next set of brochures provides an overview of the benefits of the Health Care Law in
simple language. To download these brochures in English and Spanish, click Resources 65-66.
This content is also available in video and PowerPoint training formats so you can do
group presentations or just have the video running in recovery centers and various other
community locations for consumers and family members to view.”
“As we get closer to October 2013, you may want to begin using these fact sheets. They
contain information about how to get ready to enroll in the marketplace, things to think
about when choosing a health plan, and key dates to keep in mind. Available in both English
and Spanish, these fact sheets will be extremely useful to distribute at community events.
Click on Resources 67-72 to view these fact sheets.”
“To help explain health reform and the benefits and options offered through the Health Insurance
Marketplace, there are several videos available for you to use with your organization’s
staff and directly with your consumers and their families. We’ll describe the various
types and provide links in the next few slides.” “In a series of short testimonial videos of
“real life” experiences, people like Jaime describe life without health insurance and
discuss their plans to enroll in the new health coverage options available this fall through
the Health Insurance Marketplace. Click Resource 73 to watch Jaime talk about how she is looking
forward to obtaining health insurance through the Marketplace.”
“Other real-life testimonials show people from all walks of life describing how different
provisions of the Health Care Law will help them access and pay for health care. Click
Resource 74 to visit the YouTube channel and watch people talk about how they
will benefit from the elimination of exclusions based on pre-existing conditions, the elimination
of lifetime limits on most benefits, the requirement that prevention services be provided free
of charge, and other Health Care Law provisions. There are English and Spanish videos.”
“The Health Care Law and You video, available in English and Spanish as Resources 75-76,
describes how the Health Care Law ends the worst insurance company abuses, makes health
care more affordable, strengthens Medicare, and provides better options for coverage.
The video runs about 11 minutes and provides a visual, storytelling experience that can
be used during one-on-one sessions or shown in a community venue.”
“This animated video presents information on the Health Insurance Marketplace, including
how the Marketplace makes choosing a health insurance plan easier, and what health coverage
requirements all plans in the Health Insurance Marketplace must meet. Click Resources 77-78
to view English and Spanish versions of this video.”
Trainings “As mentioned previously, this PowerPoint
presentation contains information similar to that provided in the brochure of the same
name. The presentation is customized for several different population groups and is available
in both English and Spanish. It describes how the Health Care Law ends the worst insurance
company abuses, makes health care more affordable, strengthens Medicare, and provides better
options for individuals. You may want to use it when speaking to groups of consumers and
family members or specialized populations. Click on Resources 79-86 to view the different
versions of this PowerPoint presentation.” Cards and Posters
“Cards that provide information and resources can be downloaded for use. These items can
be placed in your locations for consumers and family members to pick up and distributed
on tables at community events. Click Resources 87-90 to access English and Spanish versions
of these cards. This poster offers information on how to get updates about the Health Insurance
Marketplace. It can be hung throughout your locations and in other places where consumers
and their family members come together. The poster is available in English and Spanish
and can be accessed by clicking Resources 91-92.”
Digital and Web Content “Widgets can be uploaded to your website
or Facebook page that will automatically link your website or Facebook visitors to the Health
Insurance Marketplace. We encourage you to contact your webmaster and add this to your
website to enable users to access this enrollment information directly. You can reference this
tool on your website when working with consumers and family members seeking health insurance
information as a place to go after meeting with you and if they need more information.
Resources 93-94 provide multiple widget options in English and Spanish.”
“You can sign up for email and text message updates to receive tips and alerts to stay
on track and find affordable health insurance. Updates are available in both English and
Spanish. To sign up for these updates, click on Resources 95-96. If appropriate, you may
want to offer this link in your email communications.” “Many organizations are using social media
outlets such as Facebook, blogs, and Twitter to share information with their staff and
their consumers and families.’s Facebook account contains the latest updates
on the health insurance law – you can link to it from your own Facebook page and use
motivational messages in your own posts or on your website. Click on Resources 97-98
to access English and Spanish versions of the Facebook account.
also provides blogs about different aspects of the Health Care Law that you might want
to feature on your website or in your newsletters to keep your staff and your consumers and
their families up to date with the latest information. These are available in English
and Spanish and may be accessed by clicking Resources 99-100.”
“Finally, your organization might want to follow’s Twitter account
to get ideas for your own tweets or to re-tweet messages that you think might be of interest
to your consumers and their families. Click Resources 101-102 to view English and Spanish
versions of the Twitter account. There are resources to assist with your outreach
efforts and to help promote your health coverage-focused events. The Marketplace Multi-Purpose Messages
are short messages designed to be used for texts, in “on-hold” telephone scripts,
on instructional handouts and for other purposes. They are divided into messages to be used
during the summer and messages to be used after open enrollment begins in October. These
Multi-Purpose Messages are available in English and Spanish and can be accessed by clicking
on Resources 103-104.” “Your organization may want to hold educational
sessions or conduct community outreach in partnership with other organizations. This
Customizable Flyer, available as Resource 105, can be used to promote enrollment events
that provide information about the Health Insurance Marketplace and obtaining affordable
health coverage. The Flyer is available in English.”
“CMS has developed a program to create certified application counselors who can provide information
to consumers and help facilitate enrollment in Qualified Health Plans and insurance affordability
programs. All state Marketplaces must have a certified application counselor program.
These programs assure consumers that they are receiving assistance from trained personnel
who are overseen by organizations that are required to protect personally identifiable
information. Your organization may want to explore applying for this program to help
your consumers and their families. Click on Resource 106 to learn more.”
“As a quick reference tool, we have included a “glossary of terms” in Resources 107-110.
This glossary provides, at a glance, the most commonly used words with health care reform
and insurance and a basic definition. It is available in four different languages.”
“Want to stay informed with new materials being released by CMS for enrollment? Sign
up with the CMS listserv for partners and educators at . You
will receive email notices about new information and products available with the enrollment
rollout. The SAMHSA Enrollment Initiative Coalition will continue to inform you about
what’s happening with enrollment in the period leading up to October 1. CMS has provided
instructions for how and when to use the Health Insurance Marketplace logo with your materials.
Resource 111 offers directions for how to insert and size the logo if you are producing
any of your own materials. “Thank you for viewing this training toolkit.
The PowerPoint slides from this presentation are available for you to use as Resource 112
on the resource list. Remember that all the resources listed on the slides are available
in a single place, which you can access by clicking on Resource 113.”

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