coordinator: welcome and thank you for standingby. at this time all participants will be in a listen-only mode until the question andanswer session. at that time if you would like to ask a question you may press star1 on your touch-tone phone. today’s call is being recorded. if you have any objectionsyou may disconnect at this time. now i would like to turn the call over to charlene kazner. charlene kazner: hello everyone, thank youvery much for participating in this training webinar. my name is charlene kazner and thiswebinar 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 needsassessment 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 thatthe demand for in-language in-person certified navigators is very high while resources arevery limited. this webinar will provide guidance to community-based organizations’ non-aca-certifiedstaff on how to explain health insurance and accessing health care to the community. bythe end of the webinar you will be able to understand how to explain the value of havinghealth insurance, understand how to explain the value of preventive healthcare and understandhow 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 millionamericans 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 bystates 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, mentalhealth and substance abuse. how insurance covers medical care cost, protection fromhigh, unexpected expenses and preventive care
and treatment sooner avoiding serious illnessand higher cost. what is health insurance? health insuranceis a contract between you and your insurance company. you buy a plan and the insurancecompany agrees to pay some or all of your medical cost. did you know that an averagethree-day hospital stay is $30,000 and fixing a broken leg can cost up to $7,500. the valueof preventive healthcare; what is preventive healthcare? preventive healthcare is the mostimportant 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 withchronic conditions. many of the top risk factors leading to illnessand premature death are preventable. many
asian-americans and native hawaiian and pacificislanders are not familiar with how to access united states or western healthcare systemand seek medical help only when they are sick or hurt. many choose to skip routine examinationsand screenings which can prevent serious illness and higher cost. cancer screenings are especially importantto asian-americans and native hawaiian and pacific islanders who are less likely to undergomammograms, pap tests and colorectal screenings. those who smoke habitually smoke more cigarettesa 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 anearly stage when there is a greater chance
for a full recovery. some of the preventivehealthcare services available are screening, immunizations, regular check-ups, routinephysicals, colonoscopies, mammograms, pap smears and counseling. please check healthcare.gov for a detailedlist 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 hawaiianand pacific islanders have health insurance for the first time through the affordablecare 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, friendsand others to help them. they tend to seek
medical help only when they are sick and manytimes in the late stages of an illness. these next steps will help asian-americans and nativehawaiian and pacific islander communities to understand and use health insurance toaccess quality care. here are the 10 essential health benefits.every plan sold in the marketplace will include these benefits: outpatient care, emergencyservices for things such as heart attack or broken bones, hospital stays, baby care, mentalhealth, substance abuse, prescriptions, disability care, any lab tests, preventive services anddental and vision for children. what are the healthcare plans? there are fourdifferent healthcare plans that consumers will have to sign up for, health maintenanceorganization, or hmo, consists of in-network
doctors, specialists and hospitals who provideall the services for these members. the members must receive their referral from the primarycare physician before seeing other doctors. the plan does not cover out-of-network servicesexcept for emergencies. an exclusive provider organization, or epo, members do not needa referral from a pcp to receive in-network services. the plan does not cover out-of-networkservices except for emergencies. the point of service, or pos, members canvisit any in-network provider without a referral. members need a referral to visit an out-of-networkprovider at a much higher cost. the preferred provider organization, or ppo, members canvisit any provider without a referral. members do not need a referral to visit an out-of-networkprovider 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 pay60%, the consumer will pay 40%. the monthly payments are lower but there are higher out-of-pocketcosts when you receive medical services. the silver plan the insurance will pay 70%, theconsumer pays 30%. there are higher monthly payments than a bronze plan but lower out-of-pocketcosts 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 thanthe silver and the bronze plan when you receive medical care. the platinum plan is the highestof 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 goonline to healthcare.gov or you can call 1-800-318-2596. you can also fill out an application thatis available at healthcare.gov and mail it on, or you can go to healthcare.gov for thelist 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? theamount of tax credits and cost sharing reductions you get depends on your income and familysize. if your income falls between 100% and 400% of the federal poverty level you willreceive a tax credit that can be applied towards
your health premium. in order to get premiumassistance you must enroll through the marketplace. premiums can be applied to any of the healthplans whether you select the bronze, the silver, the gold or platinum. as this chart showsa single individual with income ranging from $11,490 to $45,960 and a family of four withincome ranging from $23,550 to $94,200 will receive a tax credit. if your income is at or below 138% of thefederal poverty level you may be eligible for medicaid. you may receive your premiumassistance in three ways; in advance, you may choose to have your assistance sent directlyto the health plan you select lowering your monthly premium payment. the insurer willbill you for the rest of the premium. when
you file your taxes you may pay the full priceof your premium payment each month and receive your tax credit in full as part of your taxreturn 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 havesome of your premium assistance sent to the health plan each month lowering your monthlypremium payments and the rest of your premium assistance sent to you as a tax refund whenyou file your tax return. here are some health insurance definitions. premium: this is theamount you pay for your health insurance plan. deductible: amount you have agreed to payfor health services before your insurance plan starts paying. as an example if the planyou have has a $1,000 deductible the insurance
plan pays nothing until you have paid $1,000for services. co-insurance: this is a percent of the costfor the covered healthcare services that you are responsible for. a co-payment: a fixedamount that you pay for a specific covered healthcare service. this is usually paid atthe time of service. when you go to a doctor’s visit you would pay $15 at the time of thevisit, and this amount varies. the most you will - out-of-pocket maximum: this is themost you would pay during a policy period -- which is usually one year -- before yourhealth insurance starts to pay at 100%. what is in and out-of-network? in-networkare facilities, providers and suppliers your health insurer has contracted with to providehealthcare 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 yourprovider and insurance company before making an appointment so you will know how much youhave to pay. out-of-network: a provider who doesn’t have a contract with your healthinsurer or plan to provide services to you. remember you will pay more to use them. networks can change so always check with yourprovider each time you make an appointment so you know exactly how much you will haveto pay for medical services. your insurance card: after enrolling in health insuranceevery enrollee will receive an insurance card. your insurance card is proof that you haveinsurance; carry it with you at all times.
your insurance card will show the plan typethat you signed up for, the member’s name, member’s number, the group number, any co-paysfor pcp or specialist and emergency room, your member service phone number where youcan contact your insurer at any time, the prescription group number and your co-payfor prescriptions whether they are generic or name brand. explanation of benefits: after each visitfor medical care services you will receive an explanation of benefits. this is not abill; it’s just an explanation of what will be covered for your medical service. it liststhe service description, your provider charges, allowed charges, what is going to be paidby 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 claimand who to send the reimbursement to. where can i go for care? primary care providerswork with their patients to ensure they get the right preventive services, manage theirchronic conditions and improve their health and well-being. some places may offer servicesand support that vary based on the needs of the community they serve. you can find a pcpand private medical groups and practices, ambulatory care centers and outpatient clinics,generally qualified health centers, community clinics and free clinics. also school-basedhealth centers, urban indian clinics and tribal health centers and veterans affairs medicalcenters 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 whospeaks a language other than english? do you want a provider who can accommodate your mobilityor functional impairment? if you already have a provider you like and want to keep, calltheir office and ask if they accept your coverage. you will have to pay more to see a providerout of your network so always ask your plan if you need prior authorization before youvisit your provider. if you don’t get pre-authorization you may be charged for things your healthplan would have paid for. how do i pick a provider? call the provider’soffice, 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? doesyour provider speak your language or is there an interpreter available to help you? do theyhave accommodations for limited mobility or functional impairment? which hospital or hospitalsdoes the provider work with? is the office staff respectful and helpful? sometimes it takes more than one visit todecide if a provider is the right one for you. it is very important that your providermeets your needs. your provider should be one that you can work with, trust and feelcomfortable talking to. here is a case scenario: mental health and substance abuse disorderservices 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 nativehawaiian and pacific islanders from seeking help. kim, a 38-year-old divorced mother of twohas a successful job with no health insurance. for the past eight months she has worriedconstantly 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 verysimple things which is out of the ordinary for her. with no health insurance and thestigma and shame of mental illness she felt she had nowhere to go.
she and her family now have health insurancethrough the aca marketplace. with health insurance kim was able to seek help from her pcp whohelped her get mental health assistance. she was diagnosed with generalized anxiety disorderand is currently in therapy and doing very well. how do i fill a prescription? what isa prescription? a prescription is an instruction written bya medical practitioner that authorizes a medicine or treatment for a patient. once you get aprescription 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 getthose pharmacies from your insurance company.
mail-order pharmacy; the prescription is sentto the mail-order pharmacy or phoned in by the provider. it may cost less but will takelonger 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 hasdirections for filling or transferring your prescription. avoid any web site that claimsa doctor can prescribe medicine without seeing you. how do i appeal if my insurance doesnot pay? if you are charged for tests or services you think your coverage should have paid keepthe bill and call the phone number on the back of your insurance card right away. theinsurance companies have call and support
centers to help plan members. what are the penalties? starting in 2014 theflat penalty for an adult if $95, 50%, or $47.50 for those in the household that areunder 18, or 1$ 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 2016the increase is based on the cost of living. so as you see as time goes on it graduallyincreases. what are the exemptions? the exemptions fornot enrolling in health insurance are if you are uninsured for less than three months inthe year. the lowest price coverage available to you would cost more than 8% on your householdincome. you don’t have to file a tax return
because your income is too low. you’re amember of a federally-recognized tribe or eligible for services through an indian healthservices provider. you’re a member of a recognized healthcare sharing ministry. you’rea member of a recognized religious sect with religious objections to insurance includingsocial security and medicare. you’re incarcerated, either detained or jailed. you are not lawfullypresent in the united states, and hardship. go to healthcare.gov to see an extensive listof at least 14 that qualify for an exemption under hardship. how do i report a change? you must reporta change if you get married or divorced, have a child, adopt a child or place a child foradoption, 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 filingstatus, 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 correctionto your name, date of birth or social security number. you can report these changes in two ways,online at healthcare.gov, select report a life change and log into your account, oryou can contact the marketplace at 1-800-318-2596. do not report these changes by mail and itis very important to report these changes
within 60 days from the life-changing event. where can i go for help? the asian-americanand native hawaiian and pacific islander communities include many, many ethnic groups. this pagelists a few in-language resources on where to go for help, english, chinese, bengaliand tongan. if there are any questions on the webinarpresented today please feel free to call either one of us, juliet bui, perry chan, suhailakhan, myself, charlene kazner, or domin chan at the e-mail addresses listed. now we willtake any questions that you have. thank you very much for your participation. coordinator: thank you. at this time we willbegin the question and answer session. if
you would like to ask a question you may pressstar 1 on your touch-tone phone. please unmute your phone and provide your first and lastname clearly when prompted. to withdraw your question press star 2, and once again if youwould like to ask a question please press star 1 and record your name. one moment tosee 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 hopethis 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.
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