How Insurance Works

Getting Ready for the Health Insurance Marketplace: Criminal Justice

“Making sure that individuals with mental
health and substance use conditions have health care coverage is a major priority for criminal
justice agencies and 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/affiliates interact with potentially
eligible individuals and their families. Our goal is to help you let the individuals you
serve and community members know about their new health insurance options, explain the
benefits of enrolling in one of the new plans, and provide basic assistance in helping them
apply and connect them with trained assistors in their communities as needed. This toolkit
will provide you with resources to learn more about health insurance, explain it in your
community and get ready for the Health Insurance Marketplace.”
“Our agency is participating in one of five different coalitions with whom SAMHSA is working
with. SAMHSA is working closely with the Centers for Medicare and Medicaid Services (CMS) to
coordinate and disseminate materials with current information about the Marketplace
and about enrollment. We are partnering with many different agencies and organizations
who have local members or affiliates working together to reach consumers and families.”
“This toolkit contains useful information for communicating about expanded health coverage
to the individuals and families you work with as well as to your agency’s or organization’s
staff. The toolkit is divided into three main sections. First we describe the health care
law, how it works, and how it is important for those we work with. Then we explain how
you can use the Health Insurance Marketplace to get information and to 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 about 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 “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,
and 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 are “Essential
Health Benefits (EHB).” Essential Health Benefits must include items and services in
ten specified categories, including mental health and substance use 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.” “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 health and substance abuse services – New health
insurance plans must offer coverage in certain “Essential Health Benefits,” including
mental health and substance use disorder services.” “Providing comparable coverage – New parity
regulations will provide coverage for behavioral health services that must generally be comparable
to other coverage for chronic health conditions like diabetes, asthma and hypertension.”
“Establishing new consumer protections – Most plans will be prohibited from denying enrollment
because an applicant’s mental health or substance use disorder is deemed a ‘pre-existing
condition’. For more information please click on Resource 4.”
Using the Health Insurance Marketplace “The Health Care 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 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.” “Agencies, non-governmental organizations,
agents, brokers 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 above infographic, which can be handed
out to individuals 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 use
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. 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 in the health care law, and using educational
materials during one-on-one sessions with the individuals you serve. 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. For more information please see Resources
12-19.” “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. This article is available in full [Resources
20-21] and in a shortened version to be used for drop-ins [Resources 22-23]. Both versions
are available in English and Spanish. For more information please click on Resources
20-23.” “These fact sheets and brochures are helpful
products that can be used by your staff when working one-on-one with individuals and as
giveaways at local community events or health fairs. 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 offices or handed directly to individuals when you meet with them. Click on Resources
50-64 to download these fact sheets.” “This next set of brochures provide an overview
of the benefits of the Health Care Law in simple language. Click on Resources 65-66
to download these brochures. This content is also available in video and PowerPoint
training formats so you can do group presentations or just have the video running in your office
for people 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. For more information please click on Resources
67-72.” “To help explain health care 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 uninsured individuals.
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. Visit the YouTube channel by clicking
on Resource 74 to 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
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 to show in a waiting room setting. To view the video
please click on Resource 75 (English) or Resource 76 (Spanish).”
“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. To view the video please
click on Resource 77 (English) or Resource 78 (Spanish)”
Trainings “As mentioned previously, this PowerPoint
presentation contains similar information as the brochure of the same name. The presentation
is customized for several different population groups. 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 individuals or specialized populations. For more information please click on Resources
79-86.” Cards and Posters
“Cards that provide information and resources can be downloaded for use. These items can
be placed in your office for individuals to pick up and distribute to offenders, defendants,
or their families. For more information please click on Resources 87-90. This poster offers
information on how to get updates about the Health Insurance Marketplace. It can be hung
in offices and in other places where individuals congregate. For more information please click
on 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 individuals
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.
If appropriate, you may want to offer this link in your email communications. For more
Information please click on Resources 95-96.” “Some organizations are using social media
outlets such as Facebook, blogs, and Twitter to share information with their staff and
the individuals they serve.’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. For more information please
click on Resources 97-98.
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 uninsured individuals
up to date with the latest information. For more information please click on 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 followers. For more information please
click on Resources 101-102.” “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. For
more information please click on Resources 103-104.”
“Some of your organizations may want to hold educational sessions or conduct community
outreach in partnership with other organizations. This Customizable Flyer 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. For more information
please click on Resource 105.” “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 the individuals you serve. Click on Resource
106 to learn more.” “As a quick reference tool, we have included
a “glossary of terms” available 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
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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