Private Option or Medicaid Expansion
- For individuals with adjusted gross family income of less than 138% of the FPL, the Private Option is available.
- As the number of family members increases, the 138% threshold income increases – it is $54,689 for a family of eight.
- The Private Option will pay 100% of premiums and, based upon income level, may pay 100% of the plan out-of-pocket expenses.
- Payment of premiums and payment to health care providers is through Medicaid but providers are paid at a higher level than traditional Medicaid reimbursement rates.
- Enrollment opportunities for the Private Option are ongoing and may be accessed through https://access.arkansas.gov/
There is NO penalty to employers if employees qualify for and enroll in the Private Option.
The Healthcare Marketplace
- Anyone can go into the Marketplace and shop for coverage.
- Individuals who have an adjusted gross family income (with no asset testing) of 138% to 400% of the Federal Poverty Level (FPV) may be eligible for subsidies, also referred to as tax credits or advanced tax refunds and may be eligible for reduced plan copayments for doctors’ visits and prescriptions.
- For a family of four, the 2013-14 FPV range of 138% to 400% is $32,499 to $94,200.
- IF an individual is offered an employer-sponsored health plan which meets the affordability and essential coverage requirements, NO subsidies are available to the individual (they might find a plan with lower premiums in the Marketplace, but no subsidy).
- IF that individual’s family members are eligible to be enrolled in that employer-sponsored health plan, NO subsidies are available to those family members (they might find a plan with lower premiums in the Marketplace, but no subsidy).
- IF an employer-sponsored health plan meets the affordability and essential coverage requirements, there is NO penalty to the employer if an employee selects coverage in the Marketplace.
- The University of Arkansas Medical Benefit Plan fully meets or exceeds the affordability test and the essential coverage requirements.
- Enrollment opportunities for the Marketplace end on March 31st.
- The plan choices in the Marketplace and in the Private Option are the same.
- In Arkansas the health plan choices are offered by Blue Cross, QualChoice and Ambetter.
- Individuals in the Private Option who are “medically frail” remain in or are enrolled in traditional Medicaid.