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 (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 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 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 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 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. 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.” “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. As we get closer to October, we will provide
you with more detailed information about how this will work and how your organization will
be able to help.” “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 patients and clients 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 patients and clients. 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 with
health care law, and using educational materials during one-on-one sessions with patients and
clients. 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 patients and clients
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 patients and clients 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 your office for patients and clients
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 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 your patients and
clients. 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 to show
in a waiting room setting.” “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 patients and clients 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 office for patients and
clients 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 in offices and in other places where patients and clients congregate. 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 patients
and clients 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.”
“Some organizations are using social media outlets such as Facebook, blogs, and Twitter
to share information with their staff and their patients and clients.’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 patients and clients 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 patients and clients. 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 patients and clients. 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 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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