Final Award of 2017 Seal of Approval (VOTE) ASHLEY HAGUE Deputy - - PowerPoint PPT Presentation
Final Award of 2017 Seal of Approval (VOTE) ASHLEY HAGUE Deputy Executive Director, Strategy and External Affairs BRIAN SCHUETZ Director of Program and Product Strategy HEATHER CLORAN Associate Director of Program and Product Strategy EDITH
ASHLEY HAGUE Deputy Executive Director, Strategy and External Affairs BRIAN SCHUETZ Director of Program and Product Strategy HEATHER CLORAN Associate Director of Program and Product Strategy EDITH BOUCHER CALVAO, FSA, MAAA Chief Actuary Board of Directors Meeting, September 8, 2016
Many unsubsidized and APTC-only enrollees, particularly those enrolled in Harvard Pilgrim HealthCare and Neighborhood Health Plan, will see large premium increases for their renewal plans Rising premium costs will also impact ConnectorCare members enrolled in higher cost carriers. These members will experience large increases in the contributions for their renewal plans
All of our carriers offer networks with high quality providers Many enrollees who shop will find plans with lower costs than their renewal plan and their current plan
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Today we share our recommendation for the award of the Final Seal of Approval (SOA) for Qualified Health and Dental Plans to be offered for sale through the Health Connector for coverage starting January 1, 2017 We will also be detailing our recommendation for the 2017 ConnectorCare program
Mar 2016 Apr May Jun Jul Aug Sept Oct Nov Dec 2016 3/10: SOA Kickoff – Board Meeting 3/18: Release Medical and Dental RFRs 5/13: RFR Responses Due 7/14: Conditional SOA – Board Meeting 11/1: Open Enrollment Begins 9/8: Final SOA – Board Meeting (TODAY) 3
Affordable Care Act (ACA) & Massachusetts Standards Health Connector SOA Requirements
QHPs
cost-sharing limits and actuarial value (AV) requirements
(QIS), Quality Reporting Standards (QRS) and QHP Enrollee Satisfaction Survey
for Division of Insurance (DOI) approval
commercial network – Option to propose one alternative network variation for each metallic tier
Connector receives a sufficient number of Bronze options
plan if Health Connector receives a sufficient number of Catastrophic options
ConnectorCare program that complies with the Health Connector’s network adequacy requirements for this population – Plans may be offered on an any network type, including a narrower network, or a network that is broader than their standard commercial network
QDPs
Family Low and Pediatric-only – Option to propose one alternative network variation for each design
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As part of the 2017 SOA, we made several key changes to the Qualified Health Plan (QHP) and Qualified Dental Plan (QDP) product shelves aimed at achieving these goals
We eliminated the second standardized Gold plan design, standardized the Bronze tier and standardized additional cost sharing categories Overall, we focused the number of allowable plan offerings on our QHP product shelf and instituted a cap on the number of allowable offerings on our QDP shelf
We also leveraged this year’s SOA to begin influencing the product design of plans in our marketplace to address the health needs of our members, through pediatric dental coverage and opioid use disorder therapy; for future years, we also plan to address chronic disease management through value-based insurance design (VBID)
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1 Enrollment-weighted premium change (2016 actuals to 2017 calculated) w/ member aging (~2%), assumes mapping to 2017 renewal plan 2 Enrollment-weighted premium change from 2016 ConnectorCare selected Silver plan to 2017 selected Silver plan (2016 actuals to 2017
calculated) w/ member aging (~2%), not directly reflected in member contributions
3 Enrollment-weighted non-group average premiums for Family High and Family Low based on age 20 and over premium value; Pediatric-only
based on age less than 20 premium value
4 Enrollment data as of August 2016
Changes in Premium: 2016 to 2017
Merged Market (Division of Insurance) Unsubsidized & APTC-only 1 ConnectorCare 2 Dental 3 50,790 members4 173,495 members 60,323 members Excluding HPHC & NHP Excluding NHP 28,153 members 130,992 members
7.3% 19.0% 6.7% 6.2% 6.6% 0.7% 6
Guardian did not submit any non-standardized plans for 2017
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Delta Dental proposed three non-standardized plans and Blue Cross Blue Shield of MA proposed one non-standardized plan, all previously offered in 2016
Carriers Non- Group Small Group Standardized Plans Non-Standardized Plans All Plans High Low Pedi Total High Low Pedi Total Altus Dental 1 1 1 3
Blue Cross Blue Shield
1 1 1 3
1 4 Delta Dental of MA 2 2 2 6
2 3 9 Guardian 1 1 1 3
Standardized Plans Non-Standardized Plans All Plans Non-Group 9 3 12 Small Group 15 4 19 9
Non-group Dental Average Changes in Premium by Tier: 2016 to 2017 1
Family High Family Low Pediatric-only
16,912 members2 43,783 members 629 members
5.3% 12.2% 25.0%
Non-group Dental Average Changes in Premium by Carrier: 2016 to 2017
1 Enrollment-weighted non-group average premiums for Family High and Family Low based on age 20 and
2 Enrollment as of August 8, 2016
Carriers Membership Share2 Premium Change1 Altus Dental 16% 12.0% Delta Dental of MA 84%
OVERALL
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Renew into Same Plan 99.90% Plan Closing (Market-wide) 0.10%
1 Enrollment as of August 8, 2016
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Fallon Health proposed standardized plans on alternative networks Three carriers requested to waive offering the standardized Bronze plan
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Carriers Platinum Gold Silver Bronze Catastrophic Total Blue Cross Blue Shield 1 1 1 1 1 5 BMC HealthNet Plan 1 1 2 1 5 CeltiCare Health 1 1 1 3 Fallon Health 2 3
(+2 frozen)
4 2
(+2 frozen)
1 12
(+4 frozen)
Health New England 1 4 1 6 Harvard Pilgrim Health Care 1 2 2 1 6 Minuteman Health 2 1 2 2 1 8 Neighborhood Health Plan 1 2 2 1 6 Tufts Health Plan - Direct 1 2 2 1 1 7 Tufts Health Plan - Premier 1 1 1 1 4 TOTAL 12 18
(+2 frozen)
18 10
(+2 frozen)
4 62
(+4 frozen) 14
Overall, Unsubsidized and APTC-only members will see a 19% increase in 20171
Excluding Neighborhood Health Plan and Harvard Pilgrim plans, outliers with much higher increases, the increase drops to 6.6%1 These data represent the change in “member-facing” premiums when mapped to the member’s corresponding 2017 plan (e.g., if a member’s 2016 plan is closing, then their experience is captured as the premium increase from the closed plan to their new plan) Platinum Gold Silver Bronze Catastrophic
5,537 members 9,837 members 28,350 members 6,493 members 573 members All Plans Excluding HPHC & NHP
Unsubsidized & APTC-only Average Changes in Premium by Tier: 2016 to 20171
20.8% 14.5% 17.6% 23.3% 4.4%
1 Enrollment-weighted premium change (2016 actuals to 2017 calculated) w/ member aging (~2%), assumes mapping to 2017
renewal plan
4.7% 9.6% 8.8% 8.6% 4.4% 15
Unsubsidized & APTC-only Average Changes in Premium by Carrier: 2016 to 2017
1 Enrollment data as of August 2016 2 Enrollment-weighted premium change (2016 actuals to 2017 calculated) w/ member aging (~2%), assumes mapping to 2017
renewal plan
3 Premium change reflects HNE 1/1/16 premium submission which contained an error resulting in consumer facing premiums being
~10% lower than intended Carriers Membership Share1 Premium Change2 Neighborhood Health Plan 28% 24.7% Tufts Health Plan - Direct 24% 2.6% Harvard Pilgrim Health Care 17% 47.1% BMC HealthNet Plan 9% 1.4% Blue Cross Blue Shield 7% 12.0% Minuteman Health 5% 9.1% Tufts Health Plan - Premier 5% 10.4% Fallon Health 3% 5.4% Health New England3 3% 17.1% CeltiCare Health <1% 4.2% OVERALL 19.0%
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$825 $571 $483 $453 $485 $347 $288 $266 $601 $453 $360 $321
$0 $100 $200 $300 $400 $500 $600 $700 $800 $900 Platinum Gold Silver Bronze
Unsubsidized Premium Range (42 year-old in Worcester) by Tier, 20171
Maximum Minimum Average Platinum Gold Silver Bronze
1 Premiums reflect an unsubsidized 42 year-old individual in Worcester
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As part of Open Enrollment, all current members will have the opportunity, and will be encouraged, to shop and compare plans.
1 Enrollment-weighted premium change (2016 actuals to 2017 calculated) w/ member aging (~2%), assumes mapping to 2017
renewal plan
Unsubsidized & APTC-only Average Subscriber-level Changes in Premium: 2016 to 2017 1
Decrease Increase <$10 Increase $10 - $25 Increase $25 - $50 Increase $50 - $75 Increase $75 - $100 Increase $100 - $150 Increase $150 - $200 Increase >$200 9% 17% 9% 11% 10% 9% 12% 9% 16%
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The Final SOA also includes the recommendation of those carriers that will participate in the ConnectorCare program, which offers state premium and cost-sharing subsidies for individuals under 300% of the Federal Poverty Level (FPL).
APTC Amount* $192.00 State Premium* Subsidy $53.01 Member Contribution* $43.00 Cost of Underlying Lowest Cost Silver Plan $288.01* The ConnectorCare selection process reviews the ConnectorCare-compatible Silver plan offerings from each carrier The selection criteria to be a ConnectorCare carrier include price competitiveness, provider and facility access, and experience with serving the subsidized population Selection of the 2017 ConnectorCare participating carriers is designed to provide continued access to those carriers currently participating in ConnectorCare or the MassHealth MCO program to ensure continuity ConnectorCare supplements federal Advance Premium Tax Credits (APTC) with State subsidies to create a more affordable program for eligible MA residents. ConnectorCare supplements federal Advance Premium Tax Credits (APTC) with State subsidies to create a more affordable program for eligible MA residents.
*Reflects the cost of subsidizing the lowest cost plan for a 42 year old living in Worcester, earning $20,000 per year or 168.35% FPL, and thus in Plan Type 2B (150-200% FPL). Note: the Member Contribution equals the state affordability schedule amount for that income cohort because this example is subsidizing the lowest cost silver plan available to this person. 20
Carriers indicated in GREEN have moved to a lower cost position relative to 2016, while carriers indicated in RED have moved to a higher cost position. Prior carrier in rank order position is noted in parentheses.
Cluster Lowest Cost 2nd Lowest Cost 3rd Lowest Cost 4th Lowest Cost 5th Lowest Cost A1 BMCHP
(formerly Tufts-Direct)
Tufts-Direct
(formerly BMCHP)
NHP HNE CeltiCare A2 BMCHP
(formerly Tufts-Direct)
Tufts-Direct
(formerly BMCHP)
HNE CeltiCare A3 Tufts-Direct HNE CeltiCare A4 HNE CeltiCare B1 BMCHP
(formerly Tufts-Direct)
Fallon
(formerly NHP)
Tufts-Direct
(formerly Fallon)
NHP
(formerly BMCHP)
CeltiCare C1 Tufts-Direct BMCHP (formerly Minuteman) Minuteman (formerly BMCHP) NHP CeltiCare C21 Tufts-Direct BMCHP
(formerly Minuteman)
Minuteman
(formerly BMCHP)
Fallon (new entrant)
(formerly NHP)
NHP
(formerly CeltiCare)2
D1 BMCHP Tufts-Direct Minuteman CeltiCare
(formerly NHP)
NHP
(formerly CeltiCare)
E1 BMCHP
(formerly Tufts-Direct)
Tufts-Direct
(formerly BMCHP)
Minuteman CeltiCare
(formerly NHP)
NHP
(formerly CeltiCare)
F1 BMCHP
(formerly Tufts-Direct)
Tufts-Direct
(formerly BMCHP)
Minuteman CeltiCare NHP F2 CeltiCare NHP G1 BMCHP
(formerly Tufts-Direct)
Tufts-Direct
(formerly BMCHP)
CeltiCare
(formerly NHP)
NHP
(formerly CeltiCare)
G2 NHP G31 BMCHP
(formerly Tufts-Direct)
Tufts-Direct
(formerly BMCHP)
Minuteman (new entrant)
(formerly NHP)
CeltiCare NHP3
1 New Region for 2017 2 CeltiCare no longer selected in
new Region C2 due to new entrant (Fallon)
3 NHP moved to higher cost
position in new Region G3 due to new entrant (Minuteman)
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1 Enrollment-weighted premium change from 2016 ConnectorCare selected Silver plan to 2017 selected Silver plan (2016
actuals to 2017 calculated) w/ member aging (~2%)
2 Membership based on August 2016 ConnectorCare enrollment 3 Premium change reflects HNE 1/1/16 premium submission which contained an error resulting in consumer facing premiums
being ~10% lower than intended
For 2017, the underlying selected Silver plan premiums for the ConnectorCare program will see an average 6.2% increase1
Excluding Neighborhood Health Plan, the underlying selected Silver plan premiums only increase by 0.7%1
Carriers Membership Share2 Premium Change1 Tufts Health Plan - Direct 51% 2.3% Neighborhood Health Plan 24% 20.7% BMC HealthNet Plan 18%
Health New England3 3% 16.8% Fallon Health 2% 1.6% Minuteman Health 1% 1.8% CeltiCare Health 1% 7.8%
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The changes in enrollee contributions, in addition to changes in relative price positioning of the ConnectorCare carriers, will result in a wide range of impacts to members
Most members enrolled in BMC HealthNet Plan and Tufts Health Plan – Direct, generally the lowest cost plans, will experience either a decrease or a small increase in enrollee contributions for their renewal plan Members enrolled in higher cost plans, particularly Neighborhood Health Plan, will see significant increases in contributions for their renewal plan – as high as $165 per month1
ConnectorCare enrollees facing large increases will be able to shop for a ConnectorCare plan from a different carrier with lower monthly contributions
1 Increase for Neighborhood Health Plan, Plan Type 1, Region G1 2 Expected member-level enrollee contribution change into renewal plan from the same carrier, if available (after APTC and
state premium subsidy); percentage values represent proportion of members
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Changes in ConnectorCare Monthly Enrollee Contributions2
Decrease No Change Increase <$10 Increase $10 - $25 Increase $25 - $50 Increase $50 - $75 Increase $75 - $100 Increase >$100 15% 10% 34% 12% 3% 4% 8% 14%
In addition to promoting shopping, we will be encouraging members to get help from Enrollment Assisters, and to take advantage of our decision support tools (e.g., shopping guides, provider search, etc.) We will be sending communications including emails, personalized letters, special inserts into monthly bills, and may deploy a robo- call campaign to encourage shopping Key Messages include:
Highlighting potential changes in monthly premiums, but making clear that there are options available offering the same or similar benefits The Health Connector has tools to help you find a good, affordable plan with access to excellent care
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“We know you might be facing significant changes in your plan for 2017, but we are here to help.” “All of our plans include access to quality doctors, hospitals and other medical care in your area. If you think it might be time to consider a new plan, you can use our tools to find a new doctor that can give you the care you need.” “For many people, there are
includes the same level of benefits and access to care, but at a lower
minutes to review your options and save hundreds of dollars over the course of the year.” “We know this can be a confusing and stressful process, but help is available. We have walk-in centers and community
with staff who are trained and ready to help you pick the right plan.”
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Plan Feature/ Service
A check mark () indicates that this benefit is subject to the annual deductible
Platinum Gold Silver Bronze
Annual Deductible – Combined N/A $1,000 $2,000 N/A N/A $2,000 $4,000 N/A Annual Deductible – Medical N/A N/A N/A $2,750 N/A N/A N/A $5,500 Annual Deductible – Prescription Drugs N/A N/A N/A $250 N/A N/A N/A $500 Annual Out-of-Pocket Maximum $3,000 $5,000 $7,150 $7,150 $6,000 $10,000 $14,300 $14,300 Primary Care Provider (PCP) Office Visits $25 $30 $30 $25 Specialist Office Visits $40 $45 $50 $40 Emergency Room $150 $150 $700 $500 Urgent Care $40 $45 $50 $40 Inpatient Hospitalization $500 $500 $1,000 $1,000 Skilled Nursing Facility $500 $500 $1,000 $1,000 Durable Medical Equipment 20% 20% 20% 20% Rehabilitative Occupational and Rehabilitative Physical Therapy $40 $45 $50 $40 Laboratory Outpatient and Professional Services $0 $20 $25 $50 X-rays and Diagnostic Imaging $0 $20 $25 $175 High-Cost Imaging $150 $200 $500 $1,000 Outpatient Surgery: Ambulatory Surgery Center $500 $250 $750 $750 Outpatient Surgery: Physician/Surgical Services $0 $0 $0 $0 Prescription Drug Retail Tier 1 $15 $20 $20 $25 Retail Tier 2 $30 $30 $60 $75 Retail Tier 3 $50 $50 $90 $100 Mail Tier 1 $30 $40 $40 $50 Mail Tier 2 $60 $60 $120 $150 Mail Tier 3 $150 $150 $270 $300 2017 Final FAVC 91.73% 81.43% 71.84% 61.86%
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Plan Feature/ Service Family High Family Low Pediatric-only
Plan Year Deductible $50/$150 $50/$150 $50 Deductible Applies to Major and Minor Restorative Major and Minor Restorative Major and Minor Restorative Plan Year Max (>=19 only) $1,250 $750 N/A Plan Year MOOP <19 Only $350 (1 child) $700 (2+ children) $350 (1 child) $700 (2+ children) $350 (1 child) Preventive & Diagnostic Co-Insurance (In/out-of-Network) 0%/20% 0%/20% 0%/20% Minor Restorative Co-Insurance (In/out-of-Network) 25%/45% 25%/45% 25%/45% Major Restorative Co-Insurance (In/out-of-Network) 50%/70% 50%/70% No Major Restorative >=19 50%/70% Medically Necessary Orthodontia, <19 only (In/out-of- Network) 50%/70% 50%/70% 50%/70% Non-Medically Necessary Orthodontia, <19 only (In/out-of- Network) N/A N/A N/A 33