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Presented by
Office of the Health Care Advocate
12/7/17
Offic ice e of the H Health Care Advocate
Who we are Today’s topics
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Help Line Stories and Issues
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Office of the Health Care Advocate Presented by Michael Fisher And - - PowerPoint PPT Presentation
Office of the Health Care Advocate Presented by Michael Fisher And - - PowerPoint PPT Presentation
Office of the Health Care Advocate Presented by Michael Fisher And The Health Care Advocate Team 12/7/17 Who we are Todays topics Help Line Stories and Issues Affordability Offic ice e of the H Health Care Advocate HCA
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Offic ice e of the H Health Care Advocate
The HCA received 327 calls from 10/15 to 11/15. Figures below are based on the All Calls data in the last quarterly report.
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24.85% (205) about Access to Care
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12.24% (101) about Billing/Coverage
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1.33% (11) about Buying Insurance
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10.79% (89) about Consumer Education
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26.42% (218) about Eligibility for state and federal programs
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24.36% (201) were categorized as Other, which includes Medicare Part D, communication problems with providers or health benefit plans, access to medical records, changing providers or plans, confidentiality issues, and complaints about insurance premium rates, as well as other issues.
HCA Help Line
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Offic ice e of the H Health Care Advocate
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Additional Activities
Outreach – Pharmacy and Targeted populations Web Page Triage - https://vtlawhelp.org/triage/vt_triage Hepatitis C Project Breast Cancer Screening Project
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Affordability
Rules-Based Approach Market-Based Approach
Activities
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Offic ice e of the H Health Care Advocate
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Rule 1: The Affordable Care Act defines health insurance premiums as unaffordable if a household must spend more than 9.69% of their income on premiums.
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Rule 2: The State of Vermont defines, in the Vermont Household Health Insurance Survey, a plan’s deductible as unaffordable if it is more than 5% of household income.
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Combined Affordability Standard:
Example - Individuals making between $23,760.00 (200% FPL) and
$64,510.21 (543%FPL) lack affordability.
Rule-Based Affordability
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Offic ice e of the H Health Care Advocate
- $40,000.00
- $30,000.00
- $20,000.00
- $10,000.00
$0.00 $10,000.00 $20,000.00 $30,000.00 $20,000.00 $40,000.00 $60,000.00 $80,000.00 $100,000.00 $120,000.00
Net Money Available Household Income Individual Average Net Money Available Small Group Average Net Money Available
Scenario: 2 Adults, 2 Children, 2 Wage Earners, Second Lowest Cost Silver Plan, 75% of Deductible of which 100% is Attributable to Children (note: deductible is $3,200 for a family above CSR Eligibility) , Employee Share of $300