The Health Insurance Marketplace in Arkansas ***** Bruce Donaldson, - - PDF document

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The Health Insurance Marketplace in Arkansas ***** Bruce Donaldson, - - PDF document

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11/8/2013 The Health Insurance Marketplace in Arkansas ***** Bruce Donaldson, CHC Arkansas Insurance Department, Arkansas Health Connector Division 1 Arkansas Healthcare Landscape More than 550,000 Uninsured Low Per Capita Income Poor

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11/8/2013 1

The Health Insurance Marketplace in Arkansas

*****

Bruce Donaldson, CHC

Arkansas Insurance Department, Arkansas Health Connector Division

1

Arkansas Healthcare Landscape

  • More than 550,000 Uninsured
  • Low Per Capita Income
  • Poor Health Status
  • Multiple Health System Improvement Efforts

2

What is a Health Insurance Marketplace (Exchange)?

  • Competitive marketplace where individuals, families

and small employers can shop for, select and enroll in high quality, affordable private health plans that meet their specific needs at competitive prices.

  • Exchanges will also help eligible individuals receive

premium tax credits and cost sharing reductions or help them enroll in other state or federal public health programs.

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11/8/2013 2

Status of Marketplaces

State‐Based Marketplace State‐Based Marketplace (SHOP only) Partnership Marketplace Federal Marketplace

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The Economic Impact of Insurance Coverage Expansion in Arkansas

RAND Health (Price & Saltzman, 2013) Predictions

  • Annual economic benefit to Arkansas in 2016 of

$550 million with implementation of Marketplace as allowed by ACA – even greater economic benefit with robust outreach, education, and enrollment.

  • 2,300 saved lives annually
  • 6,400 additional jobs in Arkansas

5

Health Care Independence Act of 2013 “Private Option”

Federal government pays 100% of private insurance premiums for those newly eligible for Medicaid for first three years (90% by 2020).

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11/8/2013 3

Money infusion

  • More than $1 billion a year in federal money will

come into Arkansas a result of the Private Option.

  • Money comes from increased Medicaid

expenditures paid toward private plan premiums and claims.

  • Businesses, especially health care providers, will

benefit greatly.

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Private Option Eligible Individuals in 2014

  • Childless adults between 19‐65 with incomes up to 138% FPL
  • Parents between 19‐65 with incomes from 17% FPL up to

138% FPL

  • Those not on Medicare and are not disabled
  • Those determined to not be more effectively covered under

the standard Medicaid program, such as individuals with complex health conditions requiring extensive care coordination.

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Who Can Shop in the Marketplace?

  • Individuals and Families.
  • Businesses with 50 or fewer employees.

– Businesses with 100 or fewer will be Marketplace eligible as soon as 2016. – Businesses with more than 100 employees will be Exchange eligible at State option beginning in 2017.

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11/8/2013 4 Essential Health Benefits

  • Outpatient Services
  • Hospitalization
  • Emergency Services
  • Maternity and Newborn Care
  • Mental Health and Substance Use Disorder Treatment
  • Prescription Drugs
  • Rehabilitative and Habilitative Services/Devices
  • Laboratory Services
  • Preventive, Wellness, and Chronic Disease

Management

  • Pediatric Services, Including Oral and Vision Care

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Premium Tax Credit Eligibility

  • Household income 139% ‐ 399% FPL
  • Enrolled in a QHP through the Exchange
  • Lawfully present
  • Not incarcerated post conviction
  • Not eligible for other coverage such as Medicare,

Medicaid, or employer‐sponsored insurance.

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Employer Shared Responsibility

  • Only if > 50 employees
  • Coverage must meet minimal standards

– At least 60% actuarial value – Employee‐only contribution < 9.5% of wages

  • Employer must cover at least 50% premium
  • Tax penalties if:

– Employer does not offer coverage and at least one employee receives tax credits through Marketplace ($2000 per employee after first 30) – Employer offers coverage that is unaffordable or does not meet minimum standards ($3000 per employee that receives tax subsidy through the Marketplace)

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11/8/2013 5 How does Private Option Affect Employer‐Sponsored Coverage?

  • If employee is < 138% FPL, they may choose Private

Option and enroll at no penalty to employer.

  • Does not count against insurance issuer participation

rate requirements.

  • Does not require employer contribution to premium.

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Premium Limits Based on Income

INCOME PREMIUM LIMIT 0 ‐ 138% FPL (Medicaid Expansion) 100 ‐ 138% FPL (non‐Medicaid eligible) 2% of income 138 – 149% FPL 3 – 4% of income 150 – 199% FPL 4 – 6.3% of income 200 – 249% FPL 6.3 – 8.05% of income 250 – 299% FPL 8.05 – 9.5% of income 300 – 399% FPL 9.5% of income

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2013 Federal Poverty Guidelines

FAMILY SIZE 100% 138% 200% 400% 1 $11,490 $15,856 $22,980 $45,960 2 $15,510 $21,404 $31,020 $62,040 3 $19,530 $26,951 $39,060 $78,120 4 $23,550 $32,499 $47,100 $94,200 5 $27,570 $38,047 $55,140 $110,280 6 $31,590 $43,594 $63,180 $126,360 7 $36,610 $49,142 $71,220 $142,440 8 $39,630 $54,689 $79,260 $158,520

For each Additional person, add $4,020 $5,347 $8,040 $16,080

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11/8/2013 6

Tax Credits at Work

With an average base individual monthly premium of $284 in Arkansas, these examples show what a 30‐year‐old will pay in monthly premium:

10313 Fifty for Future

Annual income Tax credit Out‐of‐pocket premium cost $17,235 $227 $57 $22,980 $164 $120 $28,725 $92 $192

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Family costs

With an average base monthly premium of $948 for a family of four (two adults age 40 with two children), these examples show their monthly costs:

10313 Fifty for Future

Annual income Tax Credit Out‐of‐pocket premium cost $35,325 $831 $117 $47,100 $701 $247 $58,875 $553 $395

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What about business coverage?

  • What is SHOP? This stands for the Small

business Health Options Program.

  • Aim is to help reduce health care costs for

small business.

  • The Online SHOP has been delayed a few

weeks but paper applications will be accepted

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11/8/2013 7 With SHOP, every small business

  • wner with 50 or fewer employees

will be able to:

  • Access a single place to learn about health

insurance and get accurate information about plan options

  • Make apples‐to‐apples comparisons regarding

the prices and benefits of private insurance plans for their employees

  • Find a plan that works for their budget,

business and employees

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Small Business Tax Credits

  • Businesses with 25 or fewer employees with

average annual wages <$50,000 (generous exclusions for owners and owners family)

  • Credit increases to 50% of premium costs (from

35%) or 35% (from 25%) for non‐profits

  • May also receive deductions for remaining

premium portion

  • Available for two consecutive years beginning in

2014 if insurance purchased through Marketplace (also good back to 2010).

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Act 1500

Arkansas Health Insurance Marketplace Act

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11/8/2013 8

  • Creates the pathway for Arkansas to set up a

State‐Based Marketplace.

  • Structure would be a “non‐profit legal entity”

that is also a “political subdivision, instrumentality, and body politic of the State

  • f Arkansas.”
  • Would NOT be a state agency.

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  • 11 member board appointed by Governor,

Speaker of the House, and President Pro Tem of the Senate—also include Directors of DHS and AID as ex‐officio and voting members

  • The Health Insurance Marketplace Board has met

twice for organizational purposes.

  • Sherrill Wise of Little Rock, an executive at

Dillard’s Inc., was chosen at the board’s chairperson.

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Act 1439

Concerning the Health Insurance Marketplace Navigator Programs

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11/8/2013 9

Codifies licensing program for four types of individuals who will assist potential consumers in the new Marketplace:

  • Navigators
  • Guides
  • Certified Application Counselors
  • Licensed, Certified Insurance Producers.

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  • Assisters must obtain a license from the

Arkansas Insurance Department to perform their duties connected to the Marketplace.

  • Health insurance issuers or their affiliates

may NOT serve as navigators.

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Where are We Now?

  • October 1st the Marketplaces have gone live
  • Rates and Plan Benefits have been approved

by CMS.

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11/8/2013 10

Overview of QHPs in the Individual Marketplace

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Overview of QHPs in the Individual Marketplace

  • Qualified Health Plans (QHPs) to be offered in plan year 2014 were

certified on the Federally‐Facilitated Marketplace (FFM) in mid‐ September, 2013. The four medical plan issuers with certified plans include:

  • Arkansas BlueCross BlueShield
  • BlueCross BlueShield Multi‐state plan (OPM)
  • Celtic Insurance Company
  • QCA Health Plan, Inc.

The four stand‐alone dental plan issuers include:

  • Arkansas BlueCross BlueShield
  • BEST Life and Health Insurance Company
  • Delta Dental of Arkansas
  • Dentegra Insurance Company

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Overview of QHPs in the Individual Marketplace

  • There are 71 medical QHPs participating in the AR

Marketplace in the Individual Market.

A breakdown of the actuarial values of medical individual plans is shown in the chart below.

  • Bronze = 60% of qualifying health expenses are covered by the

plan

  • Silver = 70% of qualifying health expenses are covered by the plan
  • Gold = 80% of qualifying health expenses are covered by the plan
  • Platinum = 90% of qualifying health expenses are covered by the

plan

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11/8/2013 11

There are 71 Medical QHPs participating in the AR Marketplace in the Individual Market

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Service Area Coverage

Per AID Bulletin 3B‐2013, QHPs are required to cover all counties in any geographic region included in its service area.

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Service Area Coverage

  • Some plans offer statewide coverage areas, while others cover
  • nly one complete region.
  • There are between two and four QHP medical issuers and

between three and four stand alone dental plan issuers per service area.

  • The Southeast and Southwest service area have the fewest

medical issuers, while the Central and West Central have the most.

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11/8/2013 12 Premium Rating Scenarios per Rating Area

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Central Northeast Northwest South Central Southeast Southwest West Central Adult (Age 40)

328.05 302.17 342.68 290.03 289.63 292.44 326.85

2 Adults + 2 Kids

971.30 892.00 1,012.94 856.02 860.48 868.84 969.80

Child (0-20)

157.60 143.83 163.79 137.98 140.61 141.98 158.05

Adult (Age 64)

770.07 709.33 804.40 680.83 679.87 686.49 767.25

Average Silver Premiums by Issuer

  • These are the average silver premiums for each issuer with non‐tobacco

and tobacco rates. Arkansas BlueCross BlueShield and BlueCross BlueShield Multi‐state plan (OPM) do not charge a tobacco premium Celtic Insurance Company QCA Health Plan charge a tobacco premium of approximately 20%.

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Issuer Average Premium Rate ($) Average Premium Rate f Tobacco Users ($) AR BCBS

$368.77 $368.77

BCBS Multi‐State

$383.21 $383.21

Celtic

$480.30 $576.35

QCA

$435.74 $522.16

Advanced Premium Tax Credits

Advanced Premium Tax Credits Applied– Individual Market The table below shows examples of premium rates after tax credits for an individual age 30.

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Percent of FPL Annual Income ($) Premium Limit (%) Maximum Annual Premium ($) Monthly Subsidy ($) A verage Base Premium ($) Adjusted Monthly Premium ($) 0 - 138% Eligible for Private Option (No Premium) 139%

15,971.10 3.00% 479.13 219.42 259.35 39.93

150%

17,235.00 4.00% 689.40 201.90 259.35 57.45

200%

22,980.00 6.30% 1,447.74 138.71 259.35 120.65

250%

28,725.00 8.05% 2,312.36 66.65 259.35 192.70

300%

34,470.00 9.50% 3,274.65 0.00 259.35 259.35

<400%

45,960.00 9.50% 4,366.20 0.00 259.35 259.35

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11/8/2013 13

Cost Sharing Reduction Examples

Copays for Common Services

The table below lists sample in‐network copay amounts for several common services and the associated cost‐sharing reductions (copays vary among plans). Preventive care is covered without cost sharing in all plans.

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Income Actuarial Value Primary Care Specialist Visit Generic Drugs Preventive Services Mental Health Outpatient >400% FPL Standard Silver (70%) $40 $75 $20 $0 $40 200‐250% FPL 73% A/V $25 $30 $15 $0 $25 100‐200% FPL 87% A/V $10 $20 $10 $0 $10 100‐150% FPL 94% A/V $8 $10 $4 $0 $4 <138% FPL Zero Cost $0 $0 $0 $0 $0

SHOP Medical Plans

Company Metal Level Deductible Deductible MOOP Average Premium Service Area(s)

AR BCBS Gold $1,500 $3,000 $3,000 $442.87 All AR BCBS Silver $2,000 $4,000 $6,350 $386.75 All AR BCBS Bronze $3,000 $6,000 $6,350 $343.94 All

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Guide Organizations

  • 27 organizations have contracts with AID to serve

as Guide Organizations.

  • Approximately 300 Guides have completed Phase

I Training by AATYC.

  • We anticipate having 537 across the state for
  • pen enrollment, which starts October 1.

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11/8/2013 14

Outreach and Education

Broad multi‐media campaign across Arkansas

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Touching Arkansas

  • During July and August there were 214,645

total visits to the website including 167,568 unique visitors(www.ARHealthConnector.org).

  • During July and August more than 152 million

media impressions were made across the state using television, radio, billboards, Internet, local newspaper and other media.

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Enrollment began October 1!

Open Enrollment

October 1, 2013 – March 31, 2014 first year Must enroll by December 15 for January 1 coverage Future years will be October 15 – December 7

Special Enrollment

Significant Life Event Private Option Eligible

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11/8/2013 15 October 1, 2013 is Very Soon! Full Coverage January 1, 2014

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For more information

www.healthcare.gov Federal Call Center 1‐800‐318‐2596

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Contact

Bruce.Donaldson@Arkansas.gov 501‐683‐7077 www.ARHealthConnector.org 855‐283‐3483

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