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

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 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. 3 1

11/8/2013 Status of Marketplaces State ‐ Based Marketplace State ‐ Based Marketplace (SHOP only) Partnership Marketplace Federal Marketplace 4 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). 6 2

11/8/2013 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. 7 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. 8 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. 9 3

11/8/2013 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 10 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. 11 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) 12 4

11/8/2013 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. 13 Premium Limits Based on Income INCOME PREMIUM LIMIT 0 ‐ 138% FPL (Medicaid Expansion) 0 100 ‐ 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 14 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 $4,020 $5,347 $8,040 $16,080 person, add 15 5

11/8/2013 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: Annual income Tax credit Out ‐ of ‐ pocket premium cost $17,235 $227 $57 $22,980 $164 $120 $28,725 $92 $192 10313 Fifty for Future 16 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: Annual income Tax Credit Out ‐ of ‐ pocket premium cost $35,325 $831 $117 $47,100 $701 $247 $58,875 $553 $395 10313 Fifty for Future 17 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 18 6

11/8/2013 With SHOP, every small business owner 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 19 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). 20 Act 1500 Arkansas Health Insurance Marketplace Act 21 7

11/8/2013 • 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 of Arkansas.” • Would NOT be a state agency. 22 • 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. 23 Act 1439 Concerning the Health Insurance Marketplace Navigator Programs 24 8

11/8/2013 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. 25 • 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. 26 Where are We Now? • October 1 st the Marketplaces have gone live • Rates and Plan Benefits have been approved by CMS. 27 9

11/8/2013 Overview of QHPs in the Individual Marketplace 28 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 29 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 30 10

11/8/2013 There are 71 Medical QHPs participating in the AR Marketplace in the Individual Market 31 Service Area Coverage Per AID Bulletin 3B ‐ 2013, QHPs are required to cover all counties in any geographic region included in its service area. 32 Service Area Coverage • Some plans offer statewide coverage areas, while others cover only 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 . 33 11