Delaware’s Health Insurance Marketplace:Update on Activity

Delaware Health Care Commission, March 6, 2014

Secretary Rita Landgraf, Department of Health and Social Services

Agenda

•Stories from the Ground

•Updates since last Health Care Commission meeting

•Marketplace enrollment update

•Medicaid update

•Consumer Assistance update

•Media and Outreach update

•Important Reminders

•Plan Management update

2

Stories from the Ground

• With support from a marketplace guide, a 20-year-old man from Newark enrolled and will pay $83 a month. 

• A middle-aged woman from Dover is unemployed and has several pre-existing conditions.  After her subsidy, her monthly payment will be $187 a month, which she called “truly affordable insurance coverage.”

• A 64-year-old woman, who must take regular medication to prevent seizures, will pay $79 a month after her subsidy. She also enrolled in a dental plan for $23 a month.

3

Stories from the Ground

4

• A 44-year-old woman from Clayton – whom the guide met through Westside’s partnership with $tand By Me – will pay $64 a month after her tax subsidy.

• A Houston couple met a guide at the Milford Library. The wife, who has a pre-existing condition and a mental health condition, hasn’t had insurance for the past 5 years. They will pay $203 a month.

• A Bear couple in their 40s, who haven’t had insurance for 7 years, will pay $207 a month after their tax subsidy and are excited to finally have coverage.

Recent Updates

On February 10, 2014, the U.S. Treasury Dept. and the IRS announced final regulations regarding the employer shared responsibility payments.•Under the Affordable Care Act, companies that have fewer than 50 employees are not required to provide coverage or fill out any forms in 2015, or in any year, under the Affordable Care Act.•Companies with 50-99 employees that do not yet provide affordable health insurance to their full-time workers will report on their workers and coverage in 2015, but have until 2016 before any employer responsibility payments could apply.•Large employers (100 or more employees) that offer coverage to 70 percent of their workers will be counted as fulfilling the employer mandate. By 2016, those employers will need to hit the original 95 percent target.

5

Enrollment Update

6

Marketplace and Medicaid Enrollment Update

As of February 28, 2014, 9,162 Delawareans have enrolled in health care coverage through expanded Medicaid and the Marketplace since

October 1, 2013

7

Marketplace and Medicaid Enrollment Update

Enrollment for the 5-Month Period: October 1, 2013 through February 28, 2014*

Total Number of Enrollees

Increase from previous month

Medicaid 2,168 55%

Marketplace* 6,994 38%

Total 9,162 42%

*This number represents Delawareans who have selected a Marketplace plan, either through Healthcare.gov, or through direct enrollment with an issuer (with or without the first premium payment having been received directly by the Insurance Company.) 8

Marketplace Enrollment

Marketplace Enrollment Update

Marketplace Plan Selection by Metal Level — Silver plans account for 54% of the plan selections in the Delaware Marketplace.

Metal Level Distribution (rounded to the nearest whole number):•Bronze = 14%•Silver = 54%•Gold = 22%•Platinum = 9%•Catastrophic = 1%

Marketplace Plans: Financial Assistance — More than three-quarters (77%) of the Delawareans who have selected a Marketplace plan will be receiving Federal financial assistance in paying their premiums.

•This includes people who qualify for an advance premium tax credit (APTC), with or without a cost-sharing reduction (CSR).

10

Marketplace Enrollment Update:Comparison by Age

Enrollees % Enrolled

Age Groups

0 -17 691 10%

18 – 25 456 7%

26 – 34 997 14%

35 – 44 1,068 15%

45 – 54 1,519 22%

55 – 64 2,244 32%

65+ 19 <1%

Total 6,994 100%

11

Marketplace Enrollment Update: Comparison by County

Enrollees % Enrolled

County

Kent 851 12%

New Castle 4,282 61%

Sussex 1,860 27%

Total 6,993* 100%

12

*Data received from the issuer only included county identification for 6,993 enrollees.

Marketplace Enrollment Update: Comparison by Gender

Enrollees % Enrolled

Gender

Male 3,101 44%

Female 3,893 56%

Total 6,994 100%

13

Marketplace Enrollment Update: Metal Level Comparisons by Age

14

Delaware Marketplace Enrollment

0-17 18-25 26-34 35-44 45-54 55-64 65+

Bronze 87 56 121 147 199 363 7

Silver 294 228 522 587 895 1,256 11

Gold 218 93 202 216 314 491 0

Platinum 86 47 99 118 111 134 1

Catastrophic 6 32 53 n/a n/a n/a n/a

Total 691 456 997 1,068 1,519 2,244 19

Marketplace Enrollment Update: Metal Level Comparisons by Gender and County

15

Delaware Marketplace Enrollment

New Castle Kent Sussex

Bronze 617 120 243

Silver 2,302 464 1,027

Gold 888 204 441

Platinum 414 50 132

Catastrophic 61 13 17

Total 4,282 851 1,860

Delaware Marketplace Enrollment

Male Female

Bronze 458 522

Silver 1,611 2,182

Gold 703 831

Platinum 281 315

Catastrophic 48 43

Total 3,101 3,893

Marketplace Enrollment Update: The “Young Invincibles”

16

Age Group % Uninsured1 % of Total Enrollment

0-17 18.56% 10%

18-25 19.07% 7%

26-34 20.75% 14%

35-44 17.89% 15%

45-54 13.32% 22%

55-64 10.41% 32%

1Derived from a 2 year average of 2012 and 2013 Current Population Survey (CPS) data.

*Note: Insurance company enrollment information does not indicate if enrollees were previously uninsured

• 21% of Marketplace enrollees are in the “Young Invincible” age group. The national average of enrollments for this critical age group is 25% (as of 2/1/14).

• 52% of Young Invincibles enrolled through the Marketplace have chosen a Silver QHP

Trend of Marketplace Enrollments

17

Medicaid Newly Eligible Enrollment

Medicaid (Newly Eligible) Enrollment Update: Comparison by Age

Enrollees % Enrolled

Age Groups

19 – 25 397 18%

26 – 34 527 24%

35 – 44 478 22%

45 – 54 425 20%

55 – 64 341 16%

Total 2,168 100%

19

Medicaid (Newly Eligible) Enrollment Update: Comparison by County

Enrollees % Enrolled

County

Kent 485 22.4%

Sussex 658 30.3%

New Castle 1,025 47.3%

Total 2,168 100%

20

Medicaid (Newly Eligible) Enrollment Update: Comparison by Gender

Enrollees % Enrolled

Gender

Male 669 31%

Female 1,499 69%

Total 2,168 100%

21

Consumer Assistance Update

Marketplace Guide Activities to Date

•As of February 28, 2014:

• 538 completed enrollments

• 1,137 completed applications

• 1,608 outreach activities conducted

• 695 referrals to Medicaid

23

Enrollment Support

•Guides are using unique outreach strategies to maximize contacts including partnering with tax preparation services and large retailers

•Get Covered! Enrollment Events

• More than 23 large-scale events focused on enrollments scheduled throughout February and March

• Partnering with Delaware Technical Community College, Wilmington University, and public schools

•Standing locations throughout the state in State Service Centers, libraries and other community locations

•Full schedule of recurring locations and special events is available on ChooseHealthDE.com

24

Guide Activities after Open Enrollment

•Guides will continue to provide enrollment assistance after March 31 for consumers that experience a qualifying change of life event (e.g. marriage, loss of minimum essential coverage): See https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/

•We are currently assessing the program’s workforce needs after open enrollment. A more detailed plan will be available at the April Health Care Commission meeting.

25

Media and Outreach Update

2014 Traffic to ChooseHealthDE.com

January 1-February 28, 2014Visits: 21,396Page views: 96,273Pages/Visit: 4.5Avg. Visit Duration: 2:26

Media began running

27

Referring Sites to ChooseHealthDE.com

Source Visitsdelaware.gov 980dhss.delaware.gov 639dmap.state.de.us 590delawareinsurance.gov 307westsidehealth.org 105delawareonline.com 100de.gov 78beebehealthcare.org 71stfrancishealthcare.org 34johncarney.house.gov 32christianacare.org 31webmd.com 28financialhelpforhealth.org 27hjmc.org 25healthinsurance.org 23laredhealthcenter.org 21

28

Clicks from ChooseHealthDE.com to Healthcare.gov

From Jan. 1-Feb. 28, 2014,

there have been

2,993 clicks from ChooseHealthDE.com to Healthcare.gov.

ChooseHealthDE.com

Healthcare.gov

29

Social Media Contests

Facebook: 3,153 Likes

Firefly Ticket Contest:

Increased fan base by 1,111

Lady Antebellum Ticket

Contest:

Increased fan base by 37

Bruno Mars Ticket

Contest:

Will run from March 7-14

Enrollment Opportunities

• More than 430 enrollment opportunities from today through March 31.

• Events at libraries, schools, universities/colleges, hospitals, clinics, etc.

• More expected to be added.

• To find an enrollment event that meets your schedule and location, go to:

www.ChooseHealthDE.com

31

Focus on Kent County

Specific tactics to reach this area include:

•February 15th National Youth Enrollment Day event at Dover Mall

•Advertising on WMDT and WBOC and multiple local radio stations

•Door hangers placed on over 88,000 doors in Kent/Sussex counties (households with 18-34 year olds)

•Facebook promotion for Delaware State Fair concert tickets

Combined Marketplace and Medicaid Combined Marketplace and Medicaid enrollment in Kent County: 1,336enrollment in Kent County: 1,336

Percentage of total enrollment from Kent Percentage of total enrollment from Kent County is 14.5%County is 14.5%

Media Campaign

• New testimonial campaign has launched. Items currently running include:• Commercials on TV, Hulu• Interactive ads on Pandora and

YouTube• English and Spanish radio ads• Ads in movie theaters across the

state• New brochures and other collateral

materials are printed and now available. Partners and stakeholders can order through the ChooseHealthDE.com website.

33

Video Testimonial—Jenna, Newark

Video Testimonial—Ray, Newark

Video Testimonial—Juana, Laurel

Important Reminders

Key Dates

Date Milestone

March 15, 2014 Last day to enroll for coverage to begin on April 1; those who enroll between March 16-31 will have coverage beginning May 1.

March 31, 2014 Last day of open enrollment for coverage in Plan Year 2014. In order to buy a Marketplace health insurance plan outside the open enrollment period, you must have a qualifying life event.

November 15, 2014-February 15, 2015

Open enrollment for coverage in Plan Year 2015

38

Notes:•Medicaid enrollment can occur at anytime. •Employers may continue to enroll in SHOP on a rolling monthly basis. The deadline to enroll is always the 15th of the month for coverage to be effective the 1st of the following month.

Penalty

If someone who can afford health insurance doesn’t have coverage in 2014, they may have to pay a fee. They also have to pay for all of their health care.

•For 2014, consumers will pay whichever of these amounts is higher:

• 1% of yearly household income. (Only the amount of income above the tax filing threshold, $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average yearly premium for a bronze plan.

• $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.

•The fee increases every year. In 2015, it’s the higher of 2% of income or $325 per person. In 2016 and later years it’s the higher of 2.5% of income or $695 per person.

•For those uninsured for just part of the year, 1/12 of the yearly penalty applies to each month without insurance. Those uninsured for less than 3 months do not have a penalty.

39

Penalty

Tax Year 2014

Tax Year 2015

Tax Year 2016

Beyond TY 2016

Income-based penalty

1% of household income above the filing threshold

2% of household income above the filing threshold

2.5% of household income above the filing threshold

2.5% of household income above the filing threshold

Minimum penalty amount

$95/person $325/per person

$695/person $695 + inflation adjustment/per person

40

For more information on the Individual Shared Responsibility Payment, go to:•Healthcare.gov https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014/•IRS http://www.irs.gov/uac/Newsroom/The-Individual-Shared-Responsibility-Payment-An-Overview

Plan Management Update

Plan Management: Preparing for Plan Year 2015

November 2012, the HCC approved the state-specific standards for qualified health plans (QHPs) for Plan Years 2014 and 2015 that may be purchased through the Marketplace.  Preparation for Plan Year 2015:•January 2014—DOI issued formal bulletin to Issuers, inviting them to submit a Letter of Intent to apply for the Plan Year 2015•May through September 2014—DOI team reviews plans for compliance with federal and state standards and regulations (rates, benefit design, cost-sharing, network adequacy, etc.)•October 2014—Federal government conducts final QHP reviews and certifies state-recommended plans •November 2014—Federal government releases list of certified QHPs for Plan Year 2015•November 15, 2014—Second Open Enrollment begins

The Insurance Commissioner’s bulletin to Issuers, including the approved list of the Delaware QHP Standards for Plan Year 2015 may be found at the following URL: http://www.delawareinsurance.gov/departments/documents/bulletins/DomesticForeignInsurersBulletin69.pdf

42

Plan Management: Looking Ahead

The Marketplace Program team will work with the HCC to review current state-specific QHP Standards and Essential Health Benefits (EHBs), and develop recommendations for changes for implementation in Coverage Year 2016

Proposed Schedule of Activities

43

Step Activity Proposed Timeline

1 Review current QHP Standards and EHB benchmark to identify opportunities for modification/additions.

April - July 2014

2 Submit list of recommended changes to EHB and QHP Standards to HCC for review and comment

July –August 2014

3 Conduct Public Comment Period on proposed changes to QHP Standards and EHB Benchmark

August - September 2014

4 Review stakeholder feedback on proposed changes and develop final recommendations for HCC review

September - October 2014

5 Review Final Recommendations with HCC October 2, 2014

6 Solicit HCC decision (approval/denial) on recommended changes November 6, 2014

7 Publish Delaware EHB benchmark and QHP Standards for Coverage Year 2016 December 1, 2014