+ covered california: 10 things you need to know about open enrollment darin latimore, md, facp...
TRANSCRIPT
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Covered California:10 Things You Need to Know about Open Enrollment
Darin Latimore, MD, FACPOctober 19, 2014
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Darin Latimore, MD, FACPAssociate Dean Office of Student and Resident DiversityUC Davis School of Medicine
Dr. Latimore declares that in the past 12 months neither he nor any member of his family have had a financial arrangement or affiliation with any corporate organization offering financial support of grant moneys for this continuing education program.
+ This activity is sponsored by the California Academy of Family Physicians.This initiative is a partnership of the California Academy of Family Physicians, California Academy of Physician Assistants, California Chapter of the American College of Physicians and Osteopathic Physicians and Surgeons of California.
This initiative is supported by a
grant from Covered
California.
+Learning Objectives
At the end of the session, participants should be able to:
Describe the goals for the next Covered California open enrollment period.
Identify the health plans available in 2015 through Covered CA.
Understand plan network and access Issues.
Describe to patients how to explore their options with Covered California.
+Next Open Enrollment Period
November 15, 2014 to February 15, 2015
+ Covered California 2015 Health Plan Benefit Year
January 1, 2015 toDecember 31, 2015
+10 Things to Knowabout Open Enrollment
Covered California is targeting two groups of Californians:
Californians applying for first-time coverage
Californians renewing current policies
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+Outreach Campaign Goals
Covered California aims to:
Increase enrollment from 1.2 million Californians to 1.7 million Californians;
Fix problems consumers faced during the first open enrollment period; and
Offer a streamlined renewal process.
+10 Things to Knowabout Open Enrollment
Consumers should set up Covered California accounts NOW.
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+Covered California Accounts
Consumers should have an active Covered California online account. (Having an online account is not required, but it will allow consumers to access their Covered California information without assistance and will make the renewal process easier.)
Consumers should provide email addresses to get important updates.
Consumers can use their accounts to update their income, add or remove a member of their household and change their communication preference.
+10 Things to Knowabout Open Enrollment
Consumers can choose from the same health plans…minus one.
Covered California has selected 10 health insurance plans to be in the state health exchange in 2015. All 10 health were in the exchange for 2014.
Only one of the health plans from the 2014 Open Enrollment Period is out: Alameda Alliance for Health.
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+Health Plans in 2015
Anthem Blue Cross of California
Blue Shield of California
Chinese Community Health Plan
Health Net
Kaiser Permanente
LA Care Health Plan
Molina Healthcare
Sharp Health Plan
Valley Health Plan
Western Health Advantage
+10 Things to Knowabout Open Enrollment
Having the same health plans DOES NOT mean the same network of physicians.
Networks/Access remain a problem in 2015.
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+Health Net: PPO to Narrow Network
Health Net plans to transition from a PPO network to a network with 54 percent fewer physicians and no coverage for out-of-network care in certain regions.
The slimmed-down plan will cost up to 9 percent more than the PPO coverage, however.
HealthNet said the change was necessary to keep rates affordable.
New York Times
+Blue Shield and Anthem
Blue Shield of California has proposed a physician network for 2015 that will have up to four percent fewer providers in certain areas
Anthem Blue Cross plans to maintain its current physician network.
New York Times
+Networks/Access in 2015
Remember:
Covered California does not change how existing state health care problems are administered.
Covered California does NOT regulate plan networks.
Covered California does not contract directly with physicians, hospitals or other providers.
Health insurance plans contract directly with providers and the terms of those contracts (financial and non-financial) are proprietary to each plan.
+Regulator Investigating
DMHC is investigating the accuracy of Anthem Blue Cross and Blue Shield of California’s provider directories. This was prompted by consumer complaints about access issues.
Results of investigation/DMHC response expected before next open enrollment begins (November 15).
+We’re Raising Your Concerns
+10 Things to Knowabout Open Enrollment
Confirm your network status now WITH HEALTH PLANS.
There is no Covered California Physician Directory Planned for 2015.
Confirm Contract Status with PLANs.
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+If Not Covered California,Who Can Help Me with Contracts?
Health Insurance Company
Network Development Contact Name/Title
Phone Number email
Anthem Blue Cross of California
Aldo de la Torre, Vice President Provider
Engagement and Contracting 855- 238-0095 [email protected]
Blue Shield of California
Hugo Florez, Senior Director, PPO and Specialty Networks
Network Management 818-228-2607 [email protected]
Health Net of California
David Davidson, Director, Contracts Administration &
Provider Services/Operations 818-676-7331 [email protected]
+10 Things to Knowabout Open Enrollment
Consumers can expect minimal changes in premiums and subsidies.
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+Health Plans in 2015: Premiums
Most Covered California consumers will see low premium increases in 2015, and some consumers will see no increase or even a decrease.
The statewide average increase = 4.2 percent.
Some plans offering an 8.5 percent decrease.
+Subsidies in 2015
90 percent of consumers who purchased through Covered California received federal subsidies to reduce costs.
For most consumers, that subsidy will either increase or remain very close to 2014 subsidy amounts.
For many consumers, any increase in premium will be offset by an increase in subsidy.
+10 Things to Knowabout Open Enrollment
Plans AUTOMATICALLY will renew consumers unless they (the consumers) make a change.
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+Renewals: Important Dates
Consumers can renew policies beginning on October 1.
Consumers who want to change coverage must wait until the start of Open Enrollment (November 15) to do so, however.
Exchange policies automatically will be renewed if enrollees do not specify that they want to change plans by December 15.
+10 Things to Knowabout Open Enrollment
Health Plans will mail a series of renewal notices to consumers in October, November and December.
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+Renewal Notices: Timeline
Early October: a letter letting consumers know it’s time to renew their coverage (“NOD 12” code in lower left).
a. Instructions on how to renew coverage.
b. The member’s 2014 plan selection and 2014 premium assistance amount.
c. The name and contact information for the Certified Enrollment Counselor or Certified Insurance Agent who assisted the member last year.
+Renewal Notices: Timeline
November 1: a co-branded renewal letter from the consumer’s health insurance plan.
a. The member’s 2014 and 2015 premium amounts and a description of the difference.
b. The member’s 2014 premium assistance amount.
c. Directions to go to the Shop and Compare Tool at CoveredCA.com to see the full range of 2015 plans and rates and to calculate their net premium.
+Renewal Notices: Timeline
Mid-November: a 2015 welcome letter (“NOD 01” code in lower left).
a. Confirmation of the member’s 2015 eligibility.
b. 2015 premium assistance amount.
+Renewal Notices: Timeline
Mid-November: a 2015 “You’re almost done” letter (“NOD 08” code in lower left).
a. Confirmation of the health plan selected.
b. The member’s 2015 premium amount and 2015 net premium assistance amount.
c. Reminder to pay premium directly to the health insurance company
+Renewal Notices: Timeline
Late December: an invoice from the health insurance plan the member selected.
a. The member’s 2015 monthly net premium.
b. Instructions for making the premium payments to the health insurance plan, not Covered California.
+10 Things to Knowabout Open Enrollment
During Open Enrollment, consumers have multiple avenues to purchase health insurance.
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+Reminder: How Patients Can Enroll
www.coveredca.com
CC Service Center 800-300-1505
Certified Enrollment Counselors
Certified Insurance Agents
Mail or Fax
Local county human or social services office
www.coveredca.com is the ONLY official website!
+Reminder: Three Paths to Health Insurance
Path 1
Path 2
Path 3
At or below 138% of the Federal
Poverty Level (FPL)Medi-Cal
Between 139-250% FPL
Between 251-400% FPL
Eligible for a CC Health Plan with premium
assistance and improved benefits
Eligible for a CC Health Plan with premium assistance but not improved benefits
Over 400% FPLEligible for a CC
Health Plan
+10 Things to Knowabout Open Enrollment
Encourage use of the New Shop and Compare Tool NOW. Consumers should understand cost shifts and the availability of providers.
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+New Shop and Compare Tool Available NOW!
Consumers now can use the 2015 Shop and Compare Tool on the Covered California website to look at plans and products in their areas and get preliminary estimates of costs and premium assistance.
https://www.coveredca.com/shopandcompare/#calculator
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Shop and Compare Tool
+Shop and Compare Tool Basic information needed:
Number of people in household
Age of each person Household income Zip Code
+Shop and Compare Tool
Answers questions about Covered California and what it can do for you and your family.
Displays plan options in each region and provides a breakdown on monthly costs.
+In 2014: Who Got Covered?
SUCCESS!
3.4 million or 58 percent of previously uninsured adult Californians obtained health insurance in the first open enrollment period.
25 percent through Medi-Cal
12 percent through an employer
Nine percent through Covered California
Five percent through other non-group coverage
Kaiser Family Foundation
+Who Got Covered?
Kaiser Family Foundation
25%
9%5%
12%6%
13%
29%
Medi-Cal
Covered California
Other non-group
Employer-Sponsored Insurance
Somewhere else/unknown
Remaining Undocumented Uninsured
Remaining Eligible Uninsured
Remaining Uninsured 42% Newly Insured 58%
+The Remaining Uninsured
Length of Time Uninsured37% Never insured45% 2 years +12% 1-<2 years6% 2 months-<1 year
Race/Ethnicity24% White32% Eligible Hispanics29% Undocumented Hispanics5% Blacks8% Other
Income/Eligibility30% Undocumented 30% Medi-Cal target group24% Exchange subsidized target group4% 400% FPL4% Don’t know/Refused to
Answer
Age17% 19-2525% 26-3433% 35-4924% 50-64
Total Hispanics: 62%
The Remaining Uninsured in their Own Words
I still cannot afford health insurance. It’s a total rip-off, it’s extremely expensive. I don’t have
enough income.
Can’t apply for it because of my legal status. My husband’s income is too high. Don’t think I
qualify.
Working so much I haven’t had time. I’m limited with my time and the applications are too long. I
don’t have time.
I find it too difficult to understand and there’s no support from anybody to help me. Confused
about the system.
Among California’s remaining uninsured: What is the main reason you have not gotten health insurance this year?
34% -- Can’t afford it/Too expensive.
15% -- Don’t qualify for coverage/Financial help.
9% -- Haven’t tried/Too busy.
9% -- Lack of information/ Don’t know how to get it.
Kaiser Family Foundation
+The Remaining Uninsured
An opportunity exists:
57 percent of the uninsured think they will enroll later this year; only 31 percent think they will continue without health insurance.
36 percent of the uninsured say they tried unsuccessfully to get insurance in the first open enrollment period.
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Thank you!
Questions?