12info.healthconnect.vermont.gov/sites/hcexchange/files...individuals enrolled in qualified health...
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INDIVIDUAL QHP PLAN SELECTIONINDIVIDUALS ENROLLED IN QUALIFIED HEALTH PLANS (QHP) OR MEDICAID FOR CHILDREN AND ADULTS (MCA)
DECEMBER 2014 MAY 2015
250,000
200,000
150,000
100,000
50,000
036,488
30,14138,043
33,040
ENRO
LLM
ENT
MCA - AdultQHP - IndividualQHP - Small Business
Note: Effectuated enrollments for Small Business QHP (direct enrolled) as reported by insurers to VHC. Dec. 2014 Individual QHP as reported by insurers to Center for Medicaid and Medicare Services (CMS). May 2015 Individual QHP as reported by VHC to CMS. Medicaid for Children and Adults (MCA) as reported by Vermont Health Connect and Vermont’s legacy ACCESS system. MCA includes Dr. Dynasaur and CHIP but does not include Medicaid for the Aged, Blind, and Disabled (MABD).
COVERED VERMONTERS
VERMONT HEALTH CONNECT MAY 2015 DASHBOARD
DEMOGRAPHICS
as of 5/27/2015
52%FEMALE
48%MALE
45-54
35-44
55-64
26-34
18-25
< 18
AGEWHO IS COVERED BY QUALIFIED HEALTH PLANS?
Individual QHP Population by County30%
25%
20%
15%
10%
5%
0%
Addison
Bennington
Caledonia
Chittenden
Essex
Franklin
Grand Isle
Lamoille
Orange
OrleansRutlan
d
Washington
WindhamWindsor
7%7%
24%
1%1%4%4%4%4% 5%
9%9%9% 10%
9%6%
35%
23%
12%
14%GENDER
WEBSITE AVAILABILITY* IN MAY 2015:
100%
ONLINE BY PHONE IN PERSON
96% of calls answered in under 30 seconds, compared to 69%
in May 2014.
AVERAGE WAITING TIME IN
MAY 2015:
12 SECONDS
MAY 2015 IN-PERSON
CONSULTATIONS*
1,894 (26,936 SINCE LAST
JULY)
CUSTOMER SUPPORT
< 1818-25
26-34
35-44
45-54
55-64
(up from 99.9% in April)
93% OF CALLS
ADDRESSED BY INITIAL
REPRESENTATION(NO TRANSFER).
*Unique interactions with individuals lasting at least 10 minutes.
61,013
70,980
MCA - Child
78,393
62,082
*Percentage of time web portal was up and running outside of scheduled maintenance period.
56%
12%
11%20%
1% Catastrophic
Platinum
Gold
Bronze
Silver
Published 6/18/2015
FINANCIAL HELP
WHO’S RECEIVING FINANCIAL HELP TO PURCHASE A QHP AND WHAT ARE THEY PAYING FOR HEALTH CARE?
*The BCBSVT Standard Silver Plan is the most common plan. **Note: There are four tiers of cost-sharing reductions. Depending on income, an individual in a Standard Silver CSR plan could have a deductible
between $100 and $1,900 and a maximum out-of-pocket between $500 and $4,000. The median CSR customer is in a Silver 87 plan detailed above.
POSSIBLE TOTAL COSTS (PREMIUM & OUT-OF-POCKET)
Typical (median) individual receiving Cost-Sharing Reductions**
Income: $21,500 Plan Type: BCBSVT Standard Silver 87 Plan
ELIGIBLE FOR:• Advanced Premium Tax Credits• Vermont Premium Assistance• Cost-Sharing Reductions
37%
NOT ELIGIBLE FOR: Financial Help
10%ELIGIBLE FOR:
Advanced Premium Tax Credits Only
INCOME
INDIVIDUAL
< $35,010
FAMILY OF FOUR
< $71,550
INCOME
INDIVIDUAL
> $46,680
FAMILY OF FOUR
> $95,400
PLAN SELECTION AMONG INDIVIDUALS
ELIGIBLE FOR COST-SHARING REDUCTION
PLAN SELECTION AMONG INDIVIDUALS
NOT-ELIGIBLE FORCOST-SHARING REDUCTIONS
35%
22%
16%
25%
1%
PREMIUM
MONTHLY PREMIUM FOR MOST COMMON SILVER PLAN*
$466$120
67%
8%
18%
Catastrophic
Platinum
Gold
Bronze
Silver
Gold
Bronze
Silver
Platinum7%PLAN SELECTION PLAN SELECTION
FULL PRICEPremium: $466 Deductible: $1,900
Maximum Out-of-Pocket: $5,100
AFTER SUBSIDYPremium: $104 Deductible: $600
Maximum Out-of-Pocket: $1,250
vs.
67%
< 300% Federal Poverty Level > 400% Federal Poverty Level
55% 35%
(after subsidy)
300% - 400% Federal Poverty Level
of enrolled individualsof enrolled individuals
of enrolled individuals
(full price)
Median:
69%of new enrollments
64%of re-enrollments
QHP INDIVIDUALS RECEIVING FINANCIAL HELP