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INDIVIDUAL QHP PLAN SELECTION INDIVIDUALS 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 0 36,488 30,141 38,043 33,040 ENROLLMENT MCA - Adult QHP - Individual QHP - 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 AGE WHO IS COVERED BY QUALIFIED HEALTH PLANS? Individual QHP Population by County 30% 25% 20% 15% 10% 5% 0% Addison Bennington Caledonia Chittenden Essex Franklin Grand Isle Lamoille Orange Orleans Rutland Washington Windham Windsor 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 < 18 18-25 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

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Page 1: 12info.healthconnect.vermont.gov/sites/hcexchange/files...INDIVIDUALS ENROLLED IN QUALIFIED HEALTH PLANS INDIVIDUAL QHP PLAN SELECTION (QHP) OR MEDICAID FOR CHILDREN AND ADULTS (MCA)

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

Page 2: 12info.healthconnect.vermont.gov/sites/hcexchange/files...INDIVIDUALS ENROLLED IN QUALIFIED HEALTH PLANS INDIVIDUAL QHP PLAN SELECTION (QHP) OR MEDICAID FOR CHILDREN AND ADULTS (MCA)

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