Arkansas’s Health Insurance Marketplace*****

Arkansas Social Workers in HealthcareLittle Rock, April 25, 2014

*****

Cindy Crone, APRN, Deputy CommissionerArkansas Insurance Department

Arkansas Health Connector Division

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Goals of ACA

• Reduce the growth of healthcare costs

• Promote high quality care

• Expand availability of affordable coverage

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How?

• Public and Private Coverage Expansions

• Change in Benefits and Access to Care

• Insurance Issuer Market Reforms

• Individual Responsibility

• Establishment of Health Insurance Exchanges

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Is health reform needed in AR?

• In Arkansas, 550,000+ uninsured at the end of 2013

• Historic blend of low-incomes and poor health, reflect: Lack of health careUncompensated care

• Arkansas healthcare leaders already addressing health system improvements before ACA

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Selected Health Indicators(Kaiser Family Health, 2014)

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Indicator United States Arkansas

Infant Mortality per 1,000 live births

6.6 7.6

Teen Deaths per 100,000 49 63

Life Expectancy at Birth 78.9 years 76.0 years

Population with a Disability

12.1% 16.6%

Childhood Obesity 31.3% 33.9%

Cancer incidence per 100,000

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Following three years of planning….

The Health Insurance Marketplace in Arkansas is open for business

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Status of Marketplaces

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State-Based MarketplaceState-Based Marketplace (SHOP only)Partnership MarketplaceFederal Marketplace

Diverse Partners• Government Policy Makers

State <–> Federal (Appointed and Elected)State <–> State (Appointed and Elected)

• Policy Makers <–> Non-Government ConstituentsConsumers and Consumer AdvocatesHealth Care ProvidersHealth Care InsurersBusinesses

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Consumer Assistance and Plan Management Advisory Committees

Arkansas Health Connector Staff &

Consultants

Research / Alternatives

Analysis

Steering Committee

Final Recommendation to Commissioner

Consumer Assistance Advisory Committee

Plan Management Advisory Committee

Develop Recommendations with Alternatives

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Inclusive Stakeholder Engagement

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Examples of Arkansas-Specific Plan Management

Decisions• Essential Health Benefits Base Benchmark Plan

• QHP approval by Certification vs. Competitive Bidding

• Habilitative Services Defined

• Defined Seven Rating (and Service) Areas

• Maximum 20% Upcharge for Tobacco Use AllowedCont’d….

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• Medicaid Premium Assistance Plan (Private Option) will be High-Level Silver Plan

• Network Adequacy Standards

• Quality Standards

• Federal Government to administer 3R’s (Reinsurance, Risk Corridors, Risk Adjustment) for Arkansas in 2014-2015.

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Examples of Arkansas-SpecificConsumer Assistance Decisions

• Standards for In-Person Assister (IPA) entities and Guides/other assister licensure.

• Standards for Assister Training.

• Development of Arkansas Health Connector Resource Center.

• Respond to ongoing feedback and improvement recommendations for outreach/education efforts, Resource Center, and enrollment.42514 ASWHC 12

Health Care Independence Act• “Private Option” passed in 2013 Arkansas General Assembly• Medicaid expansion unique to Arkansas • Covers newly eligible adults ages 19-64, up to 138% FPL• Incorporates private health insurance• Helps with continuity of coverage• Creates a more favorable risk pool

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Individual Premium Tax Credit Eligibility

• Household income 139% to <400% FPL

• Enrolled in a QHP through the Marketplace

• Lawfully present

• Not incarcerated (post conviction)

• Not eligible for other coverage such as Medicare, Medicaid, or affordable employer-sponsored insurance.

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29%

17%23%

31%

Age breakdown for those >138% FPL in Arkansas Marketplace plans by April 6, 2014

(does not include Private Option)

34 and younger

35-44

45-54

55-64

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39%

21 %

21%

19%

Age breakdown for those who have selected Ar-kansas Marketplace plans by April 6, 2014 (includ-

ing Private Option)

34 and younger

35-44

45-54

55-64

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AR State Partnership Marketplace Health Insurance Medical Issuers - 2014

• Arkansas Blue Cross and Blue Shield

• Blue Cross and Blue Shield Multi-State

• QualChoice of Arkansas

• Celtic, doing business as Arkansas Health and Wellness Solutions (Ambetter)

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Qualified Health Plansin Arkansas Marketplace - 2014

Metal Level Actuarial Value

Number of Plans*

Gold 80 percent 23

Silver 70 percent 16

Bronze 60 percent 24

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Additionally, 8 catastrophic plans are offered

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18% 1%

14%67 %

Metal Level in FFMApril 6, 2014

(Does not include Private Option)

BronzeCatastrophicGoldSilver

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5%0 %

4%

91%

Metal Level Combined MarketApril 6, 2014

(including Private Option)

Bronze

Catastrophic

Gold

Combined Silver

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Stand-Alone Dental IssuersOffer 24 Plans in 2014

• Arkansas Blue Cross and Blue Shield• Best Life and Health• Delta Dental of Arkansas• Dentegra Insurance Company

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Premium Limits Based on IncomeINCOME PREMIUM LIMIT

0 - 138% FPL (Medicaid Expansion) 0100 - 138% FPL (non-Medicaid eligible) 2% of income139 – 149% FPL 3 – 4% of income150 – 199% FPL 4 – 6.3% of income200 – 249% FPL 6.3 – 8.05% of income250 – 299% FPL 8.05 – 9.5% of income300 – <400% FPL 9.5% of income

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2013 Federal Poverty Guidelines

FAMILY SIZE

100% 138% 250% 400%

1 $11,490 $15,856 $28,725 $45,960

2 $15,510 $21,404 $38,775 $62,040

3 $19,530 $26,951 $48,825 $78,120

4 $23,550 $32,499 $58,875 $94,200

5 $27,570 $38,047 $68,925 $110,280

6 $31,590 $43,594 $78,975 $126,360

7 $36,610 $49,142 $89,025 $142,440

8 $39,630 $54,689 $99,075 $158,520

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Tax Credits at WorkWith an average base individual monthly premium of $259 in Arkansas for second-lowest price Silver plan, these examples show what a 30-year-old non-smoker will pay in monthly premium:

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Annual income Tax credit Out-of-pocket premium cost

$17,235 $202 $57$22,980 $139 $120$28,725 $67 $192

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What about family costs?

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With an average base monthly premium of $874 for a family of four (two adults age 40 with two children) in a second-lowest cost silver plan, these examples show monthly costs:

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Annual income Tax Credit Out-of-pocket premium cost

$35,325 $756 $117$47,100 $627 $247$58,875 $479 $395

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Premiums Vary by Age

Age Monthly average premium without tax credits

0-20 $15330 $28440 $32050 $44860 $680

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Seven rating areas in Arkansas

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Issuers/Plans per Service/Rating Area

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Central - 1 Northeast - 2 Northwest - 3 South Central - 4

Medical 4/41 3/17 4/41 3/17

Dental 4/12 3/10 3/10 4/12

Southeast - 5 Southwest - 6 West Central - 7Medical 2/11 2/11 4/35

Dental 3/10 3/10 4/12

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Regional variancesPremiums without tax credits

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Central NorthEast

NorthWest

South Central

SouthEast

SouthWest

West Central

Adult (age 40)

$328 302 343 290 290 292 3272 adults, 2 children

971 892 1,013 856 860 869 970

Child(age 0-20)

158 144 164 138 141 142 158

Adult (age 64)

770 709 804 681 680 686 767

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Average Premiums Without Subsidies March 23, 2014

FFM Catastrophic

FFM Bronze

FFM Silver

FFM Gold

FFM Composite

Private Option Silver

$134

$313

$406

$477

$400

$351

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Premium payment status

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1%

7%

26%

65%

Grace Period

Cancelled

First Payment Due

Current

Numbers reported by issuers to AID on April 7, 2014.

Important for Families

Maximum Annual Out of Pocket Maximums (which include Deductibles, Co-Insurance and Co-pay) for Plans on Marketplace:– $6,350 per individual – often less on sliding scale– $12,700 per family – often less on sliding scale

HSAs are available on some plans.Independence Accounts will be available in 2015

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FFM 2014 Individual Marketplace Enrollment (without HCIP)

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What is covered?

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Essential Health Benefits• Outpatient Services• Hospitalization• Emergency Services• Maternity and Newborn Care• Mental Health and Substance Use Disorder

TreatmentCont’d …

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• Prescription Drugs• Rehabilitative and Habilitative

Services/Devices• Laboratory Services• Preventive, Wellness, and Chronic Disease

Management• Pediatric Services, Including Oral and Vision

Care

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Preventive services include• Abdominal Aortic Aneurysm

one-time screening • Alcohol Misuse screening and

counseling• Aspirin use to prevent

cardiovascular disease for men and women of certain ages

• Blood Pressure screening • Cholesterol screening • Colorectal Cancer screening • Depression screening

• Diabetes (Type 2) screening • Diet counseling • HIV screening • Immunization vaccines • Obesity screening and

counseling• Sexually Transmitted Infection

(STI) prevention counseling• Syphilis screening • Tobacco Use screening for all

adults and cessation interventions for tobacco users

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Mental Health Coverage

Includes behavioral health and substance use disorder treatment.

Must cover:• Professional Services (by licensed practitioners

acting within the scope of their license) • Diagnostics • Inpatient hospital or other covered facility • Outpatient hospital or other covered facility

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Mental Health Parity

Coverage for the medical treatment of mental illness and substance use disorder must be provided under the same terms and conditions as that coverage provided for other illnesses and diseases.

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Enrollment Options – Individual MarketHow?

Internet

Phone

In-person

Mail

Who can help?Agents and brokers

Guides

Navigators

Certified Application Counselors

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Navigators

CACs

Guides

Producers

-100 100 300 500 700 900 1,100 1,300 1,500

Marketplace licenses by type

Through April 17… 2,275 Marketplace assister licenses were issued by AID … 1,452 licenses to producers … 566 to guides … 236 to certified application counselors … 30 to navigators.

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What about business coverage?• The Small Business Health Options Program (SHOP) is

part of the Marketplace.

• Aim is to help reduce health care costs for small business.

• Eligible businesses have 50 or fewer full-time equivalent employees.

• Shopping on Healthcare.gov delayed until November 2014 at soonest.

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SHOP in AR SPM in 2014

• One Issuer – Arkansas Blue Cross Blue Shield

• Three Plans Offered in 2014– One Gold– One Silver– One Bronze

• Only way for Business to get Tax Credits.

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Outreach and EducationBroad multi-media “Get Informed” campaign across Arkansas July 1 – September 30, 2013

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http://www.arhealthconnector.org

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• Speakers’ Bureaus

• “Get Enrolled” Enrollment Action Phase scheduled to begin October 1, 2013 not implemented due to Arkansas Legislature’s denial of continuing outreach and education contract. ARHealthConnector.org redirected to www.ahc.arkansas.gov

• Healthcare.Gov now working well after rocky start.

• Access.Arkansas.gov and InsureArk.org for Private Option.

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http://ahc.arkansas.gov/

Challenges

• Finding a way to educate people about buying their health insurance.

• Finding a way to educate people about using their health insurance.

• Lack of knowledge can lead to consumers making wrong choices.

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The four phases of Open Enrollment trends

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Teething problems in www.heathcare.govSpurt to meet the January 1 deadlineSteady growth periodThe rush to the finish

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Year-Round Enrollment

• Private Option Eligibility

• Significant Life Change in Circumstance if income over 138% FPL (Special Enrollment Period)

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Individual Responsibility• Took effect in 2014, not delayed

– 2014 - $95 per adult and ~half that for up to three children—or 1% of taxable income (whichever is greater)

– 2015 - $325 per adult and ~half that for up to three children—or 2% taxable income

– 2016 - $695 per adult and ~half that for up to three children—or 2.5% taxable income

• Exemptions include those who have bona fide religious objections and those without access to affordable minimum essential coverage.

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Hardship ExemptionsConsumers demonstrating a hardship may be exempt from the Shared Responsibility Payments for not obtaining health insurance. Hardship categories include:

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• Homelessness• Eviction• Utility shut-off• Domestic violence• Family death• Disaster property damage• Bankruptcy• Prohibitive medical expenses• Significant caregiving costs

Grace periods• Three-month grace period could apply only after a

consumer makes at least one monthly premium payment.

• The first month that someone does not pay the premium, the issuer must pay claims for the consumer.

• During the second and third months of delinquent premiums, claims may be “pended” or suspended.

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Working on 2015 Plan Year• Certification Criteria• Implementation Issues from 2014• Public Education regarding qualifying events and

Special Enrollment Periods• Quality Reporting• Re-licensure of Assisters• Recruitment of new Issuers for Plan Year 2015• Plan Year 2015 Open Enrollment

November 15, 2014 – February 15, 2015

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The Future

• Act 1500 of 2013 established a State-Based Marketplace (SBM) for Arkansas

• Arkansas HIM Board appointed and is active• Executive Director hired• Transition planning for smooth transition• Will continue SPM until transition to SBM in

plan year 2016 or plan year 2017• Stay tuned…

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Questions?

Comments?

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ContactCynthia.Crone@arkansas.gov

501-683-3634www.ARHealthConnector.org

855-283-3483www.healthcare.gov

800-318- 2596

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