Transcript Document

Delaware’s Health
Insurance
Marketplace:
Update on Activity
Delaware Health Care Commission, January 9, 2014
Secretary Rita Landgraf, Department of Health and Social Services
Agenda
• Updates since last Health Care Commission meeting
• Enrollment activity
• Marketplace Guide update
• Marketing and website update
• Stories from the ground
• Key dates
2
Pharmacy “Bridge” Coverage
• Several national pharmacies have announced plans
to provide short-term supplies of prescriptions to those
newly-enrolled in a Marketplace plan who have not yet
received an ID number from their insurance company
• Customers must provide the pharmacy with proof of
their enrollment
• Customers may receive up to a 30-day supply of their
medications to cover any gap in coverage
• Participating pharmacies include Walgreens, Rite-Aid,
CVS and Walmart
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90-Day Grace Period for Non-Payment of Premium
• The ACA provides a 90-day grace period during which insurers cannot
terminate coverage for premium tax credit recipients who fail to pay their
share of the premium.
•
Those enrollees who do NOT receive a premium tax credit will be allowed a 30day grace period for premium non-payment.
• Impact to Insurers, Providers and Enrollees:
• Insurers must cover claims incurred in the first month of nonpayment,
but for the second and third months may “pend” payments.
• If the enrollee pays the premium during the grace period, the insurer
must reinstate the enrollee and cover any claims.
• If the enrollee does not pay, the issuer can deny payment of claims and
must refund advance tax credits received for the second and third
months.
 Important—If the enrollee does not pay the premiums by the end of the 90-day grace
period, the enrollee will be left responsible for paying providers and repaying the tax
credit received for the first month, as well as the first month’s premium.
4
Delawareans with coverage due to ACA
As of January 3, 2014, 4,241 Delawareans
have gained access to health care coverage
through expanded Medicaid and the
Marketplace since October 1
5
Marketplace Enrollment Update
• Number of individuals who selected plans through
the Marketplace as of January 3, 2014: 3,183
• Number of paid enrollments as of January 3, 2014:
1,145
• Enrollment update from the Federal Government is
expected in mid-January
6
Medicaid Update
• Number of individuals assessed eligible for Medicaid/CHIP by the
Marketplace by the U.S. Dept. of HHS = 5,732
• Electronic account transfer between the State and FFM has been
delayed. Delaware is among the first group of states selected for
testing account transfer functionality with the
Marketplace. Delaware has successfully implemented account
transfer to the Federal government and successfully received
account transfers from the Federal government in a test
environment.
• For those individuals assessed eligible for Medicaid by the
Federal Government, DHSS is conducting further outreach and
completing eligibility determinations.
• As of January 3, 2014, 1,058 adults were enrolled in the Medicaid
program under the ACA expansion.
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Trend of Marketplace Enrollments
Trend of Marketplace Enrollments
3500
3183
3000
Delawareans
2500
2000
1500
1000
793
500
136
0
12-Nov
12-Dec
QHP Enrollees
8
9-Jan
Newly Covered Delawareans by County
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Newly Covered Delawareans by Age
Note that rounding may account for deviations10from 100%
Choosing the best enrollment “door”
• We are still encouraging the use of the most direct
“door” for most efficient enrollment experience:
• ASSIST – Delaware’s portal for those Medicaid
eligible https://assist.dhss.delaware.gov/
• Healthcare.gov – Federal portal for those who
may qualify for a subsidy
• Directly through insurers – for those who do not
expect a subsidy; links are available on
ChooseHealthDE.com
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Choosing
theefficient
most efficient
“door”
The most
“door” for
Delawareans:
ASSIST
(<138% FPL or
<212% for
children and
pregnant
women)
Medicaid
eligible
Healthcare.
gov
(139-399%
FPL)
Eligible for
Federal
Subsidies
12
Insurers
(>400%
FPL)
Not-eligible
for
subsidies
Marketplace Guide Activities to Date
As of January 7, 2014:
• 81 fully-certified Marketplace Guides
• 216 completed enrollments
• 486 completed applications
• 1020 outreach activities conducted
Between October 1 and December 31, 2013, Marketplace
Guides have referred 298 consumers to Medicaid
Enrollment Support
• Guides continue to focus the bulk of their efforts on
meeting one-on-one with consumers to facilitate
Marketplace applications and enrollments
• Guide organizations have and will continue to offer larger
scale enrollment events to connect with the maximum
number of consumers possible
• Please check www.ChooseHealthDE.com for the most
up-to-date information about Marketplace Guide
activities, including enrollment events
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Advanced Resolution Center
• The Federal government continues to refer consumers with
difficult cases to advanced resolution centers housed at
CMS regional offices
• Consumers that call the Federal Contact Center at 1-800318-2596 may have their case referred for active casework
• These consumers will receive follow-up communication
from the appropriate party, which may include the
designated caseworker, insurance company, call center
representative or other entity
• DHSS has also been working with the Delaware
Congressional Delegation to resolve some consumer
issues
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Plan Enrollment Verification
• Consumers who enrolled in a plan through the Marketplace and paid their
first month’s premium prior to January 1st should have received a welcome
packet or other communication from their chosen insurance company.
• For those who have not received this information, we urge the following
steps:
• Contact the insurance company directly to verify that enrollment
information has been properly received. Consumers are encouraged
to have the following information ready when verifying enrollment:
• Name of plan enrollee, Marketplace Account ID, full Plan Name,
names of anyone included on the Plan, date the enrollee
completed transaction through the Marketplace
• If the insurance company is unable to confirm the enrollment,
consumers are urged to contact the Federal Contact Center
immediately to determine if there are any issues regarding their
selection/enrollment transaction.
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Get help from the QHP Insurance Companies
The table below provides links to each of the
Delaware QHP Insurance Company Customer Service Centers
Insurance Company
Customer Service Weblink
Customer
Service Phone
Coventry Health and Life
Insurance Company
http://www.coventryone.com/
855-449-2889
Coventry Health Care of Delaware
http://www.coventryone.com/
855-449-2889
Highmark Blue Cross Blue Shield
of Delaware
http://www.highmarkbcbsde.com/
888-601-2242
TTY: 888-232-5460
Delta Dental Insurance Company
http://www.deltadentalins.com/
800-932-0783
Dentegra Insurance Company
https://www.dentegra.com/
877-280-4204
Dominion Dental Services, Inc.
https://www.dominionmembers.com/
https://www.dominiongroups.com
888-518-5388
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Marketing Updates
• ChooseHealthDE.com redesign
• Clear and easy navigation to address most
common consumer issues
• Highlights availability of Marketplace Guides and
other enrollment assistance
• Beginning the second phase of the marketing and
media campaign.
• Young Invincibles (18-29 year olds) will be a major
focus of marketing and outreach efforts in 2014
• Conducted 2 focus groups with this age group in
December, one in Georgetown, one in Wilmington
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ChooseHealthDE.com (English version):
• As of Jan. 6, 2014, there have been 134,959 visits
• Visitors are staying an average of 2 minutes, 33 seconds
ChooseHealthDE.com (Spanish version):
• As of Jan. 6, 2014, there have been 8,526 visits.
• Visitors are staying an average of 2 minutes, 48 seconds.
HEALTHCARE.GOV
Traffic from ChooseHealthDE.com to HealthCare.gov:
As of Jan. 6, 2014, ChooseHealthDE.com has directed 27,117 visits to
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HealthCare.gov.
Stories from the Ground
•
•
•
A 26-year-old Newark woman, who isn’t
offered insurance through her job, chose
a catastrophic plan. She is excited that
her PCP is in-network and that her co-pay
for visits will be only $20. Her monthly
premium is $134.
A 62-year-old Felton woman and her
husband, who are self-employed and
have individual insurance, met with a
marketplace guide to look for “something
more affordable.” She and her husband
received a tax credit and are relieved to
have new affordable insurance.
A 44-year-old New Castle man, who has
been trying to enroll since Oct. 1, was
able to enroll on Dec. 24.
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Stories from the Ground
• A family from Dover was assisted at a Westside Family
Healthcare enrollment event by a Spanish-speaking guide. The
child is enrolled in CHIP, and the husband and wife -- who
received a $545 tax credit -- will pay $38 a month for a
Marketplace plan.
• A Rehoboth Beach man was incorrectly flagged as being
potentially eligible for Medicaid. He has an upcoming
appointment with a Marketplace Guide to resolve his application.
• A Bear man in his 50s, who received a $242 tax credit, will pay
$334 a month. He told a Guide he is relieved to have insurance.
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Stories from the Ground
• A Delaware woman, who thought she had
enrolled for medical and dental coverage
Oct. 20 but whose enrollment became
stuck, enrolled Dec. 20 with the help of
Rep. John Carney’s office and a
troubleshooting team from HHS.
• A 26-year-old Wilmington woman, who
works part-time at a hospital and is a UD
nursing student, received a tax subsidy
and will pay $100 a month. “I feel like the
ACA was built for people like me,” she
said.
• One of Westside’s Guides enrolled herself
and her 19-month-old daughter, who
qualified for CHIP, in 15-20 minutes. The
Guide, who will receive a $93 tax credit;
will pay $138 a month.
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Key Dates
Date
Milestone
January 14, 2014
First premium payment due for coverage that began January 1st for
those consumers who selected Coventry Health & Life or Coventry
Healthcare of DE plans
January 15, 2014
First premium payment due for coverage that began January 1st for
those consumers who selected Highmark BCBS plans
January 31, 2014
Last day of coverage for those in the Pre-Existing Condition Insurance
Plan (PCIP).
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-January 15,
2015
Open enrollment begins for coverage in Plan Year 2015