Transcript Document

WV Office of the Insurance Commissioner, Health Policy Division
Enrollment in the Marketplace
• The first open enrollment was October 1, 2013
through April 15, 2014
• The first coverage started January 1, 2014
• Enrollment dates for the 2015 plan year
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November 15, 2014 – February 15, 2014
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with coverage starting January 1, 2015
• ALL MEDICAL PLANS WILL FOLLOW THE FEDERAL
OPEN ENROLLMENT, ON AND OFF MARKETPLACE
2014 Marketplace Enrollment
• WV Marketplace
• WV Stand Alone Dental
• Medicaid Expansion
19,856
3,700
150,000+ (10/2014)
• CMS numbers are representative of 10/1/2013- 3/31/2014
West Virginia vs The Nation
Numbers taken from CMS Report. National numbers represent all FFM states;
State Exchanges not included.
In Person Assisters
• MAXIMUS, our IPA Management Contractor, oversees
all DHHR based IPAs and IPA Entities
• There are 28 DHHR based IPAs with 7 Supervisors
• In addition to visiting and assisting the IPAs, the
supervisors also hold office hours and can be flexible
to provide additional coverage as needed
In Person Assister Entities
5 IPA Entities
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Partners In Health Network
SHIP/BOSS (Bureau of Senior Services)
Valley Health
WV Community Care
WV Primary Care Association
Navigators
• Navigator Grants are awarded directly from CMS
• In West Virginia, we have three Navigator
Organizations:
• Clay-Battelle Health Services Association
• Advanced Patient Advocacy
• Healthy Start WVU
Certified Application Counselors (CAC)
• Every state is required to have a Certified Application
Counselor program
• Interested organizations can submit a CAC application to CMS
for approval
• CMS designates which organizations are certified as a CAC
• An agreement is signed between CMS and the organization
outlining the duties each organization will be required to
fulfill
• Each person in the organization helping consumers with the
marketplace must complete training through CMS to become
certified
Insurance Agents
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The only licensed assisters
Can look at life situations and suggest plans
Experienced with health insurance
Available to insureds year round
Can compare plans on and off the Marketplace
to give consumers a complete look at their
choices
Assisters Overview
Assisters will be expected to:
• Distribute fair, accurate, and impartial information about
enrollment in Qualified Health Plans (QHP) and other
health programs such as Medicaid and CHIP
• Maintain expertise in eligibility, enrollment, and program
specifications and conduct public education activities.
• Facilitate selection of a QHP
• Refer Consumers to other programs (Medicaid and CHIP)
• Must be certified through the CMS web-based training
• Cannot accept compensation from issuers for enrollment
in QHP’s or non-QHP’s
Individual Mandate
Federal Poverty Guidelines 2014
Household
2014 FPL
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2
3
4
5
6
7
8
$11,670
$15,730
$19,790
$23,850
$27,910
$31,970
$36,030
$40,090
Premium
Medicaid
Subsidy
Eligibility
Threshold
(138% of FPL)
(400% of FPL)
$16,105
$21,707
$27,310
$32,913
$38,516
$44,119
$49,721
$55,324
$46,680
$62,920
$79,160
$95,400
$111,640
$127,880
$144,120
$160,360
Federal Subsidies for Individuals
Advanced Premium Tax Credits
Cost Sharing Reductions
Cost Sharing
Cost Sharing
Portion of medical
expenses typically paid
by the health plan
(Actuarial Value)
Portion of medical
expenses paid for by
typical enrollee
Limit on Annual Out-ofPocket Costs
CSR Silver Plan for CSR Silver Plan for
CSR Silver Plan for
Enrollees with
Enrollees with
Enrollees with
Standard Silver
Incomes from Incomes up from
Incomes up to
Plan
151% FPL to 200% 201% FPL to 250%
150% FPL
FPL
FPL
94%
87%
73%
70%
6%
13%
27%
30%
$2,250 individual /
$4,500 family
$2,250 individual/
$4,500 family
$5,200 individual/
$10,400 family
$6,300 individual/
$2,700 family
Advance Premium Tax Credits
• APTC must be reconciled each year
• If you receive APTC, you must file federal taxes for
the tax year the APTC is received
• All income changes must be reported to the Federal
Call Center immediately (800-318-2596)
• If your APTC is too high during the year, you will be
required to pay back the difference
Supreme Court Case King v. Burwell
• The statutory language in the ACA links tax credits to
health plans purchased through an Exchange
established by the State.
• The IRS is extending tax credits to qualified people
that purchase on the State or Federal Marketplace.
• Oral Arguments begin March 4. It is expected that
the Court will release its opinion in June 2015.
Health Plans on the FFE
• Every plan covers the same set of Essential
Health Benefits
• Plans come in 4 metal levels
BRONZE
SILVER
GOLD
PLATINUM
60%
70%
80%
90%
Catastrophic Coverage
• Catastrophic Coverage is a set of federally mandated
benefits for those 30 years old and younger or for those
with extreme financial hardships. The catastrophic plans
with all carriers will be the same.
$6,600 Individual Deductible
$13,200 Family Deductible
3 PCP Visits without meeting the deductible
Plan pays 100% after the Deductible
On Exchange Medical Plans
• Highmark WV
– 13 Individual Plans
The same plans will also be offered “Off Exchange”.
Stand Alone Dental Plans
On Exchange
• Delta
– 4 Individual Plans
• Dentegra
– 3 Individual Plans
The same plans are offered “Off Exchange”.
Essential Health Benefits
Consumer Service Division
• Protect you by enforcing WV laws
• Provide you with consumer information
• Help you with insurance complaints
• 1-888-TRY-WVIC
Enrollment for 2016
• Open enrollment dates are currently set for
October 1 – December 15, 2015
• All Insurance Companies offering individual or
small group health insurance in 2016 will send
their submissions by April 1, 2015 to the WV
Offices of the Insurance Commissioner
For more information
Ellen Potter
Director, Health Policy
[email protected]
Ext. 1120
Joylynn Fix
Policy and Rate Analyst, Rates and Forms
[email protected]
Ext. 1170
Pam King
Research Specialist, Health Policy
[email protected]
Ext. 1290
www.bewv.com
WV Offices of the Insurance Commissioner
(304) 558-6279 ext. 1264