Health Insurance Marketplace
March 12, 2014
1
Agenda
Overview
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Open Enrollment
Subsidy Type: Advanced Premium Tax
Credit
Subsidy Type: Cost Sharing Reductions
Membership Reports
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Blue Network E
Marketplace Performance
Membership by Service Area
Membership by Previous Coverage
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Membership by
Age/Gender/Network
Membership by Product
Financial Assistance
CMS Changes
Education Campaigns
o
o
o
Know Then Go
Phone Support
Shop Smart
Health Insurance Marketplace > Agenda
2
Overview
Health Insurance Marketplace
1
Open Enrollment
Health Insurance Marketplace
Open Enrollment Period 2014
o
Oct. 1, 2013 –
March 31, 2014
Open Enrollment Period 2015
o
Nov. 15, 2014 –
Jan. 15, 2015 (proposed dates)
Effective dates based on
application completion date:
o
o
On or before the 15th, effective
1st of the following month
After the 15th, effective 1st of
the second following month
Health Insurance Marketplace > Overview
4
Subsidy Types: Advanced Premium Tax Credit (APTC)
Health Insurance Marketplace
Advanced Premium Tax Credit
Offsets cost of health insurance
premiums
o Eligible if all of the following
apply:
– Purchasing QHP* on the
Marketplace
– Household income is
between 100%-400% FPL**
– No access to affordable,
minimum essential
coverage through an
employer or government
program
*Qualified Health Plan
**Federal Poverty Level
Health Insurance Marketplace > Overview
5
Subsidy Types: Advanced Premium Tax Credit
Health Insurance Marketplace
Example: Second Lowest Silver
o
o
o
Sample Scenario: An individual who earns 200% FPL* selects the second lowest
cost silver plan, which has an annual premium of $4,000
Individual Contribution: At 200% FPL, an individual cannot pay more than 6.3%
(or $1,448) on health insurance
Government Subsidy: The government will be required to contribute the balance,
or $2,552 (this determines the subsidy amount it will pay across all tiers)
Salary
% FPL
Individual
Annual Income at Respective FPL Max Burden as % of Individual's
Level
Income
Premium Pmt
Theoretical Total Cost
Of Health Ins.
Individual's
Premium Pmt
Gov't Subsidy
Individual
PMPM
100%
$11,490
2.0%
$230
$4,000
$230
$3,770
$19
125%
14,363
2.0%
$4,000
24
17,235
4.0%
$4,000
287
689
3,713
150%
287
689
3,311
57
175%
20,108
5.2%
1,036
$4,000
1,036
2,964
86
200%
22,980
6.3%
1,448
$4,000
1,448
2,552
121
225%
25,853
7.2%
1,856
$4,000
1,856
2,144
155
250%
28,725
8.1%
2,312
$4,000
2,312
1,688
193
275%
31,598
8.8%
2,774
$4,000
2,774
1,226
231
300%
34,470
9.5%
3,275
$4,000
3,275
725
273
325%
37,343
9.5%
3,548
$4,000
3,548
452
296
350%
40,215
9.5%
3,820
$4,000
3,820
180
318
375%
43,088
9.5%
4,000
$4,000
4,000
0
333
400%
45,960
9.5%
4,000
$4,000
4,000
0
333
425%
48,833
NA
4,000
$4,000
4,000
0
333
*Federal Poverty Level
Health Insurance Marketplace > Overview
6
Subsidy Types: Cost Sharing Reductions (CSR)
Health Insurance Marketplace
Cost Sharing Reductions
o
Low-income individuals
(income range of 100% to
250% of the FPL*) who buy
Silver plans get federal benefit
assistance through cost-sharing
reductions.
Often results in Platinum-level
benefits at Silver plan prices.
*Federal Poverty Level
Health Insurance Marketplace > Overview
7
Subsidy Types: Cost Sharing Reductions
Health Insurance Marketplace
Impact on Base Plan Benefits
Health Insurance Marketplace > Overview
8
Membership Reports
Health Insurance Marketplace
1
Marketplace Performance
Health Insurance Marketplace
Based on a February
Marketplace Enrollment
Report1, the Department of
Health and Human Service
(HHS) estimated 59,705
Tennesseans selected a
Marketplace plan as of
Feb. 1, 2014.

1
HHS enrollment figures
include those who had paid
premiums as well as those
who had not.
US Dept. of Health and Human Services, February Enrollment Report, 2/12/2014
Health Insurance Marketplace > Membership Reports
10
Membership by Service Area
Health Insurance Marketplace
Source: BlueCross Internal Market Strategy, 2014 Open Enrollment Weekly Dashboard, 2/17/2014
Health Insurance Marketplace > Membership Reports
11
Membership by Previous Coverage
Health Insurance Marketplace
Cover Tennessee includes
CoverTN, AccessTN and
Cover Kids
Source: BlueCross Internal Market Strategy, 2014 Open Enrollment Weekly Dashboard, 2/17/2014
Health Insurance Marketplace > Membership Reports
12
Membership by Age/Gender/Network
Health Insurance Marketplace
Source: BlueCross Internal Market Strategy, 2014 Open Enrollment Weekly Dashboard, 2/17/2014
Health Insurance Marketplace > Membership Reports
13
Membership by Product
Health Insurance Marketplace
Source: BlueCross Internal Market Strategy, 2014 Open Enrollment Weekly Dashboard, 2/17/2014
CSR = Cost Sharing Reduction
Health Insurance Marketplace > Membership Reports
14
Financial Assistance
Health Insurance Marketplace
Source: BlueCross Internal Market Strategy, 2014 Open Enrollment Weekly Dashboard, 2/17/2014
Health Insurance Marketplace > Membership Reports
15
CMS Challenges
Health Insurance Marketplace
1
CMS Challenges
Health Insurance Marketplace
Oct. 1 – Early/mid-November
Healthcare.gov glitches and a shaky roll-out resulted in high call volumes, consumer
confusion and persistent rule changes to accommodate limited functionality
Nov. 14
President announces transitional proposal allowing individuals enrolled in nongrandfathered plans to keep existing plans for another year
Late November/Early December
CMS announced process not in place to send 820 payment transactions for
Advanced Premium Tax Credit and advance Cost Share Reduction payments
Health Insurance Marketplace > CMS Changes
17
CMS Challenges
Health Insurance Marketplace
Dec.17
CMS/HHS* issued IFR entitled Maximizing 1/1/14 Coverage Opportunities that
changed Open Enrollment eligibility rules for obtaining a 1/1 effective date and
extended payment deadlines for first month’s premium during Open Enrollment
Jan. 8
CMS issued guidance outlining changes to enrollment data issuers are authorized
to make directly (e.g. add a dependent to a Marketplace policy)
Feb. 6
CMS issued Bulletins on Enrollment and Termination Policies and Processes for
FFM** Issuers
*Department of Health and Human Service
**Federally Facilitated Marketplace
Health Insurance Marketplace > CMS Changes
18
Education Campaigns
Health Insurance Marketplace
1
Education Campaigns
Health Insurance Marketplace
Know Then Go
o
Highlights the importance of
understanding provider
networks and the associated
potential costs savings
Phone Support
o
o
o
Help a client:
1-888-257-0996
For providers:
1-800-924-7141
For members:
1-800-565-9140
Health Insurance Marketplace > Education Campaigns
20
Education Campaigns
Health Insurance Marketplace
Shop Smart
o
Online education available
(bcbst.com/knownow)
– Find list of FFM*-certified
brokers appointed by
BlueCross
– Locate community
meetings
– Get information about
instant quotes and subsidy
calculations
– View animated videos
*Federally Facilitated Marketplace
Health Insurance Marketplace > Education Campaigns
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BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association