1 Molina Marketplace Presentation Molina Healthcare of New Mexico Community Outreach © 2013 Molina Healthcare, Inc. Who is Molina Healthcare? 2 Molina Healthcare was founded more than 30 years go by C. David Molina, MD and is the fastest growing and experienced managed care health companies in the country- offering medical insurance under Medicaid, Medicare and other government sponsored programs. Serving over 1.9 Million Members 11 states, and approximately 170,000 in New Mexico. Molina Healthcare is a family founded company and today is still a physicianled organization. Works Exclusively for people receiving health care coverage from government-sponsored, publicly-funded programs like Medicaid and Medicare. Serving low-income populations who have traditionally faced barriers to quality of health care. Molina Healthcare of NM- is pleased to have been selected by the Human Services Department (HSD) to serve as a Centennial Care Managed Care Organization! New Mexico’s #1 Ranked Medicaid Plan for third year in a row by Consumer Reports and NCQA © 2013 Molina Healthcare, Inc. Molina 3 Our Mission then and now - To provide quality healthcare services to financially vulnerable families and individuals 0 – 138% (Medicaid FPL) 139 – 250% (Health Insurance Marketplace) Molina’s • Medicaid Expansion • Centennial Care • Marketplace • Medicare MA-SNP • Medicare MAPD © 2013 Molina Healthcare, Inc. “ONE MOLINA” We’ve Got You Covered! Key Positioning Attributes with Consumers, Navigators & CBOs 1. 2. Molina has over 30 years of experience • Many that are in the Individual business today, do not cater to a low income population • They don’t have the knowledge or support mechanisms that we can provide All Plan Designs are not the same • 3. We may compete on a metal by metal basis, but understand the differences in design Pricing is not always a good comparison • Where we are positioned at a competitive price, our value and experience is the difference • Deductibles and copay ‘s • Our Plan selections - How benefits encourage access and low cost share • Value Added services - 24 hour nurse line, website services, health education programs © 2013 Molina Healthcare, Inc. 4 “Key Lingo” of the Marketplace 5 Product Feature Description Monthly premiums Monthly amount paid to health plan in return for healthcare coverage Premium Subsidy When a 3rd party covers part, or all, of the monthly premium for somebody's health insurance Medicaid Marketplace No Yes Yes (gov't. subsidizes 100%) Yes (gov't. subsidizes 50% - 100%) No Yes Yes (100%) Yes (60-90%) Federal government provides a tax credit that Advanced premium tax can be used for covering monthly premiums; credit (APTC) this is the subsidy for marketplace members Actuarial Value (AV) The percentage of cost for covered benefits that a plan will cover Deductible Fixed dollar amount member must pay before insurance starts paying anything No Yes Co-payment Fixed dollar amount member pays after their deductible, every time they visit the doctor No Yes 250%+ FPL Our success will be determined on how well we assess the consumer’s understanding and guiding them to the right choice – Molina! • A key to selecting Molina, and ultimately their satisfaction and retention. • An Opportunity for you to be recognized as a trustworthy guide © 2013 Molina Healthcare, Inc. 5 “Key Lingo” of the Marketplace Product Feature Description 6 Medicaid Marketplace Co-insurance Portion of the cost of a procedure that member must pay - applied to high $ hospital procedures usually No Yes Cost sharing subsidy When a 3rd party pays part of someone's copayments and co-insurance (low FPL - low copay) NA Yes NA Yes NA Fixed dollar amount that member can be Out of pocket expected to pay a year in combined deductibles, maximums (OOP Max) co-payments, and co-insurance Guaranteed Issue No medical underwriting/health related qualifying questions will be asked NA First dollar coverage A set number of services where deductibles and co-pays are waived. (e.g. PCP preventive care, urgent care, pre, post neonatal, MH/SH visits) NA © 2013 Molina Healthcare, Inc. 6 250%+ FPL Yes Eligibility for the Marketplace 7 Who is eligible to enroll in the Marketplace? • • • • • Anyone who is in the United States legally, does not have access to another form of health insurance, such as Medicare, Medicaid, an employer provided health plan is eligible to enroll for coverage through the Marketplace. Molina is offering six (6) Marketplace plans: Bronze, Silver (4 different plans) and Gold. More about each of these levels will be discussed shortly. Depending on an applicant’s individual or family (if applying for family coverage) Federal Poverty Level (FPL), there may be tax credits to help pay for the cost of the coverage. The FPL range for which premium assistance tax credits may be provided is between 100% and 250% of FPL. Applicants who do not qualify for a tax credit, will be required to pay the full amount of their individual or family premium. © 2013 Molina Healthcare, Inc. Enrolling in the Marketplace 8 How does an applicant enroll in the Marketplace? • • • • • The preferred method for enrolling in the Marketplace is by accessing the federal website: www.healthcare.gov. New Mexico has a joint Federal/State marketplace for calendar year 2014. The State has ceded responsibility to the federal government for enrollment and eligibility functions. It is expected that New Mexico will be a fully state run Marketplace for calendar year 2015. New Mexico as a joint Federal/State marketplace for calendar year 2014, is also allowing the use of the state Marketplace website for access to the federal enrollment site. The state website for enrollment is: www.BeWellNM.com. Due to difficulties accessing the on-line enrollment sites, two additional methods of enrollment are being considered: 1) paper enrollment and 2) enrollment through each carrier’s website. The Molina website is: http://author.molinahealthcare.com/members/nm/enus/hp/marketplace/Pages/marketplace.aspx. Intensive efforts are underway to fix the website enrollment problems. © 2013 Molina Healthcare, Inc. APTC & Cost Sharing 9 If your individual income is between $11,490 – $45,960, you may qualify for financial assistance The lower your income, the greater the tax credit you will get, and the less you will have to pay out of your own pocket in monthly premiums Advanced Premium Tax Credit (APTC) • • • • • Must meet certain income requirements Cannot have “deemed” coverage from an employer Cannot currently be on Medicaid or other government programs Available to all medal level plans Tax credits can be immediately applied to the monthly premium you pay Cost-sharing Subsidies: • • • Reduce out-of-pocket health care expenses Co-payments and deductibles Only Available If You Buy A Silver Plan On The Marketplace Think about it: If you qualify as a low-income individual (annual income between $14,000 and $23,000), the Silver Plan will be the best product because the federal government will reduce your monthly premium through tax credits and your cost sharing expenses when you see the doctor through the cost-sharing subsidies. © 2013 Molina Healthcare, Inc. 9 Unique Services 10 • Acupuncture -- Limited to 20 visits per calendar year. • Bariatric Surgery – A member must complete the medical group-approved pre-surgical educational preparatory program regarding lifestyle changes. • Chiropractic – Limited to 20 visits per calendar year. • Health Education – These materials cover such topic as nutrition, stress management, child safety, asthma, and diabetes. • Non-emergency Transportation – Members can access transportation to medical services. Limited to 4 round trip trips a month and requires arrangements in advance. • Smoking Cessation – This program offers smoking cessation services to all smokers interested in quitting. Specialized services are available for teens, pregnant smokers and tobacco chewers. • Weight Control Programs – These programs are offered for member s 17 and older. They will learn about healthy eating and exercise. Participates must agree to program criteria. © 2013 Molina Healthcare, Inc. Benefits At-A-Glance 11 Molina Marketplace 2014 Benefits-At-A-Glance Bronze MBN-001 Silve r MSN-100 Silve r MSN-150 Silve r MSN-200 Silve r MSN-250 Gold MGN-001 Fe a ture s6 Annual Deductible (individual/family) Prescription Drug Deductible (individual/family) Annual Out-of-Pocket Maximum (individual/family) Be ne fits Eme rge ncy a nd Urge nt Ca re Emergency Room 7 Urgent Care Office Visits4 Preventive Care Prenatal Visits Well-child Visits Family Planning Primary Care Specialty Care Other Practitioner Care Habilitative Care Rehabilitative Care Mental Health Services Substance Abuse services Pe dia tric Vision Se rvice s8 Vison Exam Glasses Contacts Pre scription Drugs Formulary Generic Drugs Formulary Preferred Brand Drugs Formulary Non Preferred Brand Drugs Specialty Drugs Outpa tie nt Hospita l / Fa cility Se rvice s Laboratory Services Radiology Services Specialized Scanning Services (CT, MRI, PET Scans) Medical/Surgical Services Inpa tie nt Hospita l Se rvice s Medical/Surgical, Maternity Care, Mental Health, Substance Abuse, Skilled Nursing Facility Hospice Care Tra nsporta tion Assista nce Emergency Transportation Ambulance Non-Emergency Medical Transportation to & from Medical Appointments 5 Supple me nta l Be ne fits 24-Hour Nurse Advice Line Weight control program Motherhood Matters ® , mothers-tobe program Tobacco counseling, smoking cessation program $4,000/$8,0009 2 $0 $1,500/$3,0001 $0 $1,700/$3,4001 3 $200/$400 $250/$5001 $0 $0 $0 $0 $6,350/$12,700 $2,250/$4,500 $2,250/$4,500 $5,200/$10,400 $6,350/$12,700 $6,350/$12,700 $300 co-pay $100 co-pay $100 co-pay $15 co-pay $150 co-pay $30 co-pay $250 co-pay $60 co-pay $250 co-pay $75 co-pay $250 co-pay $60 co-pay $40 co-pay $65 co-pay $65 co-pay 30% coinsurance 30% coinsurance $65 co-pay $65 co-pay $20 co-pay $50 co-pay $50 co-pay 20% coinsurance 20% coinsurance $50 co-pay $50 co-pay $300/$600 No Charge $15 co-pay $40 co-pay $40 co-pay 25% coinsurance 25% coinsurance $40 co-pay $40 co-pay $30 co-pay $60 co-pay $60 co-pay 30% coinsurance 30% coinsurance $60 co-pay $60 co-pay $45 co-pay $75 co-pay $75 co-pay 40% coinsurance 40% coinsurance $75 co-pay $75 co-pay $0 co-pay $10 co-pay $10 co-pay 10% coinsurance 10% coinsurance $10 co-pay $10 co-pay $45 co-pay $45 co-pay $0 co-pay $0 co-pay No charge $30 co-pay $15 co-pay $30 co-pay $15 co-pay $40 co-pay $40 co-pay $20 co-pay $20 co-pay $25 co-pay $75 co-pay $3 co-pay $8 co-pay $10 co-pay $20 co-pay $20 co-pay $40 co-pay $20 co-pay $55 co-pay $20 co-pay $50 co-pay 40% coinsurance 40% coinsurance 10% coinsurance 10% coinsurance 25% coinsurance 25% coinsurance 30% coinsurance 30% coinsurance 30% coinsurance 30% coinsurance 20% coinsurance 20% coinsurance $45 co-pay $75 co-pay $0 co-pay $10 co-pay $15 co-pay $40 co-pay $30 co-pay $60 co-pay $40 co-pay $65 co-pay $20 co-pay $50 co-pay 40% coinsurance 40% coinsurance 10% coinsurance 10% coinsurance 25% coinsurance 25% coinsurance 30% coinsurance 30% coinsurance 30% coinsurance 30% coinsurance 20% coinsurance 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance 25% coinsurance 0% coinsurance 30% coinsurance 20% coinsurance $100 co-pay per trip $100 co-pay per trip $150 co-pay per trip $250 co-pay per trip $250 co-pay per trip $250 co-pay per trip Not Covered $5 co-pay per round trip $10 co-pay per round trip $10 co-pay per round trip $10 co-pay per round trip Not Covered No Charge © 2013 Molina Healthcare, Inc. Rate Chart 12 Region 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 Metal Tier Age 0-20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 Gold Silver Bronze Gold Silver Bronze Gold Silver Bronze Gold Silver Bronze Gold Silver Bronze 118.42 186.49 186.49 186.49 186.49 187.24 190.97 195.45 202.72 208.69 211.67 216.15 220.62 223.42 226.40 227.90 229.39 230.88 232.37 235.36 238.34 242.82 247.11 253.07 260.53 269.30 105.50 466.14 166.14 166.14 166.14 166.80 170.12 174.11 180.59 185.91 188.57 192.55 196.54 199.03 201.69 203.02 204.35 205.68 207.01 209.67 212.32 216.31 220.13 225.45 232.09 239.90 92.82 146.15 146.15 146.15 146.15 146.74 149.66 153.17 158.87 163.55 165.89 169.39 172.90 175.09 177.43 178.60 179.77 180.94 182.11 184.45 186.79 190.29 193.66 198.33 204.18 211.05 131.34 206.84 206.84 206.84 206.84 207.66 211.80 216.76 224.83 231.45 234.76 239.72 244.69 247.79 251.10 252.75 254.41 256.06 257.72 261.03 264.34 269.30 274.06 280.68 288.95 298.67 117.00 184.26 184.26 184.26 184.26 184.99 188.68 193.10 200.29 206.18 209.13 213.55 217.98 220.74 223.69 225.16 226.64 228.11 229.58 232.53 235.48 239.90 244.14 250.04 257.41 266.07 102.93 162.10 162.10 162.10 162.10 162.74 165.99 169.88 176.20 181.39 183.98 187.87 191.76 194.19 196.78 198.08 199.38 200.67 201.97 204.56 207.16 211.05 214.78 219.96 226.45 234.07 161.42 254.21 254.21 254.21 254.21 255.22 260.31 266.41 276.32 284.46 288.52 294.63 300.73 304.54 308.61 310.64 312.67 314.71 316.74 320.81 324.88 330.98 336.82 344.96 355.13 367.07 143.80 226.46 226.46 226.46 226.46 227.36 231.89 237.33 246.16 253.41 257.03 262.46 267.90 271.30 274.92 276.73 278.54 280.35 282.17 285.79 289.41 294.85 300.06 307.30 316.36 327.00 126.50 199.22 199.22 199.22 199.22 200.02 204.00 208.78 216.55 222.93 226.12 230.90 235.68 238.67 241.85 243.45 245.04 246.63 248.23 251.42 254.60 259.38 263.97 270.34 278.31 287.67 144.24 227.16 227.16 227.16 227.16 228.06 232.61 238.06 246.92 254.19 257.82 263.27 268.72 272.13 275.77 277.58 279.40 281.22 283.04 286.67 290.30 295.76 300.98 308.25 317.34 328.01 128.50 202.36 202.36 202.36 202.36 203.17 207.22 212.07 219.96 226.44 229.68 234.53 239.39 242.43 245.66 247.28 248.90 250.52 252.14 255.38 258.61 263.47 268.13 274.60 282.70 292.21 113.04 178.02 178.02 178.02 178.02 178.73 182.29 186.57 193.51 199.20 202.05 206.33 210.60 213.27 216.12 217.54 218.97 220.39 221.81 224.66 227.51 231.78 235.88 241.57 248.69 257.06 161.42 254.21 254.21 254.21 254.21 255.22 260.31 266.41 276.32 274.46 288.52 294.63 300.73 304.54 308.61 310.64 312.67 314.71 316.74 320.81 324.88 330.98 336.82 344.96 355.13 367.07 143.80 226.46 226.46 226.46 226.46 227.36 231.89 237.33 246.16 253.41 257.03 262.46 267.90 271.30 274.92 276.73 278.54 280.35 282.17 285.79 289.41 294.85 300.06 307.30 316.36 327.00 126.50 199.22 199.22 199.22 199.22 200.02 204.00 208.78 216.55 222.93 226.12 230.90 235.68 238.67 241.85 243.45 245.04 246.63 248.23 251.42 254.60 259.38 263.97 270.34 278.31 287.67 © 2013 Molina Healthcare, Inc. APTC: Example of an Individual 13 John is 24 years old non smoker and has an annual income of $22,980, which equals 200 percent of the poverty line. His expected contribution is 6.3 percent of his income, or $1,448 a year. The benchmark plan available to John is priced at $5,000; John would be eligible for a credit amount of $3,552 ($5,000 minus $1,448). Income FPL Level Premium w/o APTC Expected Contribution % Credit Amount Monthly Credit Monthly Premium w/ APTC $22,980 200% $416.67 6.30% $1,447.74 $3,552.26 $296.02 $120.65 © 2013 Molina Healthcare, Inc. APTC: Example of a Family of Four 14 Peter, Mary and their two children have an annual income of $52,988, which translates to 225 percent of the federal poverty line. At this income level, the family’s expected contribution is 7.18 percent of their income, or $3,805 a year. In the area where Peter and Mary live, the total premiums for the benchmark plan that would cover all members of the family is $15,000. The credit amount that the family would be eligible for is $11,195, which is $933 a month. ($15,000 minus their expected premium contribution of $3,802). An advance payment of $933 a month will be paid directly to the insurer offering the health plan that the family selects; the family would be responsible for paying the remaining premium to the insurer. Income FPL Level Premium w/o APTC Expected Contribution % Credit Amount Monthly Credit Monthly Premium w/ APTC $ $ $ $ $ © 2013 Molina Healthcare, Inc. 52,988 225% 1,250 7.18% $ 11,195 932.96 317.04 3,805 New Mexico Marketplace Competitors Who is participating in the Marketplace? There are five (5) carriers participating in the New Mexico Marketplace: • • • • • Health Care Service Corporation (BC/BS) Lovelace Health Systems MOLINA Healthcare of New Mexico New Mexico Health Connections Presbyterian Health Plan For premium rating, New Mexico has been divided into five (5) regions (next to each region is Molina’s premium ranking status): • Region 1 (Albuquerque) - 2 • Region 2 (Farmington) - 1 • Region 3 (Las Cruces) - 5 • Region 4 (Santa Fe) - 3 • Region 5 (Rural/All Other) - 3 © 2013 Molina Healthcare, Inc. 15 16 MMG: Community Perspective Committed to providing Access, Quality & Affordability • • • • MMGS remove barriers for our members Clinics located in areas where our members Shop, Eat, Play & Pray Give back to the community through free transportation Great reputation within the community © 2013 Molina Healthcare, Inc. 17 Questions © 2013 Molina Healthcare, Inc.