Delaware’s Health
Insurance
Marketplace:
Update on Activity
Delaware Health Care Commission, March 6, 2014
Secretary Rita Landgraf, Department of Health and Social Services
Agenda
• Stories from the Ground
• Updates since last Health Care Commission meeting
• Marketplace enrollment update
• Medicaid update
• Consumer Assistance update
• Media and Outreach update
• Important Reminders
• Plan Management update
2
Stories from the Ground
• With support from a marketplace
guide, a 20-year-old man from
Newark enrolled and will pay $83 a
month.
• A middle-aged woman from Dover is
unemployed and has several preexisting conditions. After her subsidy,
her monthly payment will be $187 a
month, which she called “truly
affordable insurance coverage.”
• A 64-year-old woman, who must take
regular medication to prevent
seizures, will pay $79 a month after
her subsidy. She also enrolled in a
dental plan for $23 a month.
3
Stories from the Ground
• A 44-year-old woman from Clayton
– whom the guide met through
Westside’s partnership with $tand
By Me – will pay $64 a month after
her tax subsidy.
• A Houston couple met a guide at
the Milford Library. The wife, who
has a pre-existing condition and a
mental health condition, hasn’t had
insurance for the past 5 years.
They will pay $203 a month.
• A Bear couple in their 40s, who
haven’t had insurance for 7 years,
will pay $207 a month after their
tax subsidy and are excited to
finally have coverage.
4
Recent Updates
On February 10, 2014, the U.S. Treasury Dept. and the IRS
announced final regulations regarding the employer shared
responsibility payments.
• Under the Affordable Care Act, companies that have fewer
than 50 employees are not required to provide coverage or
fill out any forms in 2015, or in any year, under the
Affordable Care Act.
• Companies with 50-99 employees that do not yet provide
affordable health insurance to their full-time workers will
report on their workers and coverage in 2015, but have until
2016 before any employer responsibility payments could
apply.
• Large employers (100 or more employees) that offer
coverage to 70 percent of their workers will be counted as
fulfilling the employer mandate. By 2016, those employers
will need to hit the original 95 percent target.
5
Enrollment Update
6
Marketplace and Medicaid Enrollment Update
As of February 28, 2014, 9,162 Delawareans
have enrolled in health care coverage through
expanded Medicaid and the Marketplace since
October 1, 2013
7
Marketplace and Medicaid Enrollment Update
Enrollment for the 5-Month Period: October 1, 2013 through
February 28, 2014*
Total Number of
Enrollees
Increase from
previous month
Medicaid
2,168
55%
Marketplace*
6,994
38%
Total
9,162
42%
*This number represents Delawareans who have selected a Marketplace plan,
either through Healthcare.gov, or through direct enrollment with an issuer (with
or without the first premium payment having been received directly by the
8
Insurance Company.)
Marketplace Enrollment
Marketplace Enrollment Update
Marketplace Plan Selection by Metal Level — Silver plans account
for 54% of the plan selections in the Delaware Marketplace.
Metal Level Distribution (rounded to the nearest whole number):
• Bronze = 14%
• Silver = 54%
• Gold = 22%
• Platinum = 9%
• Catastrophic = 1%
Marketplace Plans: Financial Assistance — More than threequarters (77%) of the Delawareans who have selected a Marketplace
plan will be receiving Federal financial assistance in paying their
premiums.
•
This includes people who qualify for an advance premium tax credit
(APTC), with or without a cost-sharing reduction (CSR).
10
Marketplace Enrollment Update:
Comparison by Age
Enrollees
% Enrolled
Marketplace Enrollment by Age
Age
Groups
0 -17
0.27%
10%
691
10%
7%
32%
18 – 25
456
7%
26 – 34
997
14%
35 – 44
1,068
15%
45 – 54
1,519
22%
55 – 64
2,244
32%
65+
19
<1%
Total
6,994
100%
14%
15%
22%
11
Ages 0 - 17
Ages 18 - 25
Ages 26 - 34
Ages 45 - 54
Ages 55 - 64
Ages 65+
Ages 35 - 44
Marketplace Enrollment Update:
Comparison by County
Marketplace Enrollment by
County
Enrollees
% Enrolled
Kent
851
12%
New Castle
4,282
61%
12%
County
27%
61%
Sussex
1,860
27%
Total
6,993*
100%
Kent
*Data received from the issuer only included
county identification for 6,993 enrollees.
12
Sussex
New Castle
Marketplace Enrollment Update:
Comparison by Gender
Marketplace Enrollment by Gender
Enrollees
% Enrolled
Gender
44%
Male
3,101
44%
Female
3,893
56%
Total
6,994
100%
13
56%
Male
Female
Marketplace Enrollment Update:
Metal Level Comparisons by Age
Delaware Marketplace Enrollment
0-17
18-25
26-34 35-44
45-54
55-64
65+
Bronze
87
56
121
147
199
363
7
Silver
294
228
522
587
895
1,256
11
Gold
218
93
202
216
314
491
0
Platinum
86
47
99
118
111
134
1
Catastrophic
6
32
53
n/a
n/a
n/a
n/a
Total
691
456
997
1,068
1,519
2,244
19
14
Marketplace Enrollment Update:
Metal Level Comparisons by Gender and County
Delaware Marketplace Enrollment
Delaware Marketplace
Enrollment
New Castle
Kent
Sussex
Bronze
617
120
243
Silver
2,302
464
1,027
Gold
888
204
441
Platinum
414
50
132
Male
Female
Bronze
458
522
Silver
1,611
2,182
Gold
703
831
Platinum
281
315
Catastrophic
48
43
Catastrophic
61
13
17
Total
3,101
3,893
Total
4,282
851
1,860
15
Marketplace Enrollment Update:
The “Young Invincibles”
Age Group
% Uninsured1
% of Total Enrollment
0-17
18.56%
10%
18-25
19.07%
7%
26-34
20.75%
14%
35-44
17.89%
15%
45-54
13.32%
22%
55-64
10.41%
32%
• 21% of Marketplace enrollees are in the “Young Invincible” age group.
The national average of enrollments for this critical age group is 25%
(as of 2/1/14).
• 52% of Young Invincibles enrolled through the Marketplace have
chosen a Silver QHP
*Note: Insurance company enrollment information does not indicate if enrollees
were previously uninsured
1Derived
from a 2 year average of 2012 and 2013 Current Population
Survey
16
(CPS) data.
Trend of Marketplace Enrollments
QHP Enrollees
8000
6994
7000
6000
5062
5000
4000
3183
3000
2000
793
1000
136
0
12-Nov
12-Dec
9-Jan
17
31-Jan
28-Feb
Medicaid Newly Eligible Enrollment
Medicaid (Newly Eligible) Enrollment Update:
Comparison by Age
Enrollees
% Enrolled
Medicaid (Newly-Eligible)
Enrollment by Age
Age
Groups
16%
19 – 25
397
18%
26 – 34
527
24%
35 – 44
478
22%
45 – 54
425
20%
55 – 64
341
16%
Total
2,168
100%
18%
20%
24%
22%
19
Ages 19 - 25
Ages 26 - 34
Ages 45 - 54
Ages 55 - 64
Ages 35 - 44
Medicaid (Newly Eligible) Enrollment Update:
Comparison by County
Enrollees
% Enrolled
485
22.4%
Medicaid (Newly-Eligible)
Enrollment by County
County
Kent
22.4%
47.3%
Sussex
658
30.3%
New Castle
1,025
47.3%
Total
2,168
100%
30.3%
Kent
20
Sussex
New Castle
Medicaid (Newly Eligible) Enrollment Update:
Comparison by Gender
Medicaid (Newly-Eligible)
Enrollment by Gender
Enrollees
% Enrolled
31%
Gender
Male
669
31%
Female
1,499
69%
Total
2,168
100%
69%
Male
21
Female
Consumer Assistance Update
Marketplace Guide Activities to Date
• As of February 28, 2014:
• 538 completed enrollments
• 1,137 completed applications
• 1,608 outreach activities
conducted
• 695 referrals to Medicaid
23
Enrollment Support
• Guides are using unique outreach strategies to maximize
contacts including partnering with tax preparation services
and large retailers
• Get Covered! Enrollment Events
• More than 23 large-scale events focused on
enrollments scheduled throughout February and March
• Partnering with Delaware Technical Community
College, Wilmington University, and public schools
• Standing locations throughout the state in State Service
Centers, libraries and other community locations
• Full schedule of recurring locations and special events is
available on ChooseHealthDE.com
24
Guide Activities after Open Enrollment
• Guides will continue to provide enrollment assistance
after March 31 for consumers that experience a
qualifying change of life event (e.g. marriage, loss of
minimum essential coverage): See
https://www.healthcare.gov/how-can-i-get-coverageoutside-of-open-enrollment/
• We are currently assessing the program’s workforce
needs after open enrollment. A more detailed plan will
be available at the April Health Care Commission
meeting.
25
Media and Outreach Update
2014 Traffic to ChooseHealthDE.com
Visits to ChooseHealthDE.com (2014)
1,200
Media began running
1,000
800
600
400
200
0
1/1 1/3 1/5 1/7 1/9 1/11 1/13 1/15 1/17 1/19 1/21 1/23 1/25 1/27 1/29 1/31 2/2 2/4 2/6 2/8 2/10 2/12 2/14 2/16 2/18 2/20 2/22 2/24 2/26 2/28
January 1-February 28, 2014
Visits: 21,396
Page views: 96,273
Pages/Visit: 4.5
Avg. Visit Duration: 2:26
27
Referring Sites to ChooseHealthDE.com
Source
delaware.gov
dhss.delaware.gov
dmap.state.de.us
delawareinsurance.gov
westsidehealth.org
delawareonline.com
de.gov
beebehealthcare.org
stfrancishealthcare.org
johncarney.house.gov
christianacare.org
webmd.com
financialhelpforhealth.org
hjmc.org
healthinsurance.org
laredhealthcenter.org
Visits
980
639
590
307
105
100
78
71
34
32
31
28
27
25
23
21
28
Clicks from ChooseHealthDE.com to Healthcare.gov
ChooseHealthDE.com
Healthcare.gov
From Jan. 1-Feb. 28, 2014,
there have been
2,993 clicks from ChooseHealthDE.com to Healthcare.gov.
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Social Media Contests
Facebook: 3,153 Likes
Firefly Ticket Contest:
Increased fan base by 1,111
Lady Antebellum Ticket
Contest:
Increased fan base by 37
Bruno Mars Ticket
Contest:
Will run from March 7-14
Enrollment Opportunities
• More than 430 enrollment
opportunities from today through
March 31.
• Events at libraries, schools,
universities/colleges, hospitals,
clinics, etc.
• More expected to be added.
• To find an enrollment event that
meets your schedule and location,
go to:
www.ChooseHealthDE.com
31
Focus on Kent County
Combined Marketplace and Medicaid
enrollment in Kent County: 1,336
Percentage of total enrollment from Kent
County is 14.5%
Specific tactics to reach this area include:
• February 15th National Youth
Enrollment Day event at Dover Mall
• Advertising on WMDT and WBOC and
multiple local radio stations
• Door hangers placed on over 88,000
doors in Kent/Sussex counties
(households with 18-34 year olds)
• Facebook promotion for Delaware
State Fair concert tickets
Media Campaign
• New testimonial campaign has
launched. Items currently running
include:
• Commercials on TV, Hulu
• Interactive ads on Pandora and
YouTube
• English and Spanish radio ads
• Ads in movie theaters across the
state
• New brochures and other collateral
materials are printed and now available.
Partners and stakeholders can order
through the ChooseHealthDE.com
website.
33
Video Testimonial—Jenna, Newark
Video Testimonial—Ray, Newark
Video Testimonial—Juana, Laurel
Important Reminders
Key Dates
Date
Milestone
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-February 15,
2015
Open enrollment for coverage in Plan Year 2015
Notes:
• Medicaid enrollment can occur at anytime.
• Employers may continue to enroll in SHOP on a rolling monthly basis. The
deadline to enroll is always the 15th of the month for coverage to be effective
the 1st of the following month.
38
Penalty
If someone who can afford health insurance doesn’t have coverage in
2014, they may have to pay a fee. They also have to pay for all of their
health care.
•
For 2014, consumers will pay whichever of these amounts is higher:
• 1% of yearly household income. (Only the amount of income above
the tax filing threshold, $10,150 for an individual, is used to calculate
the penalty.) The maximum penalty is the national average yearly
premium for a bronze plan.
• $95 per person for the year ($47.50 per child under 18). The
maximum penalty per family using this method is $285.
•
The fee increases every year. In 2015, it’s the higher of 2% of income or
$325 per person. In 2016 and later years it’s the higher of 2.5% of income
or $695 per person.
•
For those uninsured for just part of the year, 1/12 of the yearly penalty
applies to each month without insurance. Those uninsured for less than 3
months do not have a penalty.
39
Penalty
Tax Year
2014
Tax Year
2015
Tax Year
2016
Beyond TY
2016
Income-based
penalty
1% of
household
income above
the filing
threshold
2% of
household
income above
the filing
threshold
2.5% of
household
income above
the filing
threshold
2.5% of
household
income above
the filing
threshold
Minimum
penalty
amount
$95/person
$325/per
person
$695/person
$695 +
inflation
adjustment/per
person
For more information on the Individual Shared Responsibility Payment, go to:
• Healthcare.gov https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014/
• IRS http://www.irs.gov/uac/Newsroom/The-Individual-Shared-Responsibility-Payment-An-Overview
40
Plan Management Update
Plan Management: Preparing for Plan Year 2015
November 2012, the HCC approved the state-specific standards for
qualified health plans (QHPs) for Plan Years 2014 and 2015 that may be
purchased through the Marketplace.
Preparation for Plan Year 2015:
• January 2014—DOI issued formal bulletin to Issuers, inviting them to
•
•
•
•
submit a Letter of Intent to apply for the Plan Year 2015
May through September 2014—DOI team reviews plans for compliance
with federal and state standards and regulations (rates, benefit design,
cost-sharing, network adequacy, etc.)
October 2014—Federal government conducts final QHP reviews and
certifies state-recommended plans
November 2014—Federal government releases list of certified QHPs for
Plan Year 2015
November 15, 2014—Second Open Enrollment begins
The Insurance Commissioner’s bulletin to Issuers, including the approved list of the
Delaware QHP Standards for Plan Year 2015 may be found at the following URL:
http://www.delawareinsurance.gov/departments/documents/bulletins/DomesticForei
gnInsurersBulletin69.pdf
42
Plan Management: Looking Ahead
The Marketplace Program team will work with the HCC to review current statespecific QHP Standards and Essential Health Benefits (EHBs), and develop
recommendations for changes for implementation in Coverage Year 2016
Proposed Schedule of Activities
Step
Activity
Proposed Timeline
1
Review current QHP Standards and EHB benchmark to identify opportunities for
modification/additions.
April - July 2014
2
Submit list of recommended changes to EHB and QHP Standards to HCC for review
and comment
July –August 2014
3
Conduct Public Comment Period on proposed changes to QHP Standards and EHB
Benchmark
August - September 2014
4
Review stakeholder feedback on proposed changes and develop final
recommendations for HCC review
September - October 2014
5
Review Final Recommendations with HCC
6
Solicit HCC decision (approval/denial) on recommended changes
November 6, 2014
7
Publish Delaware EHB benchmark and QHP Standards for Coverage Year 2016
December 1, 2014
October 2, 2014
43