Implementation of the Affordable Care Act: Choose Health Delaware The Basics • The Patient Protection and Affordable Care Act was passed and signed into law in 2010 • Delaware began working immediately to plan for the law’s implementation • Governor Markell designated Department of Health and Social Services to be the lead agency for healthcare reform with Bettina Riveros as advisor • Delaware Health Care Commission (HCC) is the public information and policy face for the Health Care Reform efforts • States could choose one of three models for implementation: Fully Federal, State-based, State partnership • Delaware chose a State/Federal Partnership model for the implementation, retaining control over plan management and consumer assistance while leaving the technical infrastructure to the Federal Government Healthcare.gov • Early part of open enrollment was stalled because of performance issues related to web-based portal • As a state/federal partnership, Delaware relies on the enrollment portal managed by the Federally Facilitated Marketplace (FFM) • Delaware retains control over the Plan Management, Consumer Assistance and Communications & Outreach functions of the Marketplace “Triple Aim” • Delaware is engaged in an effort to transform its health system: • Improve the health of all Delawareans • Improve the patient experience of care • Reducing health care costs • Access to care through expanded Medicaid and the health insurance Marketplace is a critical component of the Triple Aim Delaware Landscape • Delaware has approximately 92,000 individuals who are uninsured • The ACA allowed for the expansion of Medicaid for those with incomes up to 138% of the Federal Poverty Level. Since Jan. 1, 2014, more than 3,400 Delawareans have Medicaid due to the expansion. • To date, more than 11,000 Delawareans have enrolled in private coverage through the Marketplace. Significant Dates • March 31, 2014 – Open enrollment for Plan Year 2014 ended; Must have been enrolled in (or started the application process for) minimum essential coverage by this date to avoid penalty • November 15, 2014-February 15, 2015 – Open enrollment for Plan Year 2015 • Enrollment in Medicaid/CHIP can occur at any time. 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. 7 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 8 Plan Management Plans: Consumer Opportunity and Choice • In Plan Year 2014, individuals have a choice of 19 medical qualified health plans (QHPs) offered by three carriers: • Highmark Blue Cross Blue Shield of Delaware • Coventry Life and Health • Coventry Healthcare of Delaware • Individuals may also choose from 2 multi-state plans offered through OPM by Highmark BCBS • There are also 2 stand-alone dental QHPs offered on the Marketplace • The medical QHPs include plans at the Platinum, Gold, Silver, Bronze and Catastrophic levels to allow consumers to choose a level of benefits and out-of-pocket costs that meet their needs • Medicare-eligible individuals are not affected • Medigap or Medicare Supplement plans are not affected ACA Provisions • Individuals with preexisting conditions have access to insurance coverage in 2014 • Insurance Companies cannot rescind a policy except for fraud • Delaware requires Insurance Commissioner approval for any rescission • Plans will not have annual and lifetime dollar limits on essential health benefits 11 Essential Health Benefits • Essential Benefits include: • Rehabilitative and habilitative services • Preventive services • Paid at 100% with no deductible or copay • Mammography is considered in the covered preventive services (Baseline for ages 35-39, every 2 years for 40s, each year 50+) • Wellness services • Chronic disease management • Pediatric vision and dental care • Ambulatory Patient • Coverage for clinical trials • Colorectal cancer screening • Coverage for reconstructive surgery following mastectomies • Specialty Tier prescription coverage—Effective January 1, 2014 12 Costs of Coverage • Health status cannot be used to determine premiums • Insurers can only use age, family composition, geographic area and tobacco use to determine premiums • In Delaware, insurers must use one geographic area for Qualified Health Plans sold in the Marketplace/exchange 13 Preventive Task Force www.uspreventiveservicestaskforce.org 14 State Laws that Enhance the ACA for Delawareans • Delaware passed a law to adopt the provisions of the ACA • Effective January 1, 2014. • State Laws and Regulations • Annual pap smear coverage • Coverage of CA-125 monitoring of ovarian cancer subsequent to treatment • Equal reimbursement for Oral and Intravenous anti- cancer medication 15 Advanced Premium Tax Credits • Advanced Premium Tax Credits (APTCs) can reduce monthly premium costs for those who qualify and purchase QHPs through the Marketplace • Paid in advance to provide immediate assistance • IRS reconciles over/under payments of advance premium tax credits when individual files his/her taxes the following year • APTCs are available to those between 138%-400% of the Federal Poverty Level Cost Sharing Reductions • Cost Sharing Reductions (CSRs) help reduce out-ofpocket costs for enrollees in QHPs • Payments are made directly to issuers to reduce deductibles, co-insurance, and/or copayments (out-of-pocket) costs • CSRs are available to those between 138%-250% of the Federal Poverty Level Consumer Assistance Consumer Assistance • The State contracted with 4 organizations to provide inperson education and enrollment assistance to consumers and small businesses: • Brandywine Women’s Health Associates • Christiana Care • The Delmarva Foundation • Westside Family Healthcare • The Federal Government is also funding Navigators to complement outreach efforts. Chatman, LLC has been contracted to provide these services. • Other enrollers are available through out the state • FQHCs, other CAC organizations • Consumer experience should be consistent no matter where they seek assistance Marketplace Guides • Guides must complete Federal and Delaware-specific training as well as Federal and state background checks • Each organization developed a strategy for outreach based on geographic and demographic variables • All three counties have active outreach efforts; 68 FTE Guides available statewide Communications and Outreach Communications and Outreach • Phase 1: September-December 2013 • Focus on high-level messaging: “Health Insurance for All,” “Questions,” “Accidents Happen” • Traditional media outlets • Held back on media in Oct-Nov because of rocky rollout • Phase 2: February-March 2014 • Targeted to “Young Invincible” demographic • Focus on testimonials: “Why risk it?,” “It’s more affordable than you think” • Increased social media presence and digital tactics • Focus on penalty/deadline Communications and Outreach • Targeted grassroots efforts • • • • • Drink coasters Cash jackets Door hangers Enroll-a-thons Outreach to providers, agents/brokers, small business groups and other stakeholders • Other Media • Mall signs • Transit • Signs and brochures in barber shops, nail salons, independent grocers, walk-in clinics, libraries, State Service Centers Communications and Outreach • Website: www.ChooseHealthDE.com • Social Media • www.facebook.com/choosehealthde • Twitter @choosehealthde • YouTube: http://www.youtube.com/user/ChooseHealthDelaware • Speakers Bureau: Organizations can request a speaker through the website • Email: [email protected] Moving Forward Next steps for Choose Health Delaware’s Health Insurance Marketplace • Currently in a period of evaluation and assessment • What worked well? • What needs to improve? • Maintaining in-person support for those who qualify for Special Enrollment Period • Maintaining lesser but consistent marketing presence throughout summer • Will ramp-up with education and outreach in September in preparation for start of open enrollment (Nov. 15) Contact Information • Michelle Amadio, Director of Delaware’s Health Insurance Marketplace, Department of Health and Social Services • Phone (302) 255-4491 • [email protected] • Linda Nemes, Assistant Director Market Regulation, Delaware Department of Insurance • Phone (302) 674-7373 • [email protected]