The Affordable Care Act and You:

Planning for the Next Open Enrollment Period

October 14, 2014

What We’ll Cover

• The Affordable Care Act is Working

• Best Practices & Lessons Learned• Health Insurance Literacy• Open Enrollment – November 15• Individual Responsibility Payment• Renewal & Re-enrollment Process• How You Can Help• Resources

The Affordable Care Act is Working

Thank You!

• HRSA grantees and stakeholders played a major role in ensuring the successful implementation of the Affordable Care Act during the 1st Open Enrollment Period.

• 7.3 million people signed up for Marketplace plans, paid their premiums, and accessed quality, affordable coverage.

 • Additionally, 8 million individuals

enrolled in Medicaid and CHIP since the beginning of first Open Enrollment period.

Affordability

• American consumers have saved $9 billion dollars since 2011. The Affordable Care Act says insurance companies have to spend at least 80 cents of every premium dollar they receive on care.

• Nearly 2 in 3 newly covered consumers who went to the doctor or filled a prescription said they would not have been able to afford or access those services were it not for their coverage.

Source: CMS Consumers Benefit from 80/20 Rule in 2013, July 24, 2014

Quality

Better Care and Better Coverage

• Nearly 3 in 4 newly insured consumers who bought health plans during Open Enrollment 2014 expressed satisfaction with that coverage.

Consumer Satisfaction with Coverage Obtained Through Open Enrollment

  Source: The Commonwealth Fund Affordable Care Act Tracking Survey, April-June 2014.

Access

• During Open Enrollment 2014, consumers could choose from an average of 47 plans.

• In 2015 there will be a 25% increase in the total number of issuers selling health insurance in the Marketplace.

Best Practices and Lessons Learned by HRSA grantees

during the 1st Open Enrollment Period

Enrollment Best Practices

• Build partnerships.

• Work with the media to get information out about assistance events.

• Use a scheduling system to make appointments.

• Increase hours for assistance during the week.

• Play enrollment-focused videos in waiting rooms.

Enrollment Best Practices (cont.)

• Provide a group enrollment option for consumers who require less assistance to enroll.

• Provide classroom-style assistance, with assisters floating among consumers to respond to questions.

• Rent self-service kiosks to better accommodate those who need access to a computer but prefer to apply on their own, with assistance available if needed.

• Share the Marketplace Enrollment Checklist with consumers and have them complete prior to enrollment appointment.

Education and Outreach Best Practices

• Have clinic staff wear “ASK ME ABOUT INSURANCE” buttons, training them to answer questions and refer clients to assisters as needed.

• Highlight successes and events on social media platforms (e.g., YouTube, Instagram, Facebook, and Twitter).

• Mail postcards or personalized letters to provide education and information about upcoming events.

• Encourage consumers to refer friends and family by using word-of-mouth.

• Conduct outreach at non-traditional venues (e.g., job fairs, baby or wedding expos, sporting events, restaurants, hotels, grocery stores, roller derbies, and cultural events).

• Build off of existing collaborations to reach diverse groups.

Health Insurance Literacy

Coverage to Care

• Millions of Americans gained coverage through the Marketplace and Medicaid and CHIP during open enrollment, and this year more than 500,000 uninsured 64-year olds will become eligible for Medicare.

• For many, this is the first time they have ever had coverage.

• Unless we connect the newly insured to primary care and preventive services, we will not realize the other goals of the ACA – improving population health and reducing health care costs.

Coverage to Care (cont.)

• Coverage to Care (C2C) is an effort to help educate consumers about their new coverage and to connect them with primary care and preventive services that are right for them so they can live long, healthy lives.

• Resources online and in print include the Roadmap, Discussion Guide, videos, and more.

• C2C builds on existing networks of community partners to educate and empower newly covered individuals.

http://marketplace.cms.gov

The Health Insurance Marketplace

The next open enrollment period is November 15, 2014- February

15, 2015

http://www.healthcare.gov

Marketplace Basics

• The Marketplace is a place for qualified individuals and families to find and buy health insurance that fits their budget and health care needs.

• Some states have established their own Marketplace (State-Based Marketplace (SBM)). Others have a Federally-Facilitated Marketplace (FFM) or State-Partnership Marketplace (SPM).

• Individuals and families may be eligible for lower costs on their monthly premiums and out-of-pocket costs.

• There is assistance available to help Americans get the best coverage for their needs.

Medicaid and CHIP

• The health care law provides states with the opportunity to expand Medicaid.

• The law simplifies eligibility for Medicaid and the Children’s Health Insurance Program (CHIP).

• It coordinates coverage under Medicaid and CHIP with new qualified health plan coverage available through the Marketplace. – No wrong door if you apply through the

Marketplace. – Single application for affordability programs.

Individual Responsibility Payment

• Most people in the United States must have health coverage, qualify for an exemption, or pay a fee.

• If you did not have minimum essential coverage or an exemption for 2014, you’ll pay the higher of the following two amounts when you file your 2014 taxes:– 1% of your yearly household income that is above the

tax return filing threshold for your filing status, or  – $95 per person for the year ($47.50 per child under

18), limited to a family maximum of $285.

• Note: The fee is capped at the cost of the national average premium for a bronze level health plan available through the Marketplace in 2014.

Individual Responsibility Payment(cont.)

• If you don’t have minimum essential coverage or an exemption in 2015, you’ll pay the higher of these two amounts when you file your 2015 taxes:– 2% of your yearly household income.  The

maximum penalty is the national average premium for a bronze plan.

– $325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.

• Note: The fee is capped at the cost of the national average premium for a bronze level health plan available through the Marketplace in 2014.

Individual Responsibility Payment Calculation-

Single IndividualExample #1: Single individual with $40,000 income• Jim, an unmarried individual with no dependents, does not

have minimum essential coverage for any month during 2014 and does not qualify for an exemption. For 2014, Jim’s household income is $40,000 and his filing threshold is $10,150.– Jim’s payment using the 1% income formula is $298.50

• 2014 household income ($40,000) minus filing threshold ($10,150) = $29,850. • 1% of $29,850 = $298.50.

– Jim’s flat dollar amount is $95.– The annual national average premium for bronze level coverage

for 2014 is $2,448– Because $298.50 is greater than $95 and is less than $2,448,

Jim’s shared responsibility payment for 2014 is $298.50, or $24.87 for each month he is uninsured (1/12 of $298.50 equals $24.87).

• Jim will make his shared responsibility payment for the months he was uninsured when he files his 2014 income tax return, which is due in April 2015.

Individual Responsibility Payment Calculation-

FamilyExample #2: Married couple with 2 children, $70,000 income• Eduardo and Julia are married with two children under 18 and

do not have minimum essential coverage or qualify for an exemption. For 2014, their household income is $70,000 and their filing threshold is $20,300.– Payment using the 1% income formula is $497

• 2014 household income ($70,000) - filing threshold ($20,300) = $49,700; • 1% of $49,700 = $497.

– Flat dollar amount is $285, or $95 per adult and $47.50 per child. The total of $285 is the maximum flat dollar amount in 2014.

– The family’s annual national average premium for bronze level coverage for 2014 is $9,792 ($2,448 x 4). Because $497 is greater than $285 and is less than $9,792, Eduardo and Julia’s shared responsibility payment is $497 for 2014, or $41.41 per month for each month the family is uninsured (1/12 of $497 equals $41.41).

• Eduardo and Julia will make their shared responsibility payment for the months they and their children were uninsured when they file their 2014 income tax return, which is due in April 2015.

Individual Shared Responsibility Payment

Resources

• To learn more about the penalty and exemptions visit: – Healthcare.gov: https

://www.healthcare.gov/fees-exemptions/fees-exemptions-overview/

– The Internal Revenue Service: http://www.irs.gov/uac/Individual-Shared-Responsibility-Provision

When You Can Enroll

• Next annual open enrollment period:– November 15, 2014 – February 15,

2015

• Special enrollment periods available in certain circumstances during the year.– Visit

http://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment to learn more

• Can apply for Medicaid and CHIP at any time.

Renewal and Re-enrollment Process for 2015

• The following slides outline the process for renewal and re-enrollment process for 2015 in the Federally-facilitated Marketplace (FFM) or State Partnership Marketplace (SPM).

• Processes in State-Based Marketplaces (SBM) may differ. – For specific instructions on SBM re-enrollment

please contact your state.

Open Enrollment for 2015

• During Open Enrollment:– New applicants will be able to apply and

select plans.– Current enrollees are strongly encouraged

to come back to the Marketplace to ensure they receive the accurate amount of financial assistance and either select the same plan (if available) or select a new plan if they wish to do so.

– However, current enrollees will be automatically enrolled in plans whenever possible if they do not return by December 15, 2014.

Notices for Current QHP Enrollees

• Around Nov 15, current enrollees will receive notices from the issuer regarding product discontinuations and renewals of coverage.

• Between Oct 1-Nov 15, current enrollees will receive notices from the Marketplace regarding open enrollment and the re-enrollment process.

• Consumers should use both their notices to make sure they make the most informed decision during the annual open enrollment process.

• Consumers should review the notices carefully and take any required action, such as updating their Marketplace application or actively selecting a new plan through the Marketplace.

Key Dates for Returning Consumers

• Consumers have until December 15, 2014 to actively select and enroll in a plan if they want to have coverage starting January 1, 2015.

• Most enrollees who do not proactively select a plan for 2015 coverage by December 15, 2014 will be automatically enrolled in coverage starting January 1, 2015.

• If an enrollee returns after December 15 and selects a new plan, they will have coverage through the automatically enrolled plan until the new coverage takes effect.

Re-Enrollment Examples

• Example #1: Consumer actively selects a new plan before December 15, 2014– Mary is enrolled in plan A for 2014. – She receives a letter from her issuer stating that in 2015 she will be

automatically renewed into plan B. – On December 10, 2014, Mary selects a new plan, plan C. – She will be enrolled in plan C with coverage beginning on January 1,

2014.

• Example #2: Consumer actively selects a new plan after December 15, 2014.– Mary is enrolled in plan A for 2014. – She receives a letter from her issuer stating that in 2015 she will be

automatically renewed into plan B. – On December 23, 2014, Mary selects a new plan, plan C. – She will be enrolled in plan B for January and plan C for February.

Current Enrollees with Updated Applications

• Current enrollees are strongly encouraged to return to the Marketplace to make sure their Marketplace application has the most up-to-date information about their income and family size.

• Enrollees who proactively update their Marketplace application information will receive an updated eligibility determination for 2015.

• Enrollees with updated 2015 eligibility determinations MUST confirm plan selection in either the same plan or a new plan. If the enrollee doesn’t do this step they will be automatically enrolled with their most recent Marketplace eligibility determination (e.g. 2014).

Current Enrollees with Updated Applications

(Example)Example #1: Consumer updates application, receives a new eligibility determination, and does not select a plan by December 15, 2014 • Mary was enrolled in plan B with $100 APTC in 2014. • She receives a notice from her issuer that she will be

automatically renewed into plan B. • On 11/20/14 Mary completes an application and receives an

eligibility determination of $150 APTC for 2015. • She does not confirm her plan or select a new plan before

12/15/2014. • She will be automatically enrolled in plan B with $100 APTC with

coverage effective January 1, 2015.

Updated Application Example #2

Example #2: Consumer updates application, receives a new eligibility determination, and selects a plan by December 15, 2014 • Mary was enrolled in plan B with $100 APTC in 2014. • She receives a notice from her issuer that she will be

automatically renewed into plan B. • On 11/20/14 Mary completes an application and receives

an eligibility determination of $150 APTC for 2015. • She confirms her plan selection on December 10, 2014.• She will be enrolled in plan B with $150 APTC with

coverage effective January 1, 2015.

Changing Plans

• Consumers will be able to change plans throughout the open enrollment period (until 02/15/2015) even if their coverage has taken effect.

• Changes will be consistent with regular effective dates: – Changes by the 15th will be effective the first

day of the following month.– Changes after the 15th will be effective the first

day of the second following month (individual will retain prior plan until the newly selected plan becomes effective).

Key Messages to QHP Consumers

• Come back to the Marketplace to update your information and make an plan selection. You may be eligible for more financial assistance!

• If you don’t come back and report changes, the Marketplace does not redetermine your eligibility. Your 2014 eligibility will continue, which may not reflect the financial assistance you are entitled to.

• Even if you are automatically enrolled because you did not actively select a plan by 12/15/2014, you should still make updates to your application information and shop for a plan which best fits your needs before the end of open enrollment (2/15/2015).

Helpful Questions for Consumers

• Did you read all the notices you received from your issuer and the Marketplace?

• Were you satisfied with your plan last year?

• What has changed for you since last year? Have you experienced any changes in your health care needs or life circumstances? (e.g. did you move, did your income change, did you get married or have a baby?)

• Does your current plan still cover everything you need it to cover? Is your doctor still in your plan’s network? Is the hospital you want to receive care at still in your network?  Does your plan still cover your prescription drugs?

How HRSA Grantees Can Help

• Spread the Word: HealthCare.gov is the destination for the Health Insurance Marketplace.

• Become a Certified Application Counselor or Champion for Coverage.

• Help host an enrollment event.

• Post information about the Marketplace on your organization’s website or on social media.

• Educate the newly insured about how insurance works (e.g., premiums, provider networks).

HealthCare.gov

• Now - Sign up for Email and Text Alerts and Get Ready

• Starting November 15, 2014 individuals will be able to apply through this site and renew coverage!

Marketplace.cms.gov

Get the latest resources to help people apply, enroll, get covered and stay covered!

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HRSA Website

http://www.hrsa.gov/affordablecareact/

• Marketplace Information and Enrollment o https://www.healthcare.gov/

• HRSA Affordable Care Act Websiteo http://www.hrsa.gov/affordablecareact

• HIV/AIDS Bureau Affordable Care Act Websiteo http://hab.hrsa.gov/affordablecareact

• Provider and Partner Marketplace Resourceso http://marketplace.cms.gov

• From Coverage to Care Resourceso http://

marketplace.cms.gov/technical-assistance-resources/c2c.html

Resources