Racing to New Coverage Opportunities:Final Steps to Help You Prepare for Enrollment

September 11, 2013

Educating Patients About The New Health Insurance Exchanges

Marc Boutin Executive Vice President & Chief Operating Officer

National Health Council

© National Health Council

Helping VHAs Educate Patients About Exchanges

Training and EducationThrough education, NHC will lay a foundation for VHAs on insurance marketplaces and Medicaid expansion

1

Patient Advocacy ToolsTools will help advocates assist patients through implementation activities

2

Key MessagesKey messages will launch each month and build off messages tested by national partners

3

© National Health Council

Training and Education

Webinars: July 2013: Explain the exchanges,

discuss role of patient organizations in educating people with chronic conditions

August 2013: Discuss tools NHC is developing, hear from three VHAs about their initiatives

September 11, 2013: Update on exchanges and NHC tools, discuss information patients need when they enroll

© National Health Council

Tools: Customizable resources, such as fact sheets

and one-pagers (e.g., enrollment assistance programs, financial protections)

Infographics

Assistance in choosing an appropriate plan, capturing feedback on any problems, cataloging patient stories

Patient Advocacy Tools

© National Health Council

Key Messages

Samples: There will be new, affordable insurance options

available for people without insurance.

All insurance plans will have to cover doctor visits, hospitalizations, maternity care, emergency room care, and prescriptions.

Financial help is available so you can find a plan that fits your budget.

If you have a pre-existing condition, insurance plans cannot deny you coverage.

Help will be available online, by phone, and in person to find the plan that works best for you.

State Exchanges and Medicaid Expansion:

What do you need to know?

Corey FordSenior Manager

Avalere Health, LLC

State Implementation Activities Update

The ACA Is Expected to Reduce Number of Uninsured, Primarily through Enrollment in Medicaid and Exchanges

10

2013 2014 2015 2016 2017

49 40 35 26 24

50 55 57 58 59

16 13 12 11 10

144 144 145 146 147

5 5 5 5 5

50 52 53 55 56

314 317 319 322 325

8 12 22 24

EXPECTED SOURCES OF COVERAGE (IN MILLIONS), 2013-2017

TotalMedicareOther Public ProgramsEmployerNon-Group ExchangesMedicaid & CHIP

Source: Avalere Enrollment Model, August 2013, Scenario 2 (assumes 26 states opt out of the Medicaid expansion)ACA: Affordable Care Act

To Date, 24 States & DC Plan to Expand Medicaid Eligibility in 2014, 23 Will Not Expand, and the Remainder Are Undecided

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Source: Avalere State Reform Insights, Updated September 6, 2013*AR and IA have submitted waivers to use premium assistance models with exchange plans for parts of their expansion populations; TN is considering a similar model for expansion beneficiaries**MI’s expansion will likely take effect in March or April 2014 and will require waiver approval from CMS for a number of provisions, including the use of HSAs.

AK

HI

CA

AZ

NV

OR

MT

MN

NE

SD

ND

ID

WY

OK

KSCO

UT

TX

NMSC

FL

GAALMS

LA

AR*

MO

IA*

VA

NCTN*

IN

KY

IL

MI**

WI

PA

NY

WV

VT

ME

RICT

DEMD

NJ

MANH

WA

OH

DC

Will Expand (24 + DC)

Will Not Expand (23)

STATE COMMITMENT TO EXPAND MEDICAID ELIGIBILITY IN 2014

Leaning No (3)

States That Expand Will Face a Significant Influx of New Medicaid Enrollees

12

AK

HI

CA

AZ

NV

OR

MT

MN

NE

SD

ND

ID

WY

OK

KSCOUT

TX

NMSC

FL

GAALMS

LA

AR*

MO

IA

VA

NCTN*

IN

KY

IL

MIWI

PA

NY

WV

VT

ME

RICT

DEMD

NJ

MANH

WA

OH

DC

PERCENT INCREASE IN MEDICAID ENROLLMENT AS COMPARED TO BASELINE COVERAGE, 2022

Opting Out (26)

≥ 50.1% (7)

25.1-50.0% (10)

≤ 25.0% (7 + DC)

*AR will offer premium assistance to Medicaid beneficiaries; thus, new Medicaid enrollment is low as these individuals are captured in exchange enrollment.Source: Avalere Enrollment Model, August 2013, Scenario 2 (assumes 26 states opt out of the Medicaid expansion).

Newly Eligible Enrollees Will Have Different Characteristics Than Current Medicaid Beneficiaries

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1. Avalere Enrollment Model, August 2013, Scenario 2 (assumes 26 states opt out of the Medicaid expansion).2. All figures except condition information from U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2012. Percentages based on demographics of uninsured individuals with incomes under 125% FPL. CPS data is for coverage in 2011. Figures may not sum due to rounding. Condition information from 2010 Medical Expenditure Panel Survey (MEPS).

CHARACTERISTICS OF NEWLY ELIGIBLE MEDICAID ENROLLEES COMPARED TO

CURRENT ENROLLEES2

● ~83% previously uninsured

● 83% of newly eligible Medicaid enrollees will be adults age 19-64

o Compared to 42% of the current population—reflecting a large portion of children in current program

● Better reported self-health than current enrollees

o 87% of newly eligibles compared to 72% of current enrollees report good to excellent health, which may be due to representation of the disabled among current enrollees

● Lower incidence of common chronic conditions than adults (18-64) currently enrolled and spend less per capita, than current enrollees

o May have undiagnosed conditions

2013 2014 2015 -

5

10

15

20

25

30

35

40

45

50

55

60

65

5055 57

MEDICAID AND CHIP ENROLLEES, 2013, 2014, 2015 (IN MILLIONS)1

NU

MB

ER

OF

EN

RO

LLE

ES

(M

ILLI

ON

S)

15 States and DC Will Run Exchanges, 7 States Approved for Partnership, 8 states scheduled for Marketplace Plan Management

14

Source: Avalere State Reform Insights, August 15, 2013* Utah will operate a marketplace plan management model for its individual exchange and rely on its existing small group exchange for the SHOP exchange. ** New Mexico will operate a partnership for its individual exchange, but run its own SHOP exchange. *** Although Idaho will operate a state-based exchange, it will rely on HHS for certain functions, such as eligibility and enrollment .

AK

HI

CA

AZ

NV

OR

MT

MN

NE

SD

ND

ID***

WY

OK

KSCO

UT*

TX

NM**SC

FL

GAALMS

LA

AR

MO

IA

VA

NCTN

IN

KY

IL

MI

WI

PA

NY

WV

VT

ME

RICT

DEMD

NJ

MANH

WA

OH

D.C.

FFE – MPM (8)

State-Run (15 + DC)

FFE (20)

Partnership (7)

2014 INSURANCE EXCHANGE OPERATIONAL MODEL

Approximately 26 Million Are Expected to Enroll in Coverage through Exchanges

15

AK

HI

CA

AZ

NV

OR

MT

MN

NE

SD

ND

ID

WY

OK

KSCO

UT

TX

NM

SC

FL

GAALMS

LA

AR

MO

IA

VA

NC

TN

IN

KY

IL

MIWI

PA

NY

WV

VT

ME

RICT

DEMD

NJ

MANH

WA

OH

D.C.

≤ 100,000 (8 + DC)

≥ 501,000 (17)

251,000-500,000 (14)

101,000-250,000 (11)

TOTAL ENROLLMENT IN EXCHANGE COVERAGE, 2022

Source: Avalere Enrollment Model, August 2013, Scenario 2 (assumes 26 states opt out of the Medicaid expansion ).

EXCHANGE ENROLLEES, 2014 (MILLIONS)1

NU

MB

ER

OF

E

NR

OLL

EE

S(M

ILLI

ON

S)

1. Avalere Enrollment Model, August 2013, Scenario 2 (assumes 26 states opt out of the Medicaid expansion ).2. All figures except condition information from U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2012. Percentages based on demographics of uninsured individuals with incomes between125%-400% FPL. CPS data is for coverage in 2011. Condition information from 2010 Medical Expenditure Panel Survey (MEPS).

About 8 Million Will Enter the Exchange in 2014 with Different Health Profile Than the Currently Insured

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20141

2

3

4

5

6

7

8

9

10

7

1

Subsidized Unsubsidized

Characteristics of Subsidized Exchange Enrollees Compared to Employer Population2

~65% previously uninsured

58% of enrollees are adults < age 45

» Compared to 43% of employer population

45% White, 34% Hispanic and 13% Black

» Percentage of Hispanic enrollees is double that of employer population

Worse reported self-health than individuals with employer coverage

» Over 90% still report good to excellent health

Lower incidence of common chronic conditions than adults (18-64) with employer coverage

» May have undiagnosed conditions

Spend less per capita, than individuals with employer coverage

Snapshot of Exchange Landscape

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ISSUER COMPETITION BY STATE, INDIVIDUAL MARKET

A Majority of States Will Operate with a Lower Number of Issuer Competition in the Individual Exchange Market

AK

HI

CA

AZ

NV

OR

MT

MN

NE

SD

ND

ID

WY

OK

KSCOUT

TX

NMSC

FL

GAALMS

LA

AR

MO

IA

VA

NCTN

IN

KY

IL

MIWI

PA

NY

WV

VT

ME

RICT

DEMD

NJ

MANH

WA

OH

DC

1-3 Issuers (14 + DC)

4-6 Issuers (15)

7-9 Issuers (4)

10+ Issuers (8)

Source: Avalere State Reform Insights, Updated September 5, 2013

Information Undisclosed (9)

StateEnrollment

Number Rank

Expected lives in 2016

Aetna* Cigna HumanaUnited

HealthcareWellPoint

CA 1 2,601,000 X

FL 3 1,719,000 X X X

OH 6 783,000 X X X

NC 7 780,000 X

GA 9 724,000 X

MI 11 653,000 X X

NY 4 1,079,000 X X

VA 13 541,000 X X

National Carriers Are Participating in Markets Where They Have Experience—Not Where Most Enrollment Will Likely Be

Source: State Reform Insights, August 23, 2013*Includes participation of Coventry, given the acquisition was finalized on May 3, 2013. Given the timing of the acquisition, there will likely be QHPs under the Aetna and Coventry name. Note: The following states have not yet announced what carriers are participating in their state: TX, IL, NJ, PA, WI. 19

NATIONAL CARRIERS ARE RELYING ON EXPERIENCE AND PROVIDER NETWORKS TO DESIGN COMPETITIVE PRODUCTS

Regional and Local Players Likely to Dominate Exchange Markets in Early Years

20

National players (e.g., United, Aetna)

● Strategically deciding which state exchanges they choose to participate

Regional players (e.g., Blues, Kaiser)

● Less flexibility to decide whether to play, likely to be key participants, to maintain market share

Medicaid-only plans (e.g., Centene, Molina)

● Uniquely positioned to provide health care for individuals churning from Medicaid into exchanges

Source: Avalere Research based on 41 states plus DC that have released data about carrier participation, August 2013. *Regional plans include any Blues plans and Kaiser plans. ** Provider Sponsored plans include plans with a relationship with physician groups or part of an ACO.

Carrier by Plan Type (% of number of plans)

22%

31%12%

11%

15%

9%

RegionalLocal

Medicaid MCO

National

Provider Sponsored

CO-OP

It will be critical to identify top enrollment plans in key markets as targets for engagement. These plans are likely to be distinct from major commercial players today

Average Monthly Plan Premiums Across All Metal Tiers for Nonsmoking 40-year olds for Exchange Plans

Rates are for plans filed to be offered through exchanges for nonsmoking 40-year-old individual. Data are for the averages across all regions within a state. Based on rate filings, CT, IN, and WA do not appear to have any platinum plans available on the exchange. MD only provided rate filings for bronze and silver products. Source: Avalere Health analysis of health insurance rate filings publicly available as of August 30, 2013.

CA (12) CT (3) IN (5) MD (4) NY (16) OH (12) SD (3) VT (2) VA (8) WA (4) $200

$250

$300

$350

$400

$450

$500

$550

$600

$650

Platinum

STATE (NUMBER OF CARRIERS)

MO

NT

HL

Y P

RE

MIU

M

21

Six States Will Go Beyond Federal EHB to Require Standardized Benefits in their Exchanges

22

COST-SHARING IN SELECT STANDARDIZED SILVER PLANS

Source: State Reform Insights, July 15, 2013*Benefit cost-sharing parameters are specific to individuals. Deductibles and OOP max may be higher for family coverage. **All plans must comply with the annual limitation on OOP maximums for medical and drug benefits ($6,350 in 2014). †California’s silver copay and coinsurance plan designs vary in cost sharing for advanced imaging and home health care services as well as in the accumulation of certain cost sharing towards the deductible. ‡For brand drugs only §Parameters vary for mail-order pharmacies

State Plan Type Benefit Cost-Sharing Parameters*

Overall Deductible

Drug Deductible

Drug Formulary

Inpatient

Emergency Room

Primary Care Physician

Specialist

OOP Max for Drugs

Tier 1

Tier 2

Tier 3

Tier 4

CA

Silver Copay† Medical:$2,000 $250‡ $25 $50 $70 20% 20% $250 $45 $65 N/A

Silver Coinsurance†

Medical:$2,000 $250‡ $25 $50 $70 20% 20% $250 $45 $65 N/A

Silver HSA $1,500 N/A 20% 20% 20% 20% 20% 20% 20% 20% N/A

CT Standard Silver Medical:$3,000 $400 $10 $25 $40 40% $500 $150 $30 $45 N/A

MA Silver $2,000 N/A $20§ $35§ $70§ N/A $1,000 $250 $30 $50 N/A

NY Silver $2,000 N/A $10§ $35§ $70§ N/A $1,500 $150 $30 $50 N/A

OR Silver $2,500 $0 $15 $50 50% 50% 30% 30% $35 $70 N/A

VT

Silver Deductible $1,900 $100‡ $12 $50 50% N/A 40% $250 $20 $40 $1,250

Silver- HDHP $1,550 $1,250 $10 $40 50% N/A 20% 20% 10% 20% $1,250

Patients Meeting the OOP Cap Expected to be Underinsured

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A study of families receiving unsubsidized insurance through the Massachusetts exchange — established in 2006 — indicates that those on the lower end of the income spectrum, those with fair to poor health, and those with more children, often faced high levels of financial burden due to out-of-pocket costs for care.2

100% FPL 150% FPL 200% FPL 250% FPL 300% FPL 400% FPL 500% FPL0%

5%

10%

15%

20%

25%OUT-OF-POCKET CAP AS A PERCENT OF INCOME1

OOP cap as a % of income Underinsured threshold

1. Based on CWF definition: out-of-pocket expenses equaled 10% or more of income; out-of-pocket expenses equaled 5% or more of income if low income (<200% of poverty); or deductibles equaled 5% or more of income. Available at: http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Apr/1681_Collins_insuring_future_biennial_survey_2012_FINAL.pdf 2. Health Affairs, Some Families Who Purchased Health Coverage Through The Massachusetts Connector Wound Up With High Financial Burdens, April 2013. Available at: http://content.healthaffairs.org/content/early/2013/04/15/hlthaff.2012.0864.full.pdf+html

Lives Served by Market Today

Anticipated Future Market

Less Generous More GenerousBenefit Design Generosity

Commercial

Exchange

MedicaidCatastrophic

Exchange Plans May Have Spillover Effects by Setting a New Low Standard for Coverage Generosity

24

© National Health Council

Choosing the Best Plan for You: Tips to Navigate Exchange Websites

Kelly BrantleySenior Manager

Avalere Health, LLC

Tips for Navigating Exchange Websites

Applicant Welcome Page for the Federally Facilitated Marketplace Simplifies Consumer Options

27

The Federally Facilitated Marketplace Consumer Hotline and Additional Resources Are Available Now

28

LIVE CHAT

RESOURCES INCLUDE: CALL CENTER, LIVE CHAT, AND FAQ GUIDE

CALL CENTER

Federally Facilitated Website Currently Operating A Tool to Help People Determine Possible Coverage Options Prior to Oct. 1

29

A SERIES OF QUESTIONS WILL HELP YOU DETERMINE IF YOU WILL LIKELY BE ELIGIBLE FOR EXCHANGES, MEDICAID, AND/OR FINANCIAL ASSISTANCE

Applying for Coverage on Healthcare.gov Includes a Set of Required Application Information

30

Applicants must enter:

• Contact information, including

address, phone number, preferred

language, and preferred method of

contact.

• Social security number, federal tax

information, status of dependents,

and race

• Household, dependent, and spousal

information

• Income information using pay stubs

and W-2 forms.

The Site Then Calculates an Eligibility Determination for Financial Assistance

31

APPLICANTS ARE NOTIFIED IN REAL TIME IF THEY ARE ELIGIBILE FOR ADVANCE PREMIUM TAX CREDITS, COST SHARING REDUCTIONS, AND/OR MEDICAID

Real time eligibility

notification

Educational Slides Prior to Metal Tier and Plan Comparison

32

HEALTHCARE.GOV ATTEMPTS TO INCREASE HEALTH LITERACY AMONGST CONSUMERS

Before the applicant reviews metal tier options and plans, they will review three slides that briefly explain: Essential Health Benefits, actuarial value of the five metal tiers, and general cost-sharing information (i.e., “the lower the premium, the higher the out-of-pocket costs

when you need care”)

How to Navigate Metal Tiers, Comparing Health Plans as well as Key Information Available for Direct Comparison

• The applicant is provided information

about the number of plans in each

level, the high and low monthly

premiums, average co-pay, average

deductible, and out-of-pocket

maximum. Applicants may select one

or more metal tiers.

• After selecting the tier, applicants are

brought to a list of available plans.

Applicants have the option to sort plans

by: maximum out-of-pocket, premium,

and deductible

33

34

Using Expected Healthcare Needs to Select a Plan: Formularies, Provider Networks, and Out-of-Pocket Costs

35

● FORMULARIES

− Applicants will access plan formularies by expanding the “Prescription Drug Coverage” section and clicking on a link that will take the applicant to the issuer’s website

● PROVIDER NETWORKS

− Applicants will access the plan’s provider network by clicking on the “Provider Directory” link that is part of the initial information displayed for each plan

● OUT-OF-POCKET COSTS

− It is important to note that the out-of-pocket calculator and information available on the website may not accommodate personal health care needs

Applicants may find it difficult to quickly and accurately compare provider networks and formularies from different issuers due to the lack of standardization for formatting and the separate search function

Keep in Mind the Following Strategies for Protection against Fraud in the Marketplace

● BE INFORMED. Learn about the basics of health care at healthcare.gov and compare insurance plans in order to make an informed final decision

● PROTECT YOUR PERSONAL INFORMATION. Do not give out any personal health information. Do not give your Social Security number or credit card or banking information to companies you didn’t contact or in response to unsolicited advertisements.

● ASK QUESTIONS, VERIFY ANSWERS. The Marketplace has trained and certified assisters available to help if the information is unclear. Keep the contact information of any salesperson that assists you. Contact healthcare.gov to utilize the live chat options or the call center if you need to verify answers

● REPORT SUSPICIOUS ACTIVITY. Any suspected fraud can be reported to the Health Insurance Marketplace consumer call center at 1-800-318-2596

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QUESTIONS?

Racing to New Coverage Opportunities:Final Steps to Help You Prepare for Enrollment

September 11, 2013

www.nationalhealthcouncil.org