introducing ohio’s health marketplace
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DESCRIPTIONIntroducing Ohio’s Health Marketplace. Presented by John Dodd and John McGough September 17, 2013. So tell me more about that new free health insurance…. Confusion in the market. Starts with the name 85% recognize the name “Obamacare” < 30% recognize “ACA” PPACA ??????? - PowerPoint PPT Presentation
Introducing Ohios Health MarketplacePresented byJohn Dodd and John McGough
September 17, 2013
So tell me more about that new free health insurance
Confusion in the market Starts with the name85% recognize the name Obamacare< 30% recognize ACAPPACA ???????Is the Patient Protection Affordability and Accountability Act a law or bill?What pieces were delayed and until when?Who is eligible for a subsidy and what does it mean to me?What about those tax credits?What will be available and how much will it cost?If I do nothing now, what is the worst that could happen to me?Will the options be same in NW Ohio, Cleveland, Columbus, Cincinnati and Youngstown?Ohio will have more volatility than other states
Patient Protection Affordability and Accountability Act Signed into Law March 23, 2010
Current Political Dynamic
PPACA/ACA/ObamacareSince passage the law has never gotten above 50% approval in public opinion pollsThe law survived a Supreme Court challenge with only a change to the penalty to states not expanding Medicaid to 133-138% of FPLThe law survived two national elections with one of those re-electing President ObamaCurrent split government in Congress will not bring any legislative changes. Period.Even if the Republican controlled House of Representatives is successful in de-funding the law, all the other provisions will go forward. We are past the point of return to pre-2010.
PPACA what does it look like?
What Is The Health Care Reform Law All About?It is NOT a total takeover of the health care system to create a single payer Canadian or European style health care system.
It is a MASSIVE new law that brings federal regulation to health insurance as opposed to the traditional state regulation of the insurance industry.
It does include a number of new regulations for healthcare providers, but falls short of total takeover of the entire system.
Citizens will still be dealing with private health care providers and private insurance companies unless covered by Medicaid.
Timeline for Implementation 2010 26 total provisions scheduled to be implemented26 total provisions implemented
2010 PPACA Scheduled Provisions Review of Health Plan Premium IncreasesMore scrutiny in premium rate review More justification requiredChanges in Medicare Provider RatesQualifying Therapeutic Discovery Project CreditMedicaid and CHIP Payment Advisory Commission
2010 PPACA Scheduled Provisions (cont.)Comparative Effectiveness Research Prevention and Public Health FundMedicare Beneficiary Drug RebateSmall Business Tax Credits
2010 PPACA Scheduled Provisions (cont.)Medicaid Drug RebatesCoordinating Care for Dual EligiblesNew efficiencies for those with Medicare and MedicaidGeneric Biologic DrugsNew requirements on Non-profit HospitalsTrue non-profit??????
2010 PPACA Scheduled Provisions (cont.)Medicaid Coverage for Childless AdultsReinsurance Program for Retiree CoverageThis was a program for plan sponsors to encourage them to continue retiree plansPre-existing Condition Insurance PlanHigh Risk Pool closed earlier in 2013New Prevention CouncilConsumer Website
2010 PPACA Scheduled Provisions (cont.)Tax on Indoor Tanning ServicesExpansion of Drug Discount ProgramAdult Dependent Coverage to Age 26Consumer Protections in InsuranceEliminating lifetime limits on coveragesNo pre-ex limitation for childrenInsurance Plan Appeals Process
2010 PPACA Scheduled Provisions (cont.)Coverage of Preventive BenefitsHealth Centers and the National Health Service CorpsHealth Care Workforce CommissionMedicaid Community-Based Services
Timeline for Implementation 2011 20 total provisions scheduled to be implemented18 total provisions implemented
2011 PPACA Scheduled Provisions Minimum Medical Loss Ratio for Insurers Closing the Medicare Drug Coverage Gap$250 check to those hitting Part D doughnut hole in 2011Beginning 2012 increased % of prescription drugs paid in doughnut hole until reaching 75% in 2020Medicare Payments for Primary CareMedicare Prevention BenefitsCenter for Medicare and Medicaid Innovation
Schedule of Progress--Part D
Medicare Beneficiary pays this % for Brand-Name in GapMedicare Beneficiary pays this % for Generic in Gap201250%86%201347.5%79%201447.5%72%201545%65%201645%58%201740%51%201835%44%201930%37%202025%25%
2011 PPACA Scheduled Provisions (cont.)Medicare Part B Premium Increase for Higher-Income BeneficiariesMedicare Advantage Payment ChangesLess government payment to Advantage plans going forwardWill that increase premiums, reduce benefits, or both?Medicaid Health HomesChronic Disease Prevention in MedicaidNational Quality Strategy
2011 PPACA Scheduled Provisions (cont.)Changes to Tax-Fee Savings AccountsPenalty for ineligible withdrawals increased from 10% to 20%Grants to Establish Wellness Programs *Teaching Health CentersMedical Malpractice GrantsFunding for Health Insurance Exchanges Exploratory grants to statesFollowed by implementation grants for those states choosing to implement a state exchangeOhio choose not to establish a state exchange
2011 PPACA Scheduled Provisions (cont.)Nutritional Labeling *Medicaid Payments for Hospital-Acquired Infections Graduate Medical EducationMedicare Independent Payment Advisory BoardAn independent board that will begin making decisions on eligible expenses and amounts paid for eligible expensesMedicaid Long-Term Care Services
Timeline for Implementation 2012 11 total provisions scheduled to be implemented10 total provisions implemented
2012 PPACA Scheduled Provisions Accountable Care Organizations in MedicareUniform Coverage Summaries for ConsumersSummary of Benefits and CoverageMedicare Advantage Plan PaymentsMedicare Independence at Home DemonstrationMedicare Provider Payment Changes
2012 PPACA Scheduled Provisions (cont.)Fraud and Abuse PreventionAnnual Fees on the Pharmaceutical IndustryMedicaid Payment Demonstration Projects *Data Collection to Reduce Health Care Disparities
2012 PPACA Scheduled Provisions (cont.)Medicare Value-Based PurchasingTougher reimbursement rules Proceeding to performance based pay----not payment per procedureReduced Medicare Payments for Hospital ReadmissionsChanged name of the Exchange to Marketplace
Timeline for Implementation 2013 14 total provisions scheduled to be implemented11 total provisions implemented
2013 PPACA Scheduled Provisions Employer Notification to Employees Regarding ExchangesDelayed from March 1, 2013 to October 1, 2013Employers required to provide notice whether or not they offer a planif subject Fair Labor Standards Act (FLSA)Medicare Bundled Payment Pilot ProgramMedicaid Coverage of Preventive ServicesMedicaid Payment for Primary Care
2013 PPACA Scheduled Provisions (cont.)Itemized Deduction Floor for Medical ExpensesIncreased from 7.5% to 10% of AGIFlexible Spending Account LimitsLimited to $2500 per yearMedicare Tax Increase0.9% on income exceeding $200,000 filing single or $250,000 filing jointlyEmployee Retiree Coverage SubsidyTax on Medical Devices-$2.3% on DME
2013 PPACA Scheduled Provisions (cont.)Financial Disclose *CO-OP Health Insurance Plans One has been approved for OhioDid not get organized in time to be in the exchange/marketplace in 2014Extension of CHIP through 2015Medicare Disproportionate Share Hospital Payments *Medicaid Disproportionate Share Hospital Payments *
Timeline for Implementation 2014 and Beyond 19 total provisions scheduled to be implemented
2014 PPACA Scheduled Provisions Expanded Medicaid CoverageNot in Ohionot yetPresumptive Eligibility for MedicaidStreamlined application processIndividual Requirement to Have InsuranceHealth Insurance Exchanges/MarketplacesHealth Insurance Premium and Cost Sharing SubsidiesRefundable and Advanceable Federal Income Tax Credits to be used as Premium Subsidies on Silver Level Coverage Purchased in the Exchange/MarketplaceSilver Level Coverage Will be Enhanced to Lower MOOP Limits for those with income below 250% of FPL
2014 PPACA Scheduled Provisions (cont.)Guaranteed Availability of InsuranceNo Risk Rating, No Pre-exNo Annual Limits on CoverageEssential Health Benefits Package Required in Small Group and Individual MarketsMulti-State Health PlansTemporary Reinsurance Program for Health Plans
2014 PPACA Scheduled Provisions (cont.)Basic Health PlanCatastrophic plan for those unable to afford coverage and under age 30Employer RequirementsPenalty for non-compliance delayed until 2015Medicare Advantage Plan Loss RatiosWellness Programs Included in Insurance PlansFees on Health Insurance Sector$8 Billion in 2014looks like about 2.4% of premiumReinsurance pool charge of $5.25 PMPMMedicare Payments for Hospital-Acquired Infections
2015 and beyond PPACA Scheduled Provisions 2015 - Increase Federal Match for CHIP2016 - Health Care Choice Compacts2018 -Tax on High-Cost Insurance
What Resources Are Available?Were here to help you!
What Resources Are Available?www.NAHU.orgwww.Healthcare.govHealth and Human Services/Center for Medicare and Medicaid ServicesHealth Insurance Carriers and PlansVarious Professional Organizations (ie. IFEBS, American College, WEB International, Kaiser Family Foundation, NAIFA, PIA/Big I)Google.comGoogling Your Question Produces a Number of Qualified Answers From Consultants
Who Will Be Involved In The Exchange/Marketplace Nationally?Agents/brokersAgents and Brokers are allowed to participate if the state allows agents and brokers to participateNavigatorsBy law each state