Marketplace Mastery. Adapting to help people in the new world of insurance exchanges

Transcription

1 Marketplace Mastery Adapting to help people in the new world of insurance exchanges

2 Agenda What is a Marketplace? Features Set up costs and ongoing fees Marketplace certification On Exchange Off Exchange Qualifying Events Quoting and Enrollment Estimating Tax Subsidy Q & A

3 What is an exchange or marketplace? Health Insurance Marketplace The Exchange Basically, a marketplace or an exchange is just a website

4 Who creates marketplaces? Quotit bswift Accenture Norvax Your favorite website vendor

5 Important Considerations in Your Exchange Keep your brand in front of customers Include free education and marketing support Incorporate consumer friendly information and efficient technology Offer a broad geographic footprint Have a good team of consultants Offer Medicare products Offer an array of ancillary products Provide retention support

6 Brokers are involved In year one open enrollment, CMS estimates 53,271 agents and brokers participated in FFM enrollment In year two: 77,000 brokers and agents assisted with enrollments on the federally-facilitated marketplace up 46% from the year prior. In February at a National Association of Health Underwriters conference, Kevin Counihan, CEO of the FFM, said the broker is integral as integral as it can be in the sale and distribution of our product.

7 Exchange features Quoting Enrollment Compliance aspects Employee notices Coverage options HIPAA Notices SPDs COBRA General Notice COBRA Election Notices State Continuation Medicare Notice SBCs

8 Sample Quote - Exchange Expenses Set up fees Direct to Consumer Platform - Implementation fees $1200-$1500 Individual Major Medical $12,645 - $13,145 Medicare Advantage $7,987 - $8,487 Medicare Supplements $6,975 - $7,475 Ancillary products $2,317 $2,817 Final Expense $1,912 - $2,412 Life Insurance $ $3,425 Long Term Care $1,912 - $2,412

9 Sample Quote Exchange Expenses Ongoing fees Service fees Technology fees New enrollment set up fees Travel fees Custom programming EDI fees

10 Current situation with HIEs $677 million was spent to develop the problem-ridden Over $1B was sent to the states in the form of grants to develop their own exchanges. The District of Columbia and 14 states developed their own exchanges 7 of them are still not performing even close to adequately. Peter Suderman, "ObamaCare's Failed State Exchanges," Reason Magazine, February 27, 2014

11 The Oregon Exchange Oregon's exchange was the most disastrous of the state exchanges. $303 million in federal grants (the government thought that Oregon's exchange would be a model for all other states), the launch was delayed first for weeks, and then for months. Reports surfaced that independent consultants warned that the site was unworkable before launch, but the Oregon Health Authority actually withheld their payment in order to keep them quiet. Lawmakers have called for a federal investigation.

12 The Maryland Exchange Maryland received $157.2 million in federal dollars for a site that failed almost simultaneously with its launch The state terminated its $193 million contract with its IT contractor in February 2014 The problems are so bad that state officials have announced that they may scrap the site entirely

13 The Massachusetts Exchange Massachusetts made the mistake of hiring the same contractor that built the federal exchange, CGI, and the exchange suffered problems from the beginning. Only 5,428 people signed up for coverage during the first three months -- that's less than 1 percent of the state's goal for the first year. All of this after receiving $135.6 million in federal dollars. $135,600,000 / 5428 = $24,982 per person cost to enroll

14 The Vermont Exchange Vermont's $165.2 million in grants could not keep their exchange site -- also built by CGI -- from failing on its very first day. There are still functions that are not working, including insurance options for small businesses. Newsweek reported that CGI actually created a dummy demo site in order to pass inspection. Lawmakers have called for an investigation.

15 The Minnesota Exchange Minnesota's exchange director resigned in mid-december after taking a tropical vacation amidst site problems 14 exchange officials were given bonuses even before the launch Promises that fixes would be in place by 2014 did not hold true, and an outside group has said that problems will not be fixed by the end of open enrollment March 31 In all, the state received $153.7 million in federal dollars

16 The Nevada Exchange Nevada enrolled only 16,000 out of the 118,000 that the state had expected to enroll during the open enrollment period, One exchange board member describing the site's failure as "catastrophic The state received $83.7 million, and officials have now revised their expected enrollee projection down to 50,000

17 The Hawaii Exchange Hawaii's $205 million in federal grants did not seem to go very far The exchange was taken down for two weeks immediately after launch and enrollment has been very low Only 4,300 people have signed up, the lowest number in all the states. $205,000,000 / 4300 = $47,674 per enrollee

18 So we know what is not working What are YOU doing to bring a success story to market? Let s observe some exchanges that are working

19 Marketplace Examples

20 St Augustine and St Johns Board of Realtors

21 Oscar Health

22 PricewaterhouseCoopers: Trends in purchasing health insurance Private health insurance exchanges are changing the way insurers need to do business as the model shifts from wholesale to retail. A new study from PricewaterhouseCoopers finds consumers are a lot less focused on the price of their plan than insurance executives believe them to be

23 Trends in purchasing health insurance In a survey of 100 health insurance executives, 94% said they thought price would be most important to consumers when selecting a health plan. But of 1,000 consumers surveyed by PwC s Health Research Institute, only 64% said they consider price when selecting a plan.

24 Providers over Premium, Service Matters In the survey, released , second of importance was the network of doctors, with both 54% of executives and consumers rating it as important Consumers were also less focused on customer service (48%) than executives believe them to be (60%)

25 PWC Study: Mobile Trends Mobile technology is fast becoming an integral part of the health care consumer experience Use of health and wellness applications among consumer rose 15% in 2013 from As more young people are signing up for health insurance, PwC says it is more important than ever for insurers to have a mobile strategy Of those aged 25-44, more than 35% have these applications on their smartphones.

26 Mobile Trends 73% of those consumers want the mobile application to provide alerts and reminders, as well as access to personal health records. They also seek: Access to specific disease information and products (69%) Provider/specialist search (67.5%) Ability to track insurance claims (66.6%)

27 Marketplace Certification On Exchange Off Exchange

28 Complete the following: Register at the CMS Enterprise Portal The Individual Marketplace Curriculum of CMS' Agent/Broker Marketplace Training The carrier training Approximate time: 30 minutes Mainly covers products, networks and other health plan info CMS and Carrier Training Affirmation Form You need your Marketplace User ID to complete this form

29 ACA Certification On Exchange

30 Example: BCBSTX Certification

31 Training and Administration

32 Selling only non-marketplace products

33 New Business Submission, Deadlines and Qualifying Events

34 OEP = Open Enrollment Period For Medicare October 15 December 7 Did not change For the ACA Last year, November 15, 2014 February 15, 2015 Entering 2016, November 1, 2015 January 31, 2016

35 Qualifying Events Selling year round in the ACA

36 What are the QEs? 1. I gained a dependent due to marriage 2. I gained a dependent due to birth, adoption or placement for adoption 3. I am no longer eligible as a dependent under my prior health insurance plan due to reaching my maximum age, legal separation, divorce or death of the policyholder 4. I am no longer eligible for my prior health insurance plan due to termination of employment, reduction in number of hours of employment, loss of employer contribution toward my premium, or I have exhausted my COBRA benefits

37 What are the QEs? 5. I gained access to new health plan options because of a permanent move 6. I am newly eligible for payments of the advanced premium tax credits 7. I am no longer residing or living in my prior health insurance plan s HMO service area 8. An error occurred in my previous health plan enrollment

38 What are the QEs? 9. I have adequately demonstrated my previous health plan or insurer substantially violated a material provision of its contract with me 10. I and/or my dependents lost minimum essential coverage due to reasons other than non-payment or reccission 11. Other qualifying events as required or permitted by law. PLEASE SPECIFY HERE:

39 Online Quoting and Enrollment

40 Quoting and Enrollment

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46 HealthSherpa.com

47 Example, zip code

48 Let s check Dallas County

49 Enter ages, smoker status, and household income

50 Results are instant

51 Estimating Tax Subsidy

52 Calculating subsidies is very easy!

53 Useful resources used for this presentation

54 Q&A Please complete your evaluation form!

55 How does my income factor? If your income is more than 100% of the federal poverty level - $11,490 a year as a single person or about $23,550 for a family of 4 - you will be able to buy a private health insurance plan in the Marketplace and may get lower costs based on your household size and income If you make less than about $11,490 a year as a single person or about $23,550 for a family of 4, you may not qualify for lower costs for private insurance based on your income.

56 ACA Training You ARE required to take the Marketplace Certification if you are working On Exchange (helping your clients apply for tax subsidies/cost sharing). You Are Not required to take the Marketplace Certification if you are working Off Exchange (clients are enrolling without tax subsidies/cost sharing). BCBSTX Training You ARE required to complete the Marketplace Matters training on the BCBS website if you are selling On or Off Exchange plans On Exchange Complete Option A Off Exchange Complete Option B Completing You ARE required to send in training forms to BCBS regardless of which option you are selling. All certification instructions can be found on our website at under Products/Individual Major Medical

57 Key Points to Remember When Quoting On The Exchange Be Prepared Make sure your clients have all information needed to go to the Marketplace Names, Birthdates, Household Income, Social Security Numbers Make sure you have your FFM & NPN numbers to enter in Healthcare.gov. Consumers Need To Create Their Own Usernames and Passwords Agents will be out of compliance if creating for their clients Make sure your client records their usernames and passwords as they will need them at a later date. Eligibility Results Make sure your clients either print or save the results letter for future use.

58 You will need to log into your account and click the link to confirm your

59 You will now log in