The Affordable Care Act (ACA) Health Insurance Exchanges

Transcription

1 The Affordable Care Act (ACA) Health Insurance Exchanges Dave Chandra Senior Policy Analyst Center on Budget and Policy Priorities March 11, 2013

2 Linking Americans to Coverage (2014) FPL Unsubsidized 400% 300% 300% Exchange 250% Subsidized 200% 133% 100% 185% 133% 75% 55% Basic Health 2014 Children Pregnant Women Parents Seniors & People with Disabilities Adults w/o Children Medicaid and CHIP (based on 2013 Connecticut eligibility levels) Undocumented Immigrants 1 0%

3 State Exchange Implementation

4 State Exchange Implementation Established Exchange in 2006 (1)

5 State Exchange Implementation Pursuing State Based Exchange (18)

6 State Exchange Implementation Pursuing Partnership Exchange (7)

7 State Exchange Implementation Opting for Federally Facilitated Exchange (26)

8 What is a Health Insurance Exchange? Health Plan #1 Health Plan #2 Individuals & Families Exchange Health Plan #3 Health Plan #4 Small Businesses Health Plan #5 Health Plan #6

9 What Health Plans are Offered in the Exchange? 100% Actuarial Value (AV) Enrollee co-payments ACA Precious Metal Tiers Plan Tier Actuarial Value Medical Expenses Insurance company payments % = Actuarial value Platinum 90% Gold 80% Silver 70% Bronze 60% Catastrophic n/a 0% 8

10 Private Market & Exchange Health Plan Standards Individual and Small Group Market Health Plans Medical Loss Ratio (MLR) No co-pays for preventive care Ban on pre-existing condition exclusions Ban on rescissions No lifetime or annual dollar limits Guaranteed issue and renewal Adjusted community rating Essential Health Benefits Precious metal AV tiers Health Insurance Exchange Qualified Health Plans Medical Loss Ratio (MLR) No co-pays for preventive care Ban on pre-existing condition exclusions Ban on rescissions No lifetime or annual dollar limits Guaranteed issue and renewal Adjusted community rating Essential Health Benefits Precious metal AV tiers Network Adequacy Essential Community Providers Marketing standards Accreditation requirement Offer at least Silver and Gold 9

11 Network Adequacy Time & distance standards Provider-to-patient ratios Access to out-of-network providers Frequent directory updates Consumer reporting on directory Secret shopper Continuity of care (Medicaid) Essential Community Providers 10

12 Standardized QHP design 11

13 QHP Offerings in the Exchange Health Plan #1 Health Plan #2 Health Plan #3 Health Plan #4 Platinum 1 Platinum 2 Platinum 4 Gold 1a Gold 2a Gold 3a Gold 4a Gold 1b Gold 2b Gold 3b Individuals & Families Silver 1a Silver 2a Silver 3a Silver 4a Silver 1b Silver 2b Silver 3b Silver 4b Silver 1c Silver 3c Small Businesses Bronze 1a Bronze 2a Bronze 3a Bronze 1b Bronze 2b Bronze 3b Bronze 1c Bronze 2c Bronze 3c Bronze 4a Bronze 4b

14 Fostering Competition in the Insurance Market 13

15 Premiums and Subsidies for Exchange Coverage Annual Household Income Required Premium Contribution AV of % of FPL Income Amount 1 % of income Annual premium 2 Coverage < 133% 3 < $14,856 2% < $ % $14,856 - $16,755 3% - 4% $446 - $670 94% % $16,755 - $22,340 4% - 6.3% $670 - $1,407 87% % $22,340 - $27, % % $1,407 - $2,262 73% % $27,925 - $33, % - 9.5% $2,262 - $3,183 70% % $33,510 - $39, % $3,183 - $3,714 70% % $39,095 - $44, % $3,714 - $4,245 70% > 400% > $44,680 n/a n/a n/a 1 for a household of one (i.e. an individual) 2 based on second-lowest priced SILVER health plan in the Exchange 3 residents <100% FPL that would be eligible for Medicaid are ineligible for tax credits

16 Premiums and Subsidies for Exchange Coverage 10.0% $10,000 Annual Premium Cap (Percent of Income) 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% 100% 150% 200% 250% 300% 350% 400% $9,000 $8,000 $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 Annual Premium Cap (dollars) 1 $11,490 $17,235 $22,980 $28,725 $34,470 $40,215 $45,960 4 $23,550 $35,325 $47,100 $58,875 $70,650 $82,425 $94,200 Household Income (Percent of Federal Poverty Level) 15

17 Subsidies for Exchange Coverage Example: Pat Age: Annual income: ACA premium cap: Exchange premium cost: Tax credit: 45 year old female $28,000 (250% FPL) ~$13.46/hour 8.05% = $2,313 ($192.75/month) $5,733 ($477.75/month) $5,733 - $2,313 = $3,420 Plan Tier Actuarial Value Platinum 90% Gold 80% higher premiums Silver 70% Bronze 60% Catastrophic n/a lower premiums Source: Adapted from Henry J. Kaiser Family Foundation s Focus on Health Reform, July 2012,

18 Linking Americans to Coverage (2014) FPL Unsubsidized 400% 300% 300% Exchange 250% Subsidized 200% 133% 100% 185% 133% 75% 55% % Children Pregnant Women Parents People with Disabilities Adults w/o Children Undocumented Immigrants Medicaid and CHIP (based on 2013 Connecticut eligibility levels) 17