Center on Budget and Policy Priorities. cbpp.org
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2 QHP Certification Process Ac#ve Purchasing Market Organizer Enhanced Cer#fica#on Basic Cer#fica#on QHP Cer#fica#on Model Ac#ve Purchasing Market Organizer Enhanced Cer#fica#on Basic Cer#fica#on Cer#fica#on Standards or Characteris#cs Uses a compe**ve procurement process, limits which issuers and plans can be sold Requires standardized plan design, limits # of plans per *er per issuer Requires Bronze and/or Pla*num to be sold, has state- developed standards for meaningful difference, network adequacy and/or ECPs beyond federal minimums Applies federal minimum requirements 2
3 QHP Certification Process Ac#ve Purchasing Market Organizer Enhanced Cer#fica#on Basic Cer#fica#on California 1,3 MassachuseCs 1,2,3 Vermont 1,3 Connec#cut 1,2,3 Kentucky 2 Maryland 2 Nevada 2,3 New York 1,2 Oregon 1,2 District of Columbia 3 Minnesota 3 New Mexico Rhode Island Colorado Hawaii Idaho Washington (1) requires one or more standardized plans (2) places limits on the number of plans sold per issuer per metal tier (3) applies a meaningful difference to plans sold in the Marketplace 3
4 Standardized Plan Design Standardized Plan Policy State (Tier) # of States Standardized Plan required California* (P, G, S, B, C) Connec*cut (P, G, S, B**) MassachuseMs (2P, 3G, S, B) New York (P, G, S, B, C) Oregon (G, S, B) Vermont (P, G,2S, 2B) 6 Standardized Plan possibly in development for future plan years District of Columbia Minnesota 2 No Standardized Plan required Colorado, Hawaii, Idaho, Kentucky, Maryland, Nevada, New Mexico, Rhode Island, Washington 9 Note: P = Pla*num, G = Gold, S = Silver, B = Bronze, C = Catastrophic * The California Exchange allows insurers to only sell the standardized plan design for each metal 4 *er ** Connec*cut will be requiring 2 Bronze standardized plan designs in 2015
5 Standardized Plan Design Example (California) Source: Covered California 5
6 Standardized Plan Design (Connecticut Enrollment) Silver Plans Source: access health CT presenta*on at the Health Plan Benefits and Qualifica*ons Advisory CommiMee, Consumer Experience and Outreach Advisory CommiMee Joint Mee*ng (March 26, 2014) 6
7 Standardized Plan Design (Connecticut Enrollment) Gold Plans Source: access health CT presenta*on at the Health Plan Benefits and Qualifica*ons Advisory CommiMee, Consumer Experience and Outreach Advisory CommiMee Joint Mee*ng (March 26, 2014) 7
8 Standardized Plan Design (Connecticut Enrollment) Bronze Plans Source: access health CT presenta*on at the Health Plan Benefits and Qualifica*ons Advisory CommiMee, Consumer Experience and Outreach Advisory CommiMee Joint Mee*ng (March 26, 2014) 8
9 Meaningful Choice Par#cipa#on Requirements for Insurers 9
10 Meaningful Choice Metal Tier Requirements for Insurers CA CO CT DC HI ID KY MD MA MN NV NM NY OR RI VT WA Pla#num x x x x Gold* x x x x x x x x x x x x x x x x x Silver* x x x x x x x x x x x x x x x x x Bronze x x x x x x x x x Catastrophic x x x x * The Affordable Care Act requires QHP issuers to offer at least Gold and Silver plans 10
11 Meaningful Choice Source: Connect for Health Colorado, Silver plans for 35 year old in Denver, CO (80203)
12 Meaningful Choice Source: Connect for Health Colorado, Silver plans for 35 year old in Denver, CO (80203)
13 Meaningful Choice Source: Connect for Health Colorado, Silver plans for 35 year old in Denver, CO (80203)
14 Meaningful Choice Source: Connect for Health Colorado, Silver plans for 35 year old in Denver, CO (80203)
15 Meaningful Choice Plan Limits per Tier Plan Limit Policy State (Limit per Tier) # of States Limits number of plans each insurer can offer per #er No limit Connec*cut (3)** Kentucky(4) Maryland (4) MassachuseMs (7) Nevada (5) New York (4) Oregon (3-5) California*, Colorado, District of Columbia, Hawaii, Idaho, Minnesota, New Mexico, Rhode Island, Vermont, Washington 7 10 * California employs an ac*ve purchasing/compe**ve purchasing model which allows the Marketplace to determine the number of plans that can be sold by each carrier in each *er. ** Connec*cut will allow 4 plans per *er in
16 Tobacco Rating Tobacco Ra#ng Policy States # of States Prohibit (1:1) Narrowed Permit (1.5:1) California Connec*cut District of Columbia MassachuseMs New York Rhode Island Vermont Arkansas* (1.2:1) Colorado (1.15:1) Hawaii, Idaho, Kentucky, Maryland, Minnesota, Nevada, New Mexico, Oregon, Washington *Arkansas is a State Partnership Exchange that opted to adjust the tobacco ra*ng standard 16
17 Geographic Rating Source: Colorado Department of Regulatory Agencies, Division of Insurance (August 20, 2013) 17
18 Standards for Plans Sold Outside the Marketplace Plan Standard All Individual Market and Small Group plans must be sold solely through the Marketplace All QHP standards must be met by plans sold outside the Marketplace Catastrophic plans must be sold solely through the Marketplace Catastrophic plans can be sold outside the Marketplace only if also sold in the Marketplace QHP issuers must offer Gold and Silver plans outside the Marketplace Bronze plans can only be sold outside the Marketplace if carrier also sells Silver and Gold plans State District of Columbia* Vermont** District of Columbia Minnesota Oregon Washington California Maryland Maryland Minnesota Washington * All new plans must be sold through the Marketplace for the the Individual Market (star*ng in 2014) and Small Group Market (star*ng in 2015). ** The state will transi*on from a Marketplace to a single- payer model in
19 QHP Network Adequacy Network Adequacy Standards Time and distance Appointment wait *mes Provider to enrollee ra*os Essen*al Community Provider (ECP) Standards % of ECPs in service area Any willing provider requirement 19
20 QHP Network Adequacy QHP Network Transparency Frequency of updates Uniform online provider search tool across all carriers Standardized template for provider counts by region Hospital lis*ng by service area Labeling of network size Monitoring and Enforcement Complaints to DOI Geo mapping Outlier analysis Secret shopper 20
21 Choice Architecture Source: Connect for Health Colorado, Silver plans for 35 year old in Denver, CO (80203) 21
22 Choice Architecture Source: Health Insurance Marketplace, healthcare.gov
23 Choice Architecture Plan Filtering and Search Terms CA CO CT DC KY MD MA MN NV NY OR RI VT WA Metal *er x x x x x x x x x x x x x Premium x x x x x x x x x x x x Deduc*ble x x x x x x x x x x OOP Maximum x x x Cost- sharing x x x Provider x x x x x x x Carrier x x x x x x x x x x x x x Quality ra*ng x x x x 23 Note: Informa*on for Hawaii is not available. Idaho and New Mexico operated via Healthcare.gov for plan year 2014.
24 Customer Service Features Premium Payment Methods CA CO DC ID KY MD MA MN NV NM NY OR RI VT WA Check* x x x x x x x x x x x x x Cash x x ACH x x x x x EFT* x x x x x x x x x x x x x x Credit Card x x x x x Debit Card x x x x Money Order* x x x x x x x x x x x x x Pre- paid debit* x x x x x x x x x x * Minimum federal requirements Note: Informa*on for Connec*cut and Hawaii is not available. 24
25 Customer Service Features Adjust the APTC amount CA CO CT DC HI ID KY MD MA MN NV NM NY OR RI VT x x n/a x n/a x* x x x x x* x x x x x W A Live chat feature x x x x Apply online in Spanish Browse plans before applying x x x x* x x x* x x x x x* x x x x x* x x x Quality ra*ng displayed in 2014 n/a x n/a x n/a x x n/a x x x * Using healthcare.gov applica*on site for
26 Health Reform: Designing a Marketplace hmp:// Contact Information Dave Chandra Center on Budget and Policy Priorities 820 First St. NE Suite 510 Washington, DC chandra@ www.
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