Outreach and Communications Advisory Group October 31, 2012

Transcription

1 Outreach and Communications Advisory Group October 31,

2 Agenda Updates Discussion of research about metal tiers Small group breakouts Discussion of next steps Schedule of future meetings

3 Updates Update from October 10 meeting Staffing (Outreach and SHOP Coordinator positions) Marketing RFI Navigator program hiring Board meeting

4 Goal of Discussion Brainstorm ways to help consumers understand cost sharing tiers Create effective phrases to describe costsharing tiers for consumers Obtain feedback about how to label costsharing tiers 4

5 What are cost sharing/metal tiers? A way to organize and present health plan choices to consumers A broad measure of cost sharing breakdown in health plans A broad measure of the portion of medical costs that the carrier pays vs. what a consumer may pay (actuarial value) A new federal requirement for Qualified Health Plans offered in small group and individual market (not currently in use) Four levels 5

6 Metal Tier Levels Platinum: 90% paid by carrier and 10% paid by consumer (averaged over a large population) Gold: 80% paid by carrier and 20% paid by consumer Silver: 70% / 30% Bronze: 60% / 40% 6

7 Metal Tier Example If a population uses $100 million in medical services and the carrier pays for $80 million of those costs, the plan would have an actuarial value of 80% and that would be considered a gold plan (calculation is not made on individual basis; will be standardized for carriers based on a large historical claims database) 7

8 Why are we talking about metal tiers? We are currently designing our shopping portal and need to meet implementation deadlines Effective customer service is important We need to help consumers understand health plan choices 8

9 Important messages for consumers Cost sharing tiers are one way to understand health plan choices Cost sharing tiers do not measure quality of health care or network of providers Your total cost over the year can differ significantly from plan to plan even in the same cost sharing tier How often you need medical care, medication and related services and how much financial risk you are willing to take during the next year are factors to consider when looking at plans 9

10 Overall costs across metal tiers The Commonwealth Fund, Choosing the Best Plan in a Health Insurance Exchange 10

11 Challenges with metal tier labels Consumers may think that platinum and gold plans are higher quality than silver and bronze plans Consumers may think that bronze plans, with the cheapest premiums, will be the lowest cost to them over time Consumers may not understand cost sharing concept in general and may not understand financial risk (is less information better?) 11

12 Decision Challenges What is the best choice for a healthy person? Bronze plan will have lowest monthly premiums but would cost a consumer the most if he had a severe medical event (heart attack, accident) Ahealthy person who doesn t want to take financial risks may prefer choosing a gold plan because his costs would be better known up front What is best for a person with chronic conditions? Platinum plans may be considered best for people with frequent health care needs Depending on the health condition, a person may pay less in the long run with a bronze or silver plan than with a platinum plan; example: well controlled moderate asthma where the consumer does not need frequent medical care and uses a generic inhaler 12

13 Small Group Breakouts Discuss: How other industries use similar labels How COHBE stakeholders are approaching this communication challenge Best phrases for describing the tiers Other labeling ideas 13

14 Other Industries Financial Airlines 14

15 COHBE Stakeholders Agency partners Consumer Advocates Carriers Brokers Businesses Providers 15

16 Sample Description of Metal Tiers Bronze Silver Gold Platinum Lowest monthly premium Higher out of pocket costs when you receive certain medical services Good for those who don t expect to use a lot of medical services Higher monthly premium than bronze Lower Cost when you receive certain medical services compared to bronze Good for those who want to balance monthly premium and out of pocket expenses Higher monthly premium than silver Lower Cost when you receive certain medical services compared to silver Good for those who expect to use a fair amount of medical services Highest monthly premium Lowest cost when you receive certain medical services Good for those who expect to use a lot of medical services 16

17 Other Labeling Conventions Platinum Gold Silver Bronze Ski slopes green blue black double black Geography plains mesas mountains 14ers Boats tanker motorboat canoe kayak Colors white blue yellow red Trees oak pine aspen pinyon 17

18 Small Group Conclusions How other industries use similar labels How COHBE stakeholders are approaching this communication challenge Best phrases for describing the tiers Other labeling ideas 18

19 Next Steps Next meeting: Tentatively scheduled for November 28, 3:00 pm 19

20 THANK 20