Understanding the Health Insurance Marketplace. Melanie Hall Executive Director The Family Healthcare Foundation

Transcription

1 Understanding the Health Insurance Marketplace Melanie Hall Executive Director The Family Healthcare Foundation

2 Topics ACA 101 Challenges of Implementation Successes Lessons Learned What is on the horizon for OE4?

3 Established in 1997 as The Kids Healthcare Foundation Provided Florida KidCare application and enrollment assistance through out Tampa Bay Chosen as the lead agency in Tampa Bay for the USF statewide grant Partner with UW Suncoast, BayCare, Hispanic Service Council, Healthy Start Coalitions, REACH UP Inc.,

4 Affordable Care Act Signed into law March Patient Protection and Affordable Care Act (PPACA) 2. Health Care and Education Reconciliation Act Created the Health Insurance Marketplace

5 Affordable Care Act continued Young adults can stay on parents plans until age 26 Provides some free preventive care No longer allows for denial based on pre-existing conditions No lifetime limits Provides financial assistance to eligible individuals and families Establishment of the Health Insurance Marketplaces

6 Health Insurance Marketplace or Exchange Offers Qualified Health Plans (QHP) that provide basic consumer protections Provides information on plan premiums, deductibles, and out-of-pocket costs Provides premium tax credits and cost-sharing reductions to eligible individuals Allows for the comparison of costs and coverage between health insurance plans before purchase

7 Essential Health Benefits Essential Ambulatory patient Health services Benefits Prescription drugs Emergency services Rehabilitative and habilitative services and devices Hospitalization Mental health and substance use disorder services, including behavioral health treatment Laboratory Services Preventive and wellness services and chronic disease management Maternity and newborn care Pediatric services Chart provided by the Center for Medicare & Medicaid Services (CMS)

8 Individual Mandate Individuals must have health insurance coverage beginning January 1, 2014 Coverage can be through an employer, individual plan, or other designated programs.

9 Individual Mandate Exceptions Individuals at or below 100% of the Federal Poverty Level (FPL) of $11,770 in 2015 Individuals who cannot afford coverage Undocumented immigrants Members of health care sharing ministries

10 Special Enrollment Periods (SEPs) Lose minimum essential coverage Birth, adoption, placement for adoption Move to a new QHP service area Change of income Change in eligibility for cost sharing reductions Gain lawful immigration status or citizenship Native American/Alaskan native Enrollment error by the marketplace or its agent/enrollment misconduct by another QHP violated its contract Denied Medicaid or SHOP after enrollment closed Plan no longer offered Marriage Divorce Losing exemption from individual mandate Other exceptional circumstances (such as a medical emergency or natural disaster) prevented enrollment check with your marketplace about what exceptional circumstances are recognized! FamiliesUSA.org

11 Insurance in FL Opportunities and Challenges

12 Challenges of OE1 Website functionality Multiple legislative challenges/looming Supreme Court decision Florida opted out of expanding Medicaid Constant changes to the program

13 Challenges Post OE1 Low hanging fruit signed up OE1 Automatic re-enrollment (both a success and a challenge) Constant changes to the plans - especially the narrowing networks and changes in providers Florida opted out of expanding Medicaid

14 Successes More than 12.7 million Americans enrolled or reenrolled in the Market Place in OE3 4 million new consumers enrolled in OE3 3.5 million young adults, aged are signed up in the MP, and that does not include the 5 million that stayed on their parents insurance Almost 1.8 million Floridians are enrolled in the MP (FL has led the country in enrollment for the last two years) Clearly, MP coverage is a product people want and need

15 Successes In 2015, the uninsured rate fell to 9.1%, making it the first year in our nation s history that the uninsured rate was below 10% Among children, the uninsured rate decreased to 5.5% In Florida, the uninsured rate has dropped by more than 25%

16 Successes Affordability 9 out of 10 Floridians received financial assistance, most for less than $75/month Overall healthcare costs have risen at the lowest rates in five decades Quality Under the ACA, hospital readmission rates have dropped by an estimated 565K between , reducing patient risk and saving significant dollars

17 Lessons Learned Reach people where they live, work, play, pray and eat Focus on explaining that financial help is available there is still a knowledge gap on how tax credits and cost sharing reductions work Work with community partners to reach special populations: African Americans, Latinos and young adults are enrolling at a faster rate than their counter parts, but there is still over-representation

18 Coveringtampabay.org

19 Lessons Learned Sustained enrollment requires year round efforts eduate consumers on how to use their new coverage

20 What is on the Horizon for OE4? New search functions that allow consumers to tease plans by providers, hospitals and/or medications Testing a rating system (one to five stars) in some markets, not Florida Networks will be ranked as narrow, adequate or expanded Standardized plans will have the same benefits package, formularies, deductibles, co-pays

21 Questions? Melanie Hall Executive Director The Family Healthcare Foundation Familyhealthcarefdn.org