Health Insurance Exchanges

Exclusive to Healthcare. Dedicated to People. SM
Copyright 2013, INTEGRATED Healthcare Strategies. All rights reserved.
Health Insurance Exchanges
Presented By:
Chuck Gooder, Senior Advisor
Blake Sternard, Business Analyst
December 17, 2013

Agenda:
I. Introduction
II. Background
III. Access
IV. Exchange Analysis
I. MNsure
II. Federal Exchange
V. Conclusion
1

INTRODUCTION
2

Introduction
The marquee elements of the Affordable Care Act (a.k.a. Obamacare) are about to
take full effect, which will significantly change health insurance in 2014
INTEGRATED developed this presentation with the intent of identifying the major
changes to health care, with specific attention to the potential challenges posed to
enrollees, physicians, hospitals, and healthcare organizations associated with the
implementation of Obamacare
Main Concerns:
1. Enrollees:
– Limited understanding of out-of-pocket expenses
– Relationship between premiums and deductibles
– Inability to pay for their share of an insurance plan when they are provided with health care services
2. Physicians, Hospitals, and Healthcare Organizations:
– No formal initiatives that address the changes to health insurance
– Patients portion of the costs are considered after-the-fact
– Shrinking margins
3

BACKGROUND
4

Background
5

Background
There are 4 main ways that nearly every American will experience health care once
the health reform law takes effect on January 1, which mandates that everyone must
purchase health insurance or pay a tax
• Public (i.e., Medicare/Medicaid) coverage increases by 12%
• 7% of the population will remain uncovered due to enforcement/regulation issues and resistance
(i.e., illegal immigrants or those who are willing to pay an additional tax when they receive health
care services)
6
Source: http://www.ebri.org/pdf/briefspdf/EBRI_IB_09-13.No390.Sources1.pdf
(1) Details may not add to totals because individuals may receive coverage from more than one source
Source: http://www.youtube.com/watch?v=3-Ilc5xK2_E
55%
21%
7%
17%
2013 Health Insurance Coverage(1)
Employer
Medicare/Medicaid
Individually Purchased
No Insurance
50%
33%
10%
7%
2014 Health Insurance Coverage
Employer
Medicare/Medicaid
Individually Purchased
No Insurance

Background
The new platform for health insurance plans, called the Health Insurance Marketplace
(or “Exchange”) opened on October 1, 2013
• Each state is required to have its own Marketplace, designed to make it easier for individuals and
businesses to compare and purchase qualified health insurance plans online
• The insurance options offered through an exchange include large group, small group, and individual
markets
• Money-saving federal subsidies, such as Cost-Sharing Reductions and Advanced Premium Tax
Credits, can also be found in the Marketplace
State vs. Federal Exchanges
• States can decide which insurers can participate in an exchange and whether to require benefits
beyond those set under federal law
– States can also accept all insurers whose policies meet the law’s requirement or limit participation by requiring
that insurers meet specific quality or pricing guidelines
7

Background
The costs that comprise health care plans are as follows:
• Guaranteed Costs:
– An associated premium amount (the cost of insurance itself)
• Out-of-pocket costs (in the event you need health care services):
– Deductibles: The amount you’re required to pay out-of-pocket for the year
– Copays: A fixed amount you pay for a type of medical service or prescription
– Coinsurance: Your share of the costs of a covered service, usually calculated as a percent
– For 2014, out-of-pocket costs are capped at $6,350 for individuals and $12,700 for a family plan in any
Marketplace
Regardless of where you live, all plans in the Marketplace (and associated costs) are
determined by the following four factors:
1. Single vs. family plans
2. Location
3. Age
4. Tobacco use
8

Background
Coverage levels can vary depending on how you and the plan can expect to share
your health care costs
• The amount of coverage exclusive of the insurance company or specific plan is categorized into five
tiers, shown below:
9
Coverage Levels for the Average Individual
Catastrophic(1) Less than 60% of the expected health care costs
Bronze 60% of the expected health care costs
Silver 70% of the expected health care costs
Gold 80% of the expected health care costs
Platinum 90% of the expected health care costs
(1) Only available to those under the age of 30 who cannot find coverage for less than 8% of their income.

Background
Inverse relationship between premiums and deductibles
• The higher your deductible, the less likely you are to submit an insurance claim and the less likely
your insurer would have to pay on a claim
– Thus, insurers usually lower premiums incrementally as a deductible is raised and vice versa
• Premiums, on average, increase with metal tier (i.e., Bronze, Silver, Gold, and Platinum)
– Subsequently, deductibles, on average, decrease with metal tier
10
Deductible
Premium
Premium
Deductible

Background
The Affordable Care Act sets minimum standards that insurers must meet, and
mandates that all health plans offered to individual and small group markets include a
set of “Essential Health Benefits”:
States have the authority to specify details surrounding each Essential Health Benefit
category, although they must choose a benchmark plan that will serve as a more
detailed definition of benefits within each of the required categories
• Included in the Appendix of this presentation are the Essential Health Benefits benchmark plan for
each state
11
Essential Health Benefits
1. Ambulatory/Outpatient Services 6. Prescription Drugs
2. Emergency Services
7. Rehabilitative and “Habilitative” (therapies to help
overcome long-term disabilities) Services
3. Hospitalization 8. Laboratory Services
4. Maternity and Newborn Care
9. Preventative and Wellness Care and Management
of Chronic Diseases
5. Mental Health and Substance Use Disorder
Services
10. Pediatric Care

Background
Major changes:
• On average, existing plans provide 76% of the now-required Essential Health Benefits
• A recent study found that less than 2% of existing individual health plans provide all ten Essential
Health Benefit categories now required under Obamacare
– http://www.healthpocket.com/healthcare-research/infostat/few-existing-health-plans-meet-new-aca-
essential-health-benefit-standards/
• Dental and Vision Care for children represents the least likely category to be provided in the base
benefits for an existing plan
• Two thirds of plans currently do not offer beneficiaries prenatal, delivery, and postnatal coverage
The table on the following slide illustrates the current national coverage for each
Essential Health Benefit
• For the individual market
• If a benefit was optional and provided at an additional charge, it was not included
12
(1) Mental Health Services and Substance Use Disorder Services were separated discretely for the purposes of the study.

Background
13
% of Existing Plans with Essential Health Benefit
1. Ambulatory/Outpatient Services 99% 6. Prescription Drugs 82%
2. Emergency Services 100%
7. Rehabilitative and “Habilitative” (therapies to
help overcome long-term disabilities) Services
85%
3. Hospitalization 100% 8. Laboratory Services 99%
4. Maternity and Newborn Care 34%
9. Preventative and Wellness Care and
Management of Chronic Diseases
100%
5. Mental Health and Substance Use Disorder
Services 1)
61%/
54%
10. Pediatric Care 24%
(1) Mental Health Services and Substance Use Disorder Services were separated discretely for the purposes of the study.
Source: http://www.healthpocket.com/healthcare-research/infostat/few-existing-health-plans-meet-new-aca-essential-health-benefit-standards/

Background
Subsidies
• A subsidy (cost assistance) lowers the amount you spend on your monthly premium or reduces your
out-of-pocket costs for expenses such as deductibles, copays, coinsurance
• As of October, middle-income people under age 65, who are not eligible for coverage through their
employer, Medicaid, or Medicare, can apply for federal tax credit subsidies
Requirements for subsidies vary depending on an individuals position relative to the
federal poverty level (“FPL”), which is currently at $11,490 for individuals and $23,550
for a family of four
• Those making less than 400% ($45,960 for individuals and $94,200 for a family of four ) of the
FPL may be eligible to receive subsidies for reduced premiums via tax credits
• Those making less than 200% ($22,980 for individuals and $47,100 for a family of four) of the
FPL may be eligible for help with out-of-pocket costs
14

Background
Additionally, states have the option to expand their Medicaid programs to cover all
people making up to 133% ($15,281 for an individual and $31,321 for a family of four)
of the FPL
• Medicaid eligibility is currently categorical (i.e., low income is not the only requirement to enroll in
the program), and varies from state to state
Examples of Minnesota’s current Medicaid program includes assistance for pregnant
women, families and children, 19-20 year olds, and children with disabilities.
• Full list can be found here:
– http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMetho
d=LatestReleased&dDocName=dhs16_144033
• How much income you can have and qualify for coverage in Minnesota depends on the following:
– Household size
– Age
– Pregnancy or disability status
– The healthcare program you qualify for
15

Background
United States Census Bureau Data(1):
Subsidy calculator:
• Kaiser Family Foundation calculator provides a rough estimate of costs for insurance based on a
plan in the Silver metal tier
• http://kff.org/interactive/subsidy-calculator/
16
(1) Reflective of calendar year 2012
Total
Population,
85%
Children Under 18,
35%
People 18-64
Years, 57%
People 65 and
Older,8%
People in
Poverty,
15%
United States Poverty Distribution
United States Population (in millions)
Total Population 313.9
People in Poverty 46.5
Children Under 18 16.1
People 18-64 Years 26.5
People 65 and Older 3.9
Source: http://www.census.gov/hhes/www/poverty/data/historical/people.html

ACCESS
17

Access
Online access
• https://www.healthcare.gov/
Types of exchanges
1. Federally-Run
2. State-Run
3. State-Federal Partnership
4. Small Business Health Options Program (SHOP) Marketplace(1)
The graph on the following slide illustrates the different exchanges by state
• Due to constraints in implementing an IT system, some states wanting to run their own exchange
defaulted to a Federal or Partnership exchange (i.e., North and South Dakota)
18
(1) Open to employers with 50 or fewer FTE employees. Only operated in MS, NM, and UT.

Access
19
Source: http://obamacarefacts.com/state-health-insurance-exchange.php

Access
Facts and figures (as of December 11, 2013):
• 365,000 people have signed up for private health insurance through federal and state exchanges,
which will take effect on January 1
– Nationally, this represents 0.12% of the population
– This represents 18% of total submitted applications
• 1.9 million people have submitted an application, but the application is currently being processed
• 803,077 have been determined eligible for the expanded state Medicaid programs
Sign-up rates have varied widely from state to state
• Minnesotans have submitted 32,209 completed applications under MNsure as of November 30
The graph on the following slide illustrates the Obamacare signups as a share of
population by state
• State-based exchanges are highlighted in red
• Federal-based and Partnership exchanges are highlighted in blue
20
(1) Source: http://www.forbes.com/sites/brucejapsen/2013/12/11/healthcare-gov-gains-some-momentum-with-365000-signed-up-nearly-2-million-eligible/

Access
21
Source: http://www.businessinsider.com/obamacare-sign-ups-by-state-2013-12

Access
Notables:
• Nine of the states with the highest enrollment by share of population run their own exchanges
• Vermont has, by far, the highest rate of sign ups as a share of population
• California accounts for about 30% of total Obamacare sign ups due to its large population
• In order to reach the Obama Administration’s goal of 7 million sign ups by March 31, the total
participants as a percentage of the U.S. population must raise by 2.2% (currently at .12%)
Problems:
• The infrastructure of the federally-run exchange website has been plagued with technical problems,
which has deterred potential applicants
• Oregon, which runs its own exchange, has enrolled virtually none of its population
– Website performance issues has led to the use of a paper application process, according to the Washington
Times
Tables have been included in the Appendix that illustrate total marketplace
applications, eligibility determinations, and marketplace plan section by marketplace
type and by state
22

HEALTH INSURANCE MARKETPLACE ANALYSIS
23

MNsure
To illustrate the relationship between insurance plans in Minnesota and the
corresponding premiums, deductibles, copayments, and coinsurance, INTEGRATED
referenced published regional market data from Minnesota’s state-run insurance
exchange, MNsure
• www.mnsure.org/
Health insurance companies on MNsure:
Collectively, there are:
• 141 plans available to Minnesota consumers and small businesses
24
Individual Market Small Group Market
1. BlueCross/BlueShield 1. BlueCross/BlueShield
2. Health Partners 2. Medica
3. Medica 3. PreferredOne
4. PreferredOne
5. Ucare

MNsure
Compared to the rates released for other state exchanges, MNsure’s premium rates,
on average, are the lowest in the country:
• Minnesota has had a history of strong rate reviews
– Department of Health and Human Services requires plans to justify rate increases
– Link to an effective rate review system:
• http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/rate_review_fact_sheet.html
– Medical Loss Ratio within guidelines
• Insurers are required to spend at least 80% of premium dollars on direct medical care or to improve the
quality of care instead of on overhead, advertising, and executive salaries and bonuses
A graphical comparison of MNsure’s premiums to other states has been provided on
the following slide
Our complete findings can be found here:
• P:Physician ServicesResourcesEducational MaterialsMN Sure Premiums and Deductibles.xlsx
25

MNsure
26
Source: http://mn.gov/commerce/insurance/images/Rate-Review-Packet-9-6-13.pdf

Federal Exchange
The Affordable Care Act, based on average premiums, makes health insurance more
expensive
• In the average state, Obamacare will increase underlying premiums by 41% for those who shop for
coverage on their own
• The steepest hikes will be imposed on the healthy, the young, and the males
27
Source: http://b-i.forbesimg.com/theapothecary/files/2013/11/Rate-chart-3-27-yo.png

Federal Exchange
28
Source: http://b-i.forbesimg.com/theapothecary/files/2013/11/Rate-map-3-27-40-67.png

Federal Exchange
Overlap of insurance plans
• The metal tiered (i.e., Bronze, Silver, Gold, and Platinum) plans in the Marketplace are often
meaningless when it comes to price
• In almost two thirds of 2,511 counties surveyed by USA TODAY, the highest monthly premium
quoted for a bronze plan tops the lowest one for a silver plan
– Consumers should not automatically assume bronze plans are cheaper than higher level ones
– Consumers that do so rule our plans that may have both more affordable premiums and lower cost-sharing
(i.e., higher percentage of covered costs)
29
Source: http://www.healthpocket.com/individual-health-insurance/bronze-health-plans
Coverage Levels for the Average Individual
Catastrophic(1) Less than 60% of expected health care costs
Bronze 60% of expected health care costs
Silver 70% of the expected health care costs
Gold 80% of the expected health care costs
Platinum 90% of the expected health care costs
Low
Premiums,
High
Deductibles
High
Premiums,
Low
Deductibles

Federal Exchange
The cost of going uninsured
• The 7% of Americans who remain uninsured after Obamacare kicks in will face a tax penalty of 1%
of their annual income or $95, whichever is greater
– For families, a per-child fine of $47.50, up to a family cap of $285, will also be imposed
• By 2016, the penalty, which is added to the individual’s federal income tax, increases to the greater
of 2.5% of income of $695 per individual
Excused from penalty
• Incarcerated individuals
• Undocumented immigrants
• Members of American Indian tribes
• Congregates of religious groups opposed to health insurance
• Those with incomes so low that they are not required to file a federal income tax return (i.e.,
$10,000 for individuals and $20,000 for families)
• Those who would have to pay more than 8% of their annual income for health insurance
30
Source: http://www.foxbusiness.com/personal-finance/2013/10/08/how-will-obamacare-uninsured-penalty-work/

PRESCRIPTION DRUG COVERAGE
31

Prescription Drug Coverage
Prescription drug use
• Roughly 70% of the population uses prescription drugs during a typical year
• Now required as an Essential Health Benefit
A recent study examined publicly available rate filings for 2014 Obamacare Bronze
Plans, Silver Plans, Gold Plans, and Platinum Plans to determine what consumers will
pay for prescription drugs
The following tables include information regarding the out-of-pocket expenses for
various categories of covered drugs: generics, preferred brand name drugs,
nonpreferred brand name drugs, and expensive specialty drugs
32
Source: http://www.healthpocket.com/affordable-care-act/essential-health-benefits

33
Generic Drugs
Preferred Brand
Name Drugs
Non-Preferred
Brand Name
Drugs
Specialty Drugs
Bronze $20.24 $58.47 $125.00 $166.67
Silver $13.44 $41.33 $70.43 $83.33
Gold $10.48 $35.26 $60.43 $66.67
Platinum $8.00 $28.00 $42.50 *
Average Flat Fee Copayments for Covered Drugs
Source: http://www.healthpocket.com/healthcare-research/infostat/obamacare-expands-drug-coverage-but-out-of-pocket-expenses-go-up/

34
Generic Drugs
Preferred Brand
Name Drugs
Non-Preferred
Brand Name
Drugs
Specialty Drugs
Bronze 26% 37% 43% 40%
Silver 25% 29% 39% 38%
Gold 18% 28% 41% 32%
Platinum 2% 2% 14% 16%
Average Coinsurance (Where Enrollee Pays a % of Retail Costs) for Covered Drugs

35
Cost-Sharing Comparison Among Current Health Plans
Average Current Bronze % Change Silver % Change
Generic Copay $11.72 $20.24 73% Increase $13.44 15% Increase
Generic Coinsurance 28% 26% 7% Decrease 25% 11% Decrease
Preferred Copay $36.37 $58.47 61% Increase $41.33 14% Increase
Preferred Coinsurance 32% 37% 16% Increase 29% 9% Decrease
Specialty Copay $58.46 $166.67 185% Increase $83.33 43% Increase
Specialty Coinsurance 35% 40% 14% Increase 38% 9% Increase

Conclusions:
• In almost all cases, out-of-pocket costs for prescription drugs go down as the health plan metal
category goes up
• Many plans apply the deductible against drug costs so that the full price of drugs must be paid by
the enrollee until the deductible is satisfied
When compared to the current individual and family health insurance market, both
entry-level Bronze Plan and the higher tier Silver Plan will increase most out-of-
pocket drug costs for consumers
36

Specialty drug analysis
• Coverage of specialty drugs presents a growing concern in the health insurance marketplace
• In 2012, specialty drugs were estimated to represent 28.7% of commercially insured drug
expenditures and are projected to represent 50% of those expenditures by 2018
• Coinsurance is the most common method of cost sharing used for specialty drugs among
Obamacare plans
The following table shows coinsurance rates for Copaxone, a medication used to
treat multiple sclerosis (MS), which has been ranked among the top 10 drugs in the
U.S. as measured by dollar sales.
37

Cost-Sharing for Copaxone among Obamacare Plans
An enrollee in the Bronze plan would have spent the $6,350 annual limit on out-of-
pocket costs by the fourth month of coverage while someone in a Platinum plan
would not hit that limit until the ninth month of coverage
38
Copaxone Est.
Monthly Retail Cost
Coinsurance Rate
Monthly Out-of-
Pocket Expense
Bronze $4,951 40% $1,980
Silver $4,951 38% $1,881
Gold $4,951 32% $1,584
Platinum $4,951 16% $792

CONCLUSION
39

Conclusion
The Federal Government offers a “Summary of Benefits and Coverage” (SBC) for
each plan in the Marketplace that lets enrollees make apples-to-apples comparisons
of costs and coverage between health plans
Understanding the SBC is omnipotent to both consumers and providers
• Special attention should be paid to price overlaps
• A template SBC has been provided
INTEGRATED expects to see an influx of patients with low-premium, high-deductible
insurance plans (i.e., bronze or silver tiered) in the individual market beginning in
2014
• These consumers may not fully understand their share of health care costs
• Collecting out-of-pocket expenses from patients may prove to be difficult
– Potential to shrink margins
40

Conclusion
So, what should providers be doing?
• Implement a system of addressing a patients’ plan prior to providing services
• For patients with plans purchased in the individual market, collect a portion of the patients
responsibility of the costs up front
– Especially regarding plans with high deductibles (i.e. bronze and silver tiered plans)
– Differentiate between the fees for the hospital AND different physician specialties
– Hospital-based specialties should work with the hospital in advance (i.e., Pathology, Radiology,
Anesthesiology, etc.)
Sample Initiative:
• Develop a pre-surgery education model for patients that addresses the services provided and the
specific costs they will be accountable for
• Collect 20% up front of total costs
– Some of our clients, including affiliates of the Mayo Clinic, Hospital Sisters Health System, and a National
Ambulatory Hospital Network have recently taken steps to implement a collection system prior to providing
services
– Consistent with Medicare payment
41

Conclusion
Going Forward:
• How will the new insurance plans purchased in the individual markets affect the profitability of
hospitals and healthcare organizations?
– How will providers collect their accounts receivable?
• Will providers limit care?
– Especially for providers with a high number of entitled patients (Medicare/Medicaid)
– Catholic hospitals and healthcare organizations may experience a dilemma that conflicts with charitable
missions
• Expect credit lines to increase
• Margins may shrink
– Ability to cover overhead expenses and the physicians
• Enrollees-Will they be deterred from seeking health care due to their high deductibles?
• Will there be any improvement to the exchange access platforms?
Bottom Line:
• Hospitals will lose money if they don’t develop and implement new systems that address the
changes to healthcare associated with Obamacare
42

APPENDIX
43

Appendix
44
Alabama – "Blue Cross Blue Shield of Alabama - 320 Plan"
Alaska – "Premera Blue Cross Blue Shield of Alaska - Heritage Select Envoy"
Arizona – "State of Arizona Self-Insured Plan, administered by United Healthcare - Arizona Benefit Options EPO Plan"
Arkansas – "HMO Partners, Inc. - Open Access POS, 13262AR001"
California – "Kaiser Foundation Health Plan, Inc. - Kaiser Foundation Health Plan Small Group HMO 30 ID 40513CA035"
Colorado – "Kaiser Foundation Health Plan of Colorado - Ded HMO 1200D"
Connecticut - "Connecticare, Inc. - Connecticare HMO"
Delaware – "Blue Cross Blue Shield of Delaware - Simply Blue EPO 100 500"
D.C. – "Group Hospitalization and Medical Services, Inc. - BluePreferred PPO Option 1"
Florida – "Blue Cross and Blue Shield of Florida - BlueOptions 5462"
Georgia – "BCBS Healthcare Plan of Georgia, Inc. - HMO Urgent Care 60 Copay"
Hawaii – "Hawaii Medical Service Association - HMSA Preferred Provider Plan 2010"
Idaho – "Blue Cross of Idaho Health Service Inc. - Preferred Blue"
Illinois – "Blue Cross Blue Shield of Illinois - BlueCross BlueShield of Illinois BlueAdvantage"
Indiana – "Anthem Ins Companies Inc (Anthem BCBS) - Blue 5 Blue Access PPO Medical Option 6 Rx Option G"
Iowa – "Wellmark Inc. - Copyament Plus"
Kansas – "Blue Cross and Blue Shield of Kansas - Comprehensive Major Medical Blue Choice GF 500 Deductible with Blue Rx card"
Kentucky - "Anthem Health Plans of KY (Anthem BCBS) - Anthem PPO"
Louisiana – "Blue Cross and Blue Shield of Louisiana - GroupCare PPO"
Maine - "Anthem Health Plans of ME (Anthem BCBS) - Blue Choice 20 with Rx 10 30 50 50"
Maryland – "CareFirst BlueChoice, Inc. - Blue Choice HMO HSA Open Access"
Massachusetts – "Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. - HMO Blue 2000 Deductible"
Michigan – "Priority Health - 100 Percent Hospital Services Plan"
Minnesota – "HealthPartners, Inc. - 500 25 Open Access"
Mississippi – "Blue Cross & Blue Shield of Mississippi - Network Blue"
Essential Health Benefits Benchmark:

Appendix
45
Missouri – "Healthy Alliance Life Co (Anthem BCBS) - Blue 5 Blue"
Montana – "Blue Cross and Blue Shield of Montana - Blue Dimensions"
Nebraska – "Blue Cross and Blue Shield of Nebraska - Blue Pride"
Nevada – "Health Plan of Nevada, Inc. - Health Plan of Nevada Point Of Service Group 1 C XV 500 HCR"
New Hampshire - "Matthew Thornton Health Plan (Anthem BCBS) -Matthew Thornton Blue Health Plan"
New Jersey – "Horizon HMO - Horizon HMO Access HSA Compatible"• New Mexico – "Lovelace Insurance Company - Lovelace Classic PPO"
New York – "Horizon HMO - Horizon HMO Access HSA Compatible"
North Carolina – "Blue Cross and Blue Shield of NC - Blue Options"
North Dakota – "Sanford Health Plan - Sanford Health Plan HMO"
Ohio – "Community Insurance Company (Anthem BCBS) - Blue 6 Blue Access PPO Medical Option D4 Rx Option G"
Oklahoma – "Blue Cross Blue Shield of Oklahoma - RYB05"
Oregon – "PacificSource Health Plans - Preferred CoDeduct Value 3000 35 70"
Pennsylvania – "Aetna Health Inc. - PA POS Cost Sharing 34 1500 Ded"
Rhode Island – "Blue Cross & Blue Shield of Rhode Island - Vantage Blue BCBSRI"
South Carolina – "BlueCross BlueShield of South Carolina - Business Blue Complete"
South Dakota – "Wellmark of South Dakota - Blue Select"
Tennessee – "BlueCross BlueShield of Tennessee - BCBST PPO"
Texas – "Blue Cross Blue Shield of Texas - RS26"
Utah – "Public Employee’s Health Program - Utah Basic Plus"
Vermont – "The Vermont Health Plan, LLC - BlueCare, The Vermont Health Plan, LLC, CDHP"
Virginia – "Anthem Health Plans of VA (Anthem BCBS) - KeyCare 30 with KC30 Rx Plan 10 30 50 OR 20"
Washington – "Regence BlueShield - Regence Blue Shield nongrandfathered small group product"
West Virginia – "Highmark Blue Cross Blue Shield West Virginia - Super Blue Plus 2000 1000 Ded"
Wisconsin – "UnitedHealthcare Insurance Company - Choice Plus Definity HSA Plan A92NS"
Wyoming – "Blue Cross Blue Shield of Wyoming - Blue Choice Business 1000 80 20"
Essential Health Benefits Benchmark:

Appendix
46

Appendix
47

Appendix
48

Appendix
49
Source:
http://www.businessinside
r.com/obamacare-sign-
ups-by-state-2013-12

Appendix
50
Source:
http://www.businessinside
r.com/obamacare-sign-
ups-by-state-2013-12

Appendix
51
Medicare:

Appendix
http://mn.gov/commerce/insurance/images/Rate-Review-Packet-9-6-13.pdf
http://www.mnsure.org/images/2013-05-28-MNsureFundingAnnouncement.pdf
http://minnesota.publicradio.org/display/web/2013/09/06/health/online-health-insurance-marketplace-mnsure
http://www.forbes.com/sites/investopedia/2013/10/01/how-to-choose-between-bronze-silver-gold-and-platinum-health-insurance-
plans/
http://www.medicoverage.com/health-insurance-blog/news/comparing-exchange-plans-bronze-silver-gold-platinum
http://www.ncsl.org/research/health/american-health-benefit-exchanges.aspx
http://www.healthpocket.com/healthcare-research/infostat/obamacare-expands-drug-coverage-but-out-of-pocket-expenses-go-
up/
http://www.hullfinancialplanning.com/bronze-may-be-the-most-precious-metal-under-obamacare/
http://mn.gov/health-reform/images/WG-Access-HMO-B-Summary.pdf
http://www.bluecrossmn.com/internet_core/en_US/ccurl/976/36/2014_Blue_Essentials_overview.pdf
http://www.ucare.org/SiteCollectionDocuments/HealthPlans/UFS/2014/U1750UFSMNGuide2014.pdf
http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-11-12.html
https://www.healthcare.gov/glossary/essential-health-benefits/
http://www.dol.gov/ebsa/pdf/SBCtemplate.pdf
http://kff.org/interactive/subsidy-calculator/
https://www.healthcare.gov/find-premium-
estimates/#results/&aud=indv&type=med&state=WI&county=Milwaukee&cov=self&age=49andUnder
52

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