Explaining the Health Insurance Marketplace October 2013
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Basic information about the healthcare.gov marketplace. What is it, how is it affecting Wisconsin, and what is to come? Presented in October of 2013, there is a lot we did not know and still do not.
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Explaining the Health Insurance Marketplace October 2013
- 1. What you need to know Shawn Daughenbaugh, MHA October 23, 2013 hfmhealth.org Copyright © 2013 Holy Family Memorial. All rights reserved.
- 2. Education Goals • • • • • hfmhealth.org What is the marketplace When does it begin Who is affected How to enroll Doing What’s Right 2
- 4. In Wisconsin… land of cheese hfmhealth.org • Wisconsin is operating a Federally Facilitated Marketplace – Initial set up and operation controlled by federal government – No state involvement in operations • Marketplace is an online entity • National hotline and website at healthcare.gov 4
- 5. Participating insurers hfmhealth.org • Including HFM – Common Ground Healthcare Coop – WPS Health Plan, Inc. (Arise) – Dean Health Plan, Inc. (Preva 360) • Not including HFM – Molina Healthcare of WI, Inc – Compcare Health Services Ins. Corp. (Anthem) 5
- 7. Reimbursement hfmhealth.org Financial Impact on HFM • Reimbursement will remain at current negotiated rates for each insurer • While contracted rates will remain the same, the ability of individuals to pay deductible and copayments may be an issue • What will private insurance do? 7
- 8. Tiers of Coverage hfmhealth.org “Metal Plans” • Each metal indicates the actuarial value Source:HealthPocket 8
- 9. Tax Credit hfmhealth.org How it works • An “advanced premium” paid directly to insurer • Based on federal poverty level, the individual may get 2% to 9.5% of income back for credit • Credit is based on benchmark – That difference between 2nd lowest silver and specified percent from above 9
- 10. Mathematical example hfmhealth.org All figures are annual costs • Smith Family: Married couple with 2 children • Income: $47,100; equals 200% of FPL – This means the Smith family gets 6.3% of $47,100 back to them. Equals $2,968 per year • 2nd lowest silver plan premium $10,000/ year • Credit due to Smith Family is $7,032 – $10,000 minus $2,968 Source: Health Affairs 10
- 12. The days of infamy hfmhealth.org 12
- 14. Fantastic. How does one enroll? hfmhealth.org 14
- 15. Community Help hfmhealth.org • Community “Mobilizers” are key • Manitowoc County will have 3,000-5,000 individuals affected • HFM stepped up to Do What’s Right – Manitowoc County Community Action Enrollment Coalition 15
- 16. At HFM hfmhealth.org Where to find help • Insights is already hard at work – The point of contact for most patients with concerns – Activity • www.hfmhealth.org/EnrollAmerica – Website hosted by HFM for citizens • CAEC Toolkits at Wellness Center, Main Entrance, Clinics, ER, EVERYWHERE! 16
- 17. Enroll America: Answers for you hfmhealth.org 17
- 18. Recap hfmhealth.org • Nationally speaking uneven expansion of Medicaid leaves many holes • Health Insurance Marketplaces will insure millions of Americans –though many may remain or become uninsured 18
- 19. Recap Continued hfmhealth.org • Qualified Health Plans will be sold with different levels of coverage – several options tailored to peoples’ need but will be confusing • Open Enrollment is from October 1-March 31 • Healthcare.gov 19
- 20. Thank you. Questions? October 23, 2013 hfmhealth.org Copyright © 2013 Holy Family Memorial. All rights reserved.
Editor's Notes
- Listed are the educational goals for this presentation on the federal marketplace and Holy Family Memorial’s actions. What is the marketplace When does it begin Who is affected How to enroll Doing What’s Right
- Healthcare.gov video explaining how the marketplace will operate.
- Wisconsin is a federal marketplace. The Walker Administration choose not to run a state-based marketplace. This type of marketplace is set up and run completely by the federal government.
- Single with no family Lowest cost plan is the Common Ground Healthcare Cooperative Envision- Catastrophic 6350/100 plan for $135.99/ month. The most expensive plan is Arise Health Plan Healthy1 Engage Platinum plan. $492.92/ month Individual and Spouse Lowest cost plan is the Common Ground Healthcare Cooperative Envision- Catastrophic 6350/100 plan for 331.68/month. The most expensive plan is Arise Health Plan Healthy1 Engage Platinum plan. $1200.98/month Small business owner Lowest cost plan is the Common Ground Healthcare Cooperative Envision- Catastrophic 6350/100 plan for $176.76/month. The most expensive plan is Arise Health Plan Healthy1 Engage Platinum plan. $509.35/month
- If an insurer participates in the marketplace, they will not have a separate reimbursement for those Qualified health plans within the marketplace. If an individual has Anthem, regardless if it is private, employer sponsored, or marketplace, the discount will remain the same for providers servicing Anthem. Average current discounts: Dean (Prevea 360) 40% of service price WPS (Arise) 35% Common Ground- Triology plan 33% Molina- Unknown Anthem-36% but HFM not in network The question of financial impact lies within the ability of individuals to pay their copayments and deductibles.
- The actuarial value corresponds to a value of health care expenses that the insurer will pay. For instance, a bronze metal plan with a 60% actuarial value will pay 60% of health care costs.
- The federal marketplace began selling insurance on October 1st, 2013.