Delaware’s Health Insurance Marketplace:Update on Activity

Delaware Health Care Commission, January 9, 2014

Secretary Rita Landgraf, Department of Health and Social Services

Agenda

•Updates since last Health Care Commission meeting

•Enrollment activity

•Marketplace Guide update

•Marketing and website update

•Stories from the ground

•Key dates

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Pharmacy “Bridge” Coverage

•Several national pharmacies have announced plans to provide short-term supplies of prescriptions to those newly-enrolled in a Marketplace plan who have not yet received an ID number from their insurance company

•Customers must provide the pharmacy with proof of their enrollment

•Customers may receive up to a 30-day supply of their medications to cover any gap in coverage

•Participating pharmacies include Walgreens, Rite-Aid, CVS and Walmart

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90-Day Grace Period for Non-Payment of Premium

• The ACA provides a 90-day grace period during which insurers cannot terminate coverage for premium tax credit recipients who fail to pay their share of the premium.

• Those enrollees who do NOT receive a premium tax credit will be allowed a 30-day grace period for premium non-payment.

• Impact to Insurers, Providers and Enrollees:

• Insurers must cover claims incurred in the first month of nonpayment, but for the second and third months may “pend” payments. 

• If the enrollee pays the premium during the grace period, the insurer must reinstate the enrollee and cover any claims.

• If the enrollee does not pay, the issuer can deny payment of claims and must refund advance tax credits received for the second and third months. 

Important—If the enrollee does not pay the premiums by the end of the 90-day grace period, the enrollee will be left responsible for paying providers and repaying the tax credit received for the first month, as well as the first month’s premium.

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Delawareans with coverage due to ACA

As of January 3, 2014, 4,241 Delawareans have gained access to health care coverage

through expanded Medicaid and the Marketplace since October 1

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Marketplace Enrollment Update

• Number of individuals who selected plans through the Marketplace as of January 3, 2014: 3,183

• Number of paid enrollments as of January 3, 2014: 1,145

• Enrollment update from the Federal Government is expected in mid-January

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Medicaid Update

• Number of individuals assessed eligible for Medicaid/CHIP by the Marketplace by the U.S. Dept. of HHS = 5,732

• Electronic account transfer between the State and FFM has been delayed.  Delaware is among the first group of states selected for testing account transfer functionality with the Marketplace.  Delaware has successfully implemented account transfer to the Federal government and successfully received account transfers from the Federal government in a test environment. 

• For those individuals assessed eligible for Medicaid by the Federal Government, DHSS is conducting further outreach and completing eligibility determinations. 

• As of January 3, 2014, 1,058 adults were enrolled in the Medicaid program under the ACA expansion.

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Trend of Marketplace Enrollments

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9-Jan

Newly Covered Delawareans by County

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Newly Covered Delawareans by Age

10Note that rounding may account for deviations from 100%

Choosing the best enrollment “door”

•We are still encouraging the use of the most direct “door” for most efficient enrollment experience:

• ASSIST – Delaware’s portal for those Medicaid eligible https://assist.dhss.delaware.gov/

• Healthcare.gov – Federal portal for those who may qualify for a subsidy

• Directly through insurers – for those who do not expect a subsidy; links are available on ChooseHealthDE.com

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Choosing the most efficient “door”

ASSIST (<138% FPL or

<212% for children and

pregnant women)

Medicaid eligible

ASSIST (<138% FPL or

<212% for children and

pregnant women)

Medicaid eligible

Healthcare.gov

(139-399% FPL)

Eligible for Federal

Subsidies

Healthcare.gov

(139-399% FPL)

Eligible for Federal

Subsidies

Insurers (>400% FPL)

Not-eligible for

subsidies

Insurers (>400% FPL)

Not-eligible for

subsidies

The most efficient “door” for Delawareans:

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Marketplace Guide Activities to Date

As of January 7, 2014:

• 81 fully-certified Marketplace Guides

• 216 completed enrollments

• 486 completed applications

• 1020 outreach activities conducted

Between October 1 and December 31, 2013, Marketplace Guides have referred 298 consumers to Medicaid

Enrollment Support

•Guides continue to focus the bulk of their efforts on meeting one-on-one with consumers to facilitate Marketplace applications and enrollments

•Guide organizations have and will continue to offer larger scale enrollment events to connect with the maximum number of consumers possible

•Please check www.ChooseHealthDE.com for the most up-to-date information about Marketplace Guide activities, including enrollment events

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Advanced Resolution Center

•The Federal government continues to refer consumers with difficult cases to advanced resolution centers housed at CMS regional offices

•Consumers that call the Federal Contact Center at 1-800-318-2596 may have their case referred for active casework

•These consumers will receive follow-up communication from the appropriate party, which may include the designated caseworker, insurance company, call center representative or other entity

•DHSS has also been working with the Delaware Congressional Delegation to resolve some consumer issues

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Plan Enrollment Verification

• Consumers who enrolled in a plan through the Marketplace and paid their first month’s premium prior to January 1st should have received a welcome packet or other communication from their chosen insurance company.

• For those who have not received this information, we urge the following steps:

• Contact the insurance company directly to verify that enrollment information has been properly received. Consumers are encouraged to have the following information ready when verifying enrollment:• Name of plan enrollee, Marketplace Account ID, full Plan Name,

names of anyone included on the Plan, date the enrollee completed transaction through the Marketplace

• If the insurance company is unable to confirm the enrollment, consumers are urged to contact the Federal Contact Center immediately to determine if there are any issues regarding their selection/enrollment transaction.

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Get help from the QHP Insurance Companies

The table below provides links to each of the Delaware QHP Insurance Company Customer Service Centers

Insurance Company Customer Service Weblink Customer Service Phone

Coventry Health and Life Insurance Company

http://www.coventryone.com/ 855-449-2889

Coventry Health Care of Delaware

http://www.coventryone.com/ 855-449-2889

Highmark Blue Cross Blue Shield of Delaware

http://www.highmarkbcbsde.com/ 888-601-2242TTY: 888-232-5460

Delta Dental Insurance Company http://www.deltadentalins.com/ 800-932-0783 

Dentegra Insurance Company https://www.dentegra.com/ 877-280-4204

Dominion Dental Services, Inc. https://www.dominionmembers.com/https://www.dominiongroups.com

888-518-5388

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Marketing Updates

•ChooseHealthDE.com redesign

• Clear and easy navigation to address most common consumer issues

• Highlights availability of Marketplace Guides and other enrollment assistance

•Beginning the second phase of the marketing and media campaign.

• Young Invincibles (18-29 year olds) will be a major focus of marketing and outreach efforts in 2014

• Conducted 2 focus groups with this age group in December, one in Georgetown, one in Wilmington

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ChooseHealthDE.com (English version):•As of Jan. 6, 2014, there have been 134,959 visits•Visitors are staying an average of 2 minutes, 33 seconds

ChooseHealthDE.com (Spanish version):•As of Jan. 6, 2014, there have been 8,526 visits. •Visitors are staying an average of 2 minutes, 48 seconds.

HEALTHCARE.GOV

Traffic from ChooseHealthDE.com to HealthCare.gov:As of Jan. 6, 2014, ChooseHealthDE.com has directed 27,117 visits to HealthCare.gov. 21

Stories from the Ground

• A 26-year-old Newark woman, who isn’t offered insurance through her job, chose a catastrophic plan. She is excited that her PCP is in-network and that her co-pay for visits will be only $20. Her monthly premium is $134.

• A 62-year-old Felton woman and her husband, who are self-employed and have individual insurance, met with a marketplace guide to look for “something more affordable.” She and her husband received a tax credit and are relieved to have new affordable insurance.

• A 44-year-old New Castle man, who has been trying to enroll since Oct. 1, was able to enroll on Dec. 24.

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Stories from the Ground

• A family from Dover was assisted at a Westside Family Healthcare enrollment event by a Spanish-speaking guide. The child is enrolled in CHIP, and the husband and wife -- who received a $545 tax credit -- will pay $38 a month for a Marketplace plan.

• A Rehoboth Beach man was incorrectly flagged as being potentially eligible for Medicaid. He has an upcoming appointment with a Marketplace Guide to resolve his application.

• A Bear man in his 50s, who received a $242 tax credit, will pay $334 a month.  He told a Guide he is relieved to have insurance.

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Stories from the Ground

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• A Delaware woman, who thought she had enrolled for medical and dental coverage Oct. 20 but whose enrollment became stuck, enrolled Dec. 20 with the help of Rep. John Carney’s office and a troubleshooting team from HHS.

• A 26-year-old Wilmington woman, who works part-time at a hospital and is a UD nursing student, received a tax subsidy and will pay $100 a month. “I feel like the ACA was built for people like me,” she said.

• One of Westside’s Guides enrolled herself and her 19-month-old daughter, who qualified for CHIP, in 15-20 minutes. The Guide, who will receive a $93 tax credit; will pay $138 a month.

Key Dates

Date Milestone

January 14, 2014 First premium payment due for coverage that began January 1st for those consumers who selected Coventry Health & Life or Coventry Healthcare of DE plans

January 15, 2014 First premium payment due for coverage that began January 1st for those consumers who selected Highmark BCBS plans

January 31, 2014 Last day of coverage for those in the Pre-Existing Condition Insurance Plan (PCIP).

March 15, 2014 Last day to enroll for coverage to begin on April 1; those who enroll between March 16-31 will have coverage beginning May 1.

March 31, 2014 Last day of open enrollment for coverage in Plan Year 2014. In order to buy a Marketplace health insurance plan outside the open enrollment period, you must have a qualifying life event.

November 15, 2014-January 15, 2015

Open enrollment begins for coverage in Plan Year 2015