Delaware’s Health Insurance Marketplace: Update on Activity

1. Delaware’s Health Insurance Marketplace:Update on Activity Delaware Health Care Commission, March 6, 2014 Secretary Rita Landgraf, Department of Health and Social Services

2. Agenda • Stories from the Ground • Updates since last Health Care Commission meeting • Marketplace enrollment update • Medicaid update • Consumer Assistance update • Media and Outreach update • Important Reminders • Plan Management update

3. Stories from the Ground With support from a marketplace guide, a 20-year-old man from Newark enrolled and will pay $83 a month.  A middle-aged woman from Dover is unemployed and has several pre-existing conditions.  After her subsidy, her monthly payment will be $187 a month, which she called “truly affordable insurance coverage.” A 64-year-old woman, who must take regular medication to prevent seizures, will pay $79 a month after her subsidy. She also enrolled in a dental plan for $23 a month.

4. Stories from the Ground • A 44-year-old woman from Clayton – whom the guide met through Westside’s partnership with $tandBy Me – will pay $64 a month after her tax subsidy. • A Houston couple met a guide at the Milford Library. The wife, who has a pre-existing condition and a mental health condition, hasn’t had insurance for the past 5 years. They will pay $203 a month. • A Bear couple in their 40s, who haven’t had insurance for 7 years, will pay $207 a month after their tax subsidy and are excited to finally have coverage.

5. Recent Updates On February 10, 2014, the U.S. Treasury Dept. and the IRS announced final regulations regarding the employer shared responsibility payments. Under the Affordable Care Act, companies that have fewer than 50 employees are not required to provide coverage or fill out any forms in 2015, or in any year, under the Affordable Care Act. Companies with 50-99 employees that do not yet provide affordable health insurance to their full-time workers will report on their workers and coverage in 2015, but have until 2016 before any employer responsibility payments could apply. Large employers (100 or more employees) that offer coverage to 70 percent of their workers will be counted as fulfilling the employer mandate. By 2016, those employers will need to hit the original 95 percent target.

6. Enrollment Update

7. Marketplace and Medicaid Enrollment Update As of February 28, 2014, 9,162 Delawareans have enrolled in health care coverage through expanded Medicaid and the Marketplace since October 1, 2013

8. Marketplace and Medicaid Enrollment Update *This number represents Delawareans who have selected a Marketplace plan, either through Healthcare.gov, or through direct enrollment with an issuer (with or without the first premium payment having been received directly by the Insurance Company.) Enrollment for the 5-Month Period: October 1, 2013 through February 28, 2014*

9. Marketplace Enrollment

10. Marketplace Enrollment Update Marketplace Plan Selection by Metal Level — Silver plans account for 54% of the plan selections in the Delaware Marketplace. Metal Level Distribution(rounded to the nearest whole number): • Bronze = 14% • Silver = 54% • Gold = 22% • Platinum = 9% • Catastrophic = 1% Marketplace Plans: Financial Assistance — More than three-quarters (77%) of the Delawareans who have selected a Marketplace plan will be receiving Federal financial assistance in paying their premiums. • This includes people who qualify for an advance premium tax credit (APTC), with or without a cost-sharing reduction (CSR).

11. Marketplace Enrollment Update:Comparison by Age

12. Marketplace Enrollment Update: Comparison by County *Data received from the issuer only included county identification for 6,993 enrollees.

13. Marketplace Enrollment Update: Comparison by Gender

14. Marketplace Enrollment Update: Metal Level Comparisons by Age

15. Marketplace Enrollment Update: Metal Level Comparisons by Gender and County

16. Marketplace Enrollment Update: The “Young Invincibles” • 21% of Marketplace enrollees are in the “Young Invincible” age group. The national average of enrollments for this critical age group is 25% (as of 2/1/14). • 52% of Young Invincibles enrolled through the Marketplace have chosen a SilverQHP *Note: Insurance company enrollment information does not indicate if enrollees were previously uninsured 1Derived from a 2 year average of 2012 and 2013 Current Population Survey (CPS) data.

17. Trend of Marketplace Enrollments

18. Medicaid Newly Eligible Enrollment

19. Medicaid (Newly Eligible) Enrollment Update: Comparison by Age

20. Medicaid (Newly Eligible) Enrollment Update: Comparison by County

21. Medicaid (Newly Eligible) Enrollment Update: Comparison by Gender

22. Consumer Assistance Update

23. Marketplace Guide Activities to Date • As of February 28, 2014: • 538 completed enrollments • 1,137 completed applications • 1,608 outreach activities conducted • 695 referrals to Medicaid

24. Enrollment Support • Guides are using unique outreach strategies to maximize contacts including partnering with tax preparation services and large retailers • Get Covered! Enrollment Events • More than 23 large-scale events focused on enrollments scheduled throughout February and March • Partnering with Delaware Technical Community College, Wilmington University, and public schools • Standing locations throughout the state in State Service Centers, libraries and other community locations • Full schedule of recurring locations and special events is available on ChooseHealthDE.com

25. Guide Activities after Open Enrollment Guides will continue to provide enrollment assistance after March 31 for consumers that experience a qualifying change of life event (e.g. marriage, loss of minimum essential coverage): See https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/ We are currently assessing the program’s workforce needs after open enrollment. A more detailed plan will be available at the April Health Care Commission meeting.

26. Media and Outreach Update

27. 2014 Traffic to ChooseHealthDE.com Media began running January 1-February 28, 2014 Visits: 21,396 Page views: 96,273 Pages/Visit: 4.5 Avg. Visit Duration: 2:26

28. Referring Sites to ChooseHealthDE.com

29. Clicks from ChooseHealthDE.com to Healthcare.gov ChooseHealthDE.com Healthcare.gov From Jan. 1-Feb. 28, 2014, there have been 2,993 clicks from ChooseHealthDE.com to Healthcare.gov.

30. Social Media Contests Facebook: 3,153 Likes Firefly Ticket Contest:Increased fan base by 1,111 Lady Antebellum Ticket Contest: Increased fan base by 37 Bruno Mars Ticket Contest: Will run from March 7-14

31. Enrollment Opportunities • More than 430 enrollment opportunities from today through March 31. • Events at libraries, schools, universities/colleges, hospitals, clinics, etc. • More expected to be added. • To find an enrollment event that meets your schedule and location, go to: www.ChooseHealthDE.com

32. Focus on Kent County Combined Marketplace and Medicaid enrollment in Kent County: 1,336 Percentage of total enrollment from Kent County is 14.5% Specific tactics to reach this area include: February 15thNational Youth Enrollment Day event at Dover Mall Advertising on WMDT and WBOC and multiple local radio stations Door hangers placed on over 88,000 doors in Kent/Sussex counties (households with 18-34 year olds) Facebook promotion for Delaware State Fair concert tickets

33. Media Campaign • New testimonial campaign has launched. Items currently running include: • Commercials on TV, Hulu • Interactive ads on Pandora and YouTube • English and Spanish radio ads • Ads in movie theaters across the state • New brochures and other collateral materials are printed and now available. Partners and stakeholders can order through the ChooseHealthDE.com website.

34. Video Testimonial—Jenna, Newark

35. Video Testimonial—Ray, Newark

36. Video Testimonial—Juana, Laurel

37. Important Reminders

38. Key Dates • Notes: • Medicaid enrollment can occur at anytime. • Employers may continue to enroll in SHOP on a rolling monthly basis. The deadline to enroll is always the 15th of the month for coverage to be effective the 1st of the following month.

39. Penalty If someone who can afford health insurance doesn’t have coverage in 2014, they may have to pay a fee. They also have to pay for all of their health care. • For 2014, consumers will pay whichever of these amounts is higher: • 1% of yearly household income.(Only the amount of income above the tax filing threshold, $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average yearly premium for a bronze plan. • $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285. • The fee increases every year. In 2015, it’s the higher of 2% of income or $325 per person. In 2016 and later years it’s the higher of 2.5% of income or $695 per person. • For those uninsured for just part of the year, 1/12 of the yearly penalty applies to each month without insurance. Those uninsured for less than 3 months do not have a penalty.

40. Penalty • For more information on the Individual Shared Responsibility Payment, go to: • Healthcare.gov https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014/ • IRS http://www.irs.gov/uac/Newsroom/The-Individual-Shared-Responsibility-Payment-An-Overview

41. Plan Management Update

42. Plan Management: Preparing for Plan Year 2015 November 2012, the HCC approved the state-specific standards for qualified health plans (QHPs) for Plan Years 2014 and 2015 that may be purchased through the Marketplace. Preparation for Plan Year 2015: January 2014—DOI issued formal bulletin to Issuers, inviting them to submit a Letter of Intent to apply for the Plan Year 2015 May through September 2014—DOI team reviews plans for compliance with federal and state standards and regulations (rates, benefit design, cost-sharing, network adequacy, etc.) October 2014—Federal government conducts final QHP reviews and certifies state-recommended plans November 2014—Federal government releases list of certified QHPs for Plan Year 2015 November 15, 2014—Second Open Enrollment begins The Insurance Commissioner’s bulletin to Issuers, including the approved list of the Delaware QHP Standards for Plan Year 2015 may be found at the following URL: http://www.delawareinsurance.gov/departments/documents/bulletins/DomesticForeignInsurersBulletin69.pdf

43. Plan Management: Looking Ahead The Marketplace Program team will work with the HCC to review current state-specific QHP Standards and Essential Health Benefits (EHBs), and develop recommendations for changes for implementation in Coverage Year 2016 Proposed Schedule of Activities