Delawares Health Insurance Marketplace Update on Activity Delaware

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

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 2

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 preexisting 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. 3

Stories from the Ground • A 44 -year-old woman from Clayton – whom the guide met through Westside’s partnership with $tand By 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 40 s, who haven’t had insurance for 7 years, will pay $207 a month after their tax subsidy and are excited to finally have coverage. 4

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. 5

Enrollment Update

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 7

Marketplace and Medicaid Enrollment Update Enrollment for the 5 -Month Period: October 1, 2013 through February 28, 2014* Total Number of Enrollees Increase from previous month Medicaid 2, 168 55% Marketplace* 6, 994 38% Total 9, 162 42% *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 8 Insurance Company. )

Marketplace Enrollment

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 threequarters (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). 10

Marketplace Enrollment Update: Comparison by Age Enrollees % Enrolled 0 -17 691 10% 18 – 25 456 7% 26 – 34 997 14% 35 – 44 1, 068 15% 45 – 54 1, 519 22% 55 – 64 2, 244 32% 65+ 19 <1% Total 6, 994 100% Age Groups 11

Marketplace Enrollment Update: Comparison by County Enrollees % Enrolled Kent 851 12% New Castle 4, 282 61% Sussex 1, 860 27% Total 6, 993* 100% County *Data received from the issuer only included county identification for 6, 993 enrollees. 12

Marketplace Enrollment Update: Comparison by Gender Enrollees % Enrolled Male 3, 101 44% Female 3, 893 56% Total 6, 994 100% Gender 13

Marketplace Enrollment Update: Metal Level Comparisons by Age Delaware Marketplace Enrollment 0 -17 18 -25 26 -34 35 -44 45 -54 55 -64 65+ Bronze 87 56 121 147 199 363 7 Silver 294 228 522 587 895 1, 256 11 Gold 218 93 202 216 314 491 0 Platinum 86 47 99 118 111 134 1 Catastrophic 6 32 53 n/a n/a Total 691 456 997 1, 068 1, 519 2, 244 19 14

Marketplace Enrollment Update: Metal Level Comparisons by Gender and County Delaware Marketplace Enrollment New Castle Kent Sussex Bronze 617 120 243 Silver 2, 302 464 1, 027 Gold 888 204 441 Platinum 414 50 132 Male Female Bronze 458 522 Silver 1, 611 2, 182 Gold 703 831 Platinum 281 315 Catastrophic 48 43 Catastrophic 61 13 17 Total 3, 101 3, 893 Total 4, 282 851 1, 860 15

Marketplace Enrollment Update: The “Young Invincibles” Age Group % Uninsured 1 % of Total Enrollment 0 -17 18. 56% 10% 18 -25 19. 07% 7% 26 -34 20. 75% 14% 35 -44 17. 89% 15% 45 -54 13. 32% 22% 55 -64 10. 41% 32% • 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 Silver QHP *Note: Insurance company enrollment information does not indicate if enrollees were previously uninsured 1 Derived from a 2 year average of 2012 and 2013 Current Population Survey 16 (CPS) data.

Trend of Marketplace Enrollments QHP Enrollees 8000 6994 7000 6000 5062 5000 4000 [VALUE] 3000 2000 793 1000 136 0 12 -Nov 12 -Dec 9 -Jan 17 31 -Jan 28 -Feb

Medicaid Newly Eligible Enrollment

Medicaid (Newly Eligible) Enrollment Update: Comparison by Age Enrollees % Enrolled 19 – 25 397 18% 26 – 34 527 24% 35 – 44 478 22% 45 – 54 425 20% 55 – 64 341 16% Total 2, 168 100% Age Groups 19

Medicaid (Newly Eligible) Enrollment Update: Comparison by County Enrollees % Enrolled Kent 485 22. 4% Sussex 658 30. 3% New Castle 1, 025 47. 3% Total 2, 168 100% County 20

Medicaid (Newly Eligible) Enrollment Update: Comparison by Gender Enrollees % Enrolled Male 669 31% Female 1, 499 69% Total 2, 168 100% Gender 21

Consumer Assistance Update

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 23

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 Choose. Health. DE. com 24

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-coverageoutside-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. 25

Media and Outreach Update

2014 Traffic to Choose. Health. DE. 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 27

Referring Sites to Choose. Health. DE. com Source delaware. gov dhss. delaware. gov dmap. state. de. us delawareinsurance. gov westsidehealth. org delawareonline. com de. gov beebehealthcare. org stfrancishealthcare. org johncarney. house. gov christianacare. org webmd. com financialhelpforhealth. org hjmc. org healthinsurance. org laredhealthcenter. org Visits 980 639 590 307 105 100 78 71 34 32 31 28 27 25 23 21 28

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

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

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 31

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 15 th National 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

Media Campaign • New testimonial campaign has launched. Items currently running include: • Commercials on TV, Hulu • Interactive ads on Pandora and You. Tube • 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 Choose. Health. DE. com website. 33

Video Testimonial—Jenna, Newark

Video Testimonial—Ray, Newark

Video Testimonial—Juana, Laurel

Important Reminders

Key Dates Date Milestone 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 -February 15, 2015 Open enrollment for coverage in Plan Year 2015 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 15 th of the month for coverage to be effective the 1 st of the following month. 38

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 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 person. In 2016 and later years it’s the higher of 2. 5% of income or $695 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. 39

Penalty Tax Year 2014 Tax Year 2015 Tax Year 2016 Beyond TY 2016 Income-based penalty 1% of household income above the filing threshold 2. 5% of household income above the filing threshold Minimum penalty amount $95/person $325/per person $695/person $695 + inflation adjustment/per person 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 40

Plan Management Update

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/Domestic. Forei gn. Insurers. Bulletin 69. pdf 42

Plan Management: Looking Ahead The Marketplace Program team will work with the HCC to review current statespecific QHP Standards and Essential Health Benefits (EHBs), and develop recommendations for changes for implementation in Coverage Year 2016 Proposed Schedule of Activities Step Activity Proposed Timeline 1 Review current QHP Standards and EHB benchmark to identify opportunities for modification/additions. April - July 2014 2 Submit list of recommended changes to EHB and QHP Standards to HCC for review and comment July –August 2014 3 Conduct Public Comment Period on proposed changes to QHP Standards and EHB Benchmark August - September 2014 4 Review stakeholder feedback on proposed changes and develop final recommendations for HCC review September - October 2014 5 Review Final Recommendations with HCC 6 Solicit HCC decision (approval/denial) on recommended changes November 6, 2014 7 Publish Delaware EHB benchmark and QHP Standards for Coverage Year 2016 December 1, 2014 October 2, 2014 43