Health Insurance Marketplace Survey of the 2019 Virginia

Health Insurance Marketplace Survey of the 2019 Virginia QHP Options Deepak Madala Enroll Virginia Program Manager Virginia Poverty Law Center October 28, 2018 www. enrollva. org | 1 -888 -392 -5132

Virginia Health Insurance Marketplace www. enrollva. org | 1 -888 -392 -5132

Virginia Health Insurance Marketplace Number of Issuers in Each County in Virginia 120 100 80 60 40 2017 1 Issuer 2018 2 Issuers 2019 3 or more Issuers www. enrollva. org | 1 -888 -392 -5132

Premiums and Projected Membership Avg Rate Change Avg 2019 Per from 2018 to 2019 Member Per Month Rates 2019 Projected Covered Lives Care. First Blue. Choice 14. 5% $809. 21 5, 135 Cigna 11. 0% $584. 00 73, 597 Care. First PPO 45. 1% $1389. 34 3. 101 Anthem Health. Keepers 2. 5% $730. 73 94, 000 Kaiser Permanente 33. 8% $641. 44 54, 232 Optima -7. 2% $761. 06 59, 973 11. 94% $858. 80 17, 786 N/A $575. 92 3, 506 Piedmont Virginia Premier Source: Virginia Bureau of Insurance, 2019 ACA Rate Filing Data available at https: //www. scc. virginia. gov/boi/co/acafilinginfo/files/acaratefile. pdf www. enrollva. org | 1 -888 -392 -5132

2019 Rate Increase Drivers No Mandate in 2019 Increase in Medical Costs Short-Term and Association Health Plans Non-Payment of Cost-Sharing Reduction Reimbursement • Decrease in Outreach and Enrollment Funding • • www. enrollva. org | 1 -888 -392 -5132

Cost Sharing Reductions (CSRs) • Special protections for those with income under 250% FPL • Limits on Out-Of-Pocket Costs: Deductibles, Co-Pays, and Co-insurance • Only applies if Silver Plan is purchased – Increases Actuarial Value of Silver Plan to: • 94% AV (income 100%-150% FPL) • 87% AV (income 150%-200% FPL) • 73% AV (income 200%-250% FPL) www. enrollva. org | 1 -888 -392 -5132

Cost Sharing Reductions (CSRs) • Insurers are required to provide CSRs whether they get reimbursed by the government or not • Insurers have compensated for loss of CSR reimbursement by raising premiums for 2018 • People affected the most are those who don’t qualify for premium tax credits www. enrollva. org | 1 -888 -392 -5132

How Much Will Coverage Cost? • Premium Cost is based on sliding-fee scale for people with income below 400% FPL: Income Percent of income required to pay toward premiums Up to 133% of poverty 2. 01% 133 -150% of poverty 3. 02 -4. 03% 150 -200% of poverty 4. 03 -6. 34% 200 -250% of poverty 6. 34 -8. 10% 250 -300% of poverty 8. 10 -9. 56% 300 -400% of poverty 9. 56% • Premium Tax Credit picks up difference between required contribution and premium for second lowest cost silver plan. www. enrollva. org | 1 -888 -392 -5132

Premium Tax Credit Example Heather is 32 -year old single female Annual Income of $18, 090/year (150% FPL) Maximum Contribution 4% Income = $724/yr Cost of 2 nd lowest Silver Plan $4, 000 ($333. 33/mo. ) Subtract Contribution - $724 ($ 60. 33/mo. ) Annual Federal Tax Credit $3, 276 ($273. 00/mo. ) Heather can pay as little as $60. 33 per month Tax Credit of $3, 276 can go straight to Health Plan www. enrollva. org | 1 -888 -392 -5132

Premium Tax Credits Increase if Rates Increase Annual Income of $18, 090/year (150% FPL) Maximum Contribution 4% Income = $724/yr Cost of 2 nd Lowest Cost Silver Plan Maximum Contribution for Heather Annual Federal Tax Credit $4, 000 ($333. 33/mo. ) $724 ($60. 33/mo. ) $3, 276 ($273. 00/mo. ) $6, 000 ($500. 00/mo. ) $724 ($60. 33/mo. ) $5, 276 ($439. 67/mo. ) www. enrollva. org | 1 -888 -392 -5132

Silver Plan Options for People w/o APTCs • If an insurer sells the same plan ON and OFF the Marketplace then both will have same cost and as a result both will include the cost of CSRs – But OFF exchange plan doesn’t qualify for APTC • Some Issuers in Virginia have created slightly different OFF exchange only plans that do not have the cost of CSRs added – Cigna, Anthem, Piedmont, and Virginia Premier do not have OFF exchange plans – Care. First, Kaiser Permanente, and Optima all have OFF exchange silver plans that are different from their ON exchange plans. These silver plans do not include the cost of CSRs www. enrollva. org | 1 -888 -392 -5132

Anthem Health. Keepers Premiums for an Adult Individual Age 40 in Roanoke, VA Metal Level Plan Marketing Name Plan Type Premium Bronze Anthem Health. Keepers Bronze X 6500 HMO $439. 87 Bronze Anthem Health. Keepers Bronze X 5250 HMO $448. 77 Bronze Anthem Health. Keepers Bronze X 5900 HMO $460. 74 Bronze Anthem Health. Keepers Bronze X 4900 for HSA HMO $465. 43 Bronze Anthem Health. Keepers Bronze X 5700 Online Plus HMO $467. 26 Gold Anthem Health. Keepers Gold X 1350 HMO $569. 87 Silver Anthem Health. Keepers Silver X 6100 HMO $570. 09 Silver Anthem Health. Keepers Silver X 1800 HMO $623. 31 www. enrollva. org | 1 -888 -392 -5132

Care. First Premiums for an Adult Individual Age 40 in Alexandria, VA Metal Level Plan Marketing Name Plan Type Premium Gold Healthy. Blue HMO Gold $1, 750 HMO $750. 51 Silver Blue. Choice HMO Silver $3, 000 HMO $801. 57 Gold Healthy. Blue PPO Gold $1, 750 PPO $1, 166. 85 Silver Blue. Preferred Silver $3, 000 PPO $1, 210. 27 www. enrollva. org | 1 -888 -392 -5132

Cigna Premiums for an Adult Individual Age 40 in Sterling, VA Metal Level Plan Marketing Name Plan Type Premium Bronze Cigna Connect 7000 EPO $403. 82 Bronze Cigna Connect 6750 EPO $416. 52 Silver Cigna Connect 6500 EPO $507. 85 Gold Cigna Connect 1500 EPO $520. 17 Silver Cigna Connect 4500 EPO $521. 91 www. enrollva. org | 1 -888 -392 -5132

Kaiser Permanente Premiums for an Adult Individual Age 40 in Fredericksburg, VA Metal Level Plan Marketing Name Plan Type Premium Bronze KP VA Bronze 5500/50/Dental HMO $517. 40 Gold KP VA Gold 1500/20/Dental HMO $611. 16 Gold KP VA Gold 1000/20/Dental HMO $626. 07 Silver KP VA Silver 6000/35/Dental HMO $638. 47 Gold KP VA Gold 0/20/Dental HMO $643. 97 Silver KP VA Silver 3200/20%/HSA/Dental HMO $674. 87 Silver KP VA Silver 2500/30/Dental HMO $718. 42 Platinum KP VA Platinum 0/5/Dental HMO $744. 33 www. enrollva. org | 1 -888 -392 -5132

Silver Premiums Higher than Most Gold Plans Premiums for an Adult Individual Age 40 in Fredericksburg, VA KP VA Standard Silver 6000/35/Dental KP VA Gold 1500/20/Dental Monthly Premium $638. 47 $611. 16 Deductible $6, 000 $1, 500 Out-of-Pocket Maximum $7, 900 $6, 850 Primary Doctor $35 $20 Specialist $55 $40 Tier 2 Brand Drugs $60 $30 www. enrollva. org | 1 -888 -392 -5132

Optima Premiums for an Adult Individual Age 40 in Norfolk, VA Metal Level Plan Marketing Name Plan Type Premium Bronze Optima. Fit Bronze 7200 20% Direct M HMO $443. 48 Bronze Optima. Fit Bronze 6000 20% HSA Direct M HMO $478. 79 Silver Optima. Fit Silver 6600 30% Direct M HMO $601. 63 Gold Optima. Fit Gold 1600 10% Direct M HMO $610. 31 Silver Optima. Fit Silver 1800 25% Direct M HMO $663. 65 www. enrollva. org | 1 -888 -392 -5132

Piedmont Premiums for an Adult Individual Age 40 in Lynchburg, VA Metal Level Plan Marketing Name Plan Type Premium Bronze Standard 6800 POS $468. 66 Bronze 7800 POS $471. 94 Bronze HSA 5500 POS $504. 79 Gold 1600/35/60 POS $606. 84 Silver 6600/20% POS $640. 75 Silver 4500/40/25% POS $651. 80 www. enrollva. org | 1 -888 -392 -5132

Virginia Premier Premiums for an Adult Individual Age 40 in Richmond, VA Metal Level Plan Marketing Name Plan Type Premium Bronze Preferred Bronze 6600 HMO $379. 00 Gold Preferred Gold 1600 HMO $499. 02 Silver Preferred Silver 6500 HMO $503. 95 Silver Preferred Silver 4500 HMO $518. 61 www. enrollva. org | 1 -888 -392 -5132

Premium Rates Will Vary • • Age Geographic Region (12 regions in Virginia) Metal Tier Tobacco • Actual rates and plan details are available on www. healthcare. gov www. enrollva. org | 1 -888 -392 -5132

Maximum Out-of-Pocket in 2019 • Puts a cap on what the enrollee pays in cost-sharing charges each year – Only applies to in-network services – Out-of-Pocket limit is not the amount that an enrollee must spend each year – All people, regardless of whether they are in a family or individual health plan, will not have to pay more than the individual max for cost-sharing 2017 2018 2019 Individual Maximum $7, 150 $7, 350 $7, 900 Family Maximum $14, 300 $14, 700 $15, 800 21 www. enrollva. org | 1 -888 -392 -5132

Tobacco Surcharge in Virginia • Tobacco use is defined as – Using tobacco products an average of four times per week within no longer than the past six months – Religious or ceremonial uses of tobacco is excluded • APTC does not apply to the tobacco surcharge – Tobacco users will need to pay for this additional cost. • Tobacco cessation services are included as an EHB with no cost sharing in all qualified health plans available on the marketplace www. enrollva. org | 1 -888 -392 -5132

Tobacco Surcharge in Virginia Insurance Company Tobacco Surcharge Anthem Health. Keepers Blue Cross Blue Shield 0 -30% Care. First Blue. Cross Blue. Shield 0% Cigna 25% Kaiser Permanente 20% Optima Health 20% Piedmont 0 -50% Virginia Premier 15% www. enrollva. org | 1 -888 -392 -5132

Anthem Tobacco Surcharge Age Tobacco Factors 0 -17 0% 18 -24 5% 25 -29 10% 30 -39 15% 40 -49 20% 50 -59 25% 60+ 30% www. enrollva. org | 1 -888 -392 -5132

Piedmont Tobacco Surcharge Age Tobacco Factors 0 -18 0% 19 -24 5% 25 -29 10% 30 -34 15% 35 -39 20% 40 -44 25% 45 -49 30% 50 -54 40% 55+ 50% www. enrollva. org | 1 -888 -392 -5132

Plan Selection Checklist • Always consider all costs • Any services not subject to the deductible? • Check provider networks: many providers are now out-of-network • Check the prescription drug formulary and cost sharing requirements for the various drug tiers • Remind consumers to take advantage of no-cost sharing preventive services • Are there any exclusions or limitations on covered services? www. enrollva. org | 1 -888 -392 -5132

QUESTIONS? Thank you! www. enrollva. org | 1 -888 -392 -5132