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1 © 2013 Molina Healthcare, Inc. Molina Marketplace Presentation Molina Healthcare of New Mexico Community Outreach
2 © 2013 Molina Healthcare, Inc. Who is Molina Healthcare? Molina Healthcare was founded more than 30 years go by C. David Molina, MD and is the fastest growing and experienced managed care health companies in the country- offering medical insurance under Medicaid, Medicare and other government sponsored programs. Serving over 1.9 Million Members 11 states, and approximately 170,000 in New Mexico. Molina Healthcare is a family founded company and today is still a physician- led organization. Works Exclusively for people receiving health care coverage from government-sponsored, publicly-funded programs like Medicaid and Medicare. Serving low-income populations who have traditionally faced barriers to quality of health care. Molina Healthcare of NM- is pleased to have been selected by the Human Services Department (HSD) to serve as a Centennial Care Managed Care Organization! New Mexico’s #1 Ranked Medicaid Plan for third year in a row by Consumer Reports and NCQA
3 © 2013 Molina Healthcare, Inc. Molina Our Mission then and now - To provide quality healthcare services to financially vulnerable families and individuals 0 – 138% (Medicaid FPL) 139 – 250% (Health Insurance Marketplace ) Medicaid Expansion Centennial Care Marketplace Medicare MA-SNP Medicare MAPD Molina’s “ ONE MOLINA” We’ve Got You Covered!
4 © 2013 Molina Healthcare, Inc. Key Positioning Attributes with Consumers, Navigators & CBOs 1.Molina has over 30 years of experience Many that are in the Individual business today, do not cater to a low income population They don’t have the knowledge or support mechanisms that we can provide 2.All Plan Designs are not the same We may compete on a metal by metal basis, but understand the differences in design 3.Pricing is not always a good comparison Where we are positioned at a competitive price, our value and experience is the difference Deductibles and copay ‘s Our Plan selections - How benefits encourage access and low cost share Value Added services - 24 hour nurse line, website services, health education programs
5 © 2013 Molina Healthcare, Inc. 250%+ FPL “Key Lingo” of the Marketplace 5 Our success will be determined on how well we assess the consumer’s understanding and guiding them to the right choice – Molina! A key to selecting Molina, and ultimately their satisfaction and retention. An Opportunity for you to be recognized as a trustworthy guide
6 © 2013 Molina Healthcare, Inc. 250%+ FPL “Key Lingo” of the Marketplace 6
7 © 2013 Molina Healthcare, Inc. Eligibility for the Marketplace Who is eligible to enroll in the Marketplace? Anyone who is in the United States legally, does not have access to another form of health insurance, such as Medicare, Medicaid, an employer provided health plan is eligible to enroll for coverage through the Marketplace. Molina is offering six (6) Marketplace plans: Bronze, Silver (4 different plans) and Gold. More about each of these levels will be discussed shortly. Depending on an applicant’s individual or family (if applying for family coverage) Federal Poverty Level (FPL), there may be tax credits to help pay for the cost of the coverage. The FPL range for which premium assistance tax credits may be provided is between 100% and 250% of FPL. Applicants who do not qualify for a tax credit, will be required to pay the full amount of their individual or family premium.
8 © 2013 Molina Healthcare, Inc. Enrolling in the Marketplace How does an applicant enroll in the Marketplace? The preferred method for enrolling in the Marketplace is by accessing the federal website: New Mexico has a joint Federal/State marketplace for calendar year The State has ceded responsibility to the federal government for enrollment and eligibility functions. It is expected that New Mexico will be a fully state run Marketplace for calendar year New Mexico as a joint Federal/State marketplace for calendar year 2014, is also allowing the use of the state Marketplace website for access to the federal enrollment site. The state website for enrollment is: Due to difficulties accessing the on-line enrollment sites, two additional methods of enrollment are being considered: 1) paper enrollment and 2) enrollment through each carrier’s website. The Molina website is: us/hp/marketplace/Pages/marketplace.aspx. us/hp/marketplace/Pages/marketplace.aspx Intensive efforts are underway to fix the website enrollment problems.
9 © 2013 Molina Healthcare, Inc. APTC & Cost Sharing Advanced Premium Tax Credit (APTC) Must meet certain income requirements Cannot have “deemed” coverage from an employer Cannot currently be on Medicaid or other government programs Available to all medal level plans Tax credits can be immediately applied to the monthly premium you pay Cost-sharing Subsidies: Reduce out-of-pocket health care expenses Co-payments and deductibles Only Available If You Buy A Silver Plan On The Marketplace Think about it: If you qualify as a low-income individual (annual income between $14,000 and $23,000), the Silver Plan will be the best product because the federal government will reduce your monthly premium through tax credits and your cost sharing expenses when you see the doctor through the cost-sharing subsidies. 9 If your individual income is between $11,490 – $45,960, you may qualify for financial assistance The lower your income, the greater the tax credit you will get, and the less you will have to pay out of your own pocket in monthly premiums
10 © 2013 Molina Healthcare, Inc. Unique Services Acupuncture -- Limited to 20 visits per calendar year. Bariatric Surgery – A member must complete the medical group-approved pre-surgical educational preparatory program regarding lifestyle changes. Chiropractic – Limited to 20 visits per calendar year. Health Education – These materials cover such topic as nutrition, stress management, child safety, asthma, and diabetes. Non-emergency Transportation – Members can access transportation to medical services. Limited to 4 round trip trips a month and requires arrangements in advance. Smoking Cessation – This program offers smoking cessation services to all smokers interested in quitting. Specialized services are available for teens, pregnant smokers and tobacco chewers. Weight Control Programs – These programs are offered for member s 17 and older. They will learn about healthy eating and exercise. Participates must agree to program criteria.
11 © 2013 Molina Healthcare, Inc. Benefits At-A-Glance
12 © 2013 Molina Healthcare, Inc. Rate Chart
13 © 2013 Molina Healthcare, Inc. APTC: Example of an Individual John is 24 years old non smoker and has an annual income of $22,980, which equals 200 percent of the poverty line. His expected contribution is 6.3 percent of his income, or $1,448 a year. The benchmark plan available to John is priced at $5,000; John would be eligible for a credit amount of $3,552 ($5,000 minus $1,448).
14 © 2013 Molina Healthcare, Inc. APTC: Example of a Family of Four Peter, Mary and their two children have an annual income of $52,988, which translates to 225 percent of the federal poverty line. At this income level, the family’s expected contribution is 7.18 percent of their income, or $3,805 a year. In the area where Peter and Mary live, the total premiums for the benchmark plan that would cover all members of the family is $15,000. The credit amount that the family would be eligible for is $11,195, which is $933 a month. ($15,000 minus their expected premium contribution of $3,802). An advance payment of $933 a month will be paid directly to the insurer offering the health plan that the family selects; the family would be responsible for paying the remaining premium to the insurer.
15 © 2013 Molina Healthcare, Inc. New Mexico Marketplace Competitors Who is participating in the Marketplace? There are five (5) carriers participating in the New Mexico Marketplace: Health Care Service Corporation (BC/BS) Lovelace Health Systems MOLINA Healthcare of New Mexico New Mexico Health Connections Presbyterian Health Plan For premium rating, New Mexico has been divided into five (5) regions (next to each region is Molina’s premium ranking status): Region 1 (Albuquerque) - 2 Region 2 (Farmington) - 1 Region 3 (Las Cruces) - 5 Region 4 (Santa Fe) - 3 Region 5 (Rural/All Other) - 3
16 © 2013 Molina Healthcare, Inc. MMG: Community Perspective Committed to providing Access, Quality & Affordability MMGS remove barriers for our members Clinics located in areas where our members Shop, Eat, Play & Pray Give back to the community through free transportation Great reputation within the community Committed to providing Access, Quality & Affordability MMGS remove barriers for our members Clinics located in areas where our members Shop, Eat, Play & Pray Give back to the community through free transportation Great reputation within the community
17 © 2013 Molina Healthcare, Inc. Questions
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