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WV Office of the Insurance Commissioner, Health Policy Division.

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Presentation on theme: "WV Office of the Insurance Commissioner, Health Policy Division."— Presentation transcript:

1 WV Office of the Insurance Commissioner, Health Policy Division

2 Enrollment in the Marketplace The first open enrollment was October 1, 2013 through April 15, 2014 The first coverage started January 1, 2014 Enrollment dates for the 2015 plan year November 15, 2014 – February 15, 2014 with coverage starting January 1, 2015 ALL MEDICAL PLANS WILL FOLLOW THE FEDERAL OPEN ENROLLMENT, ON AND OFF MARKETPLACE

3 2014 Marketplace Enrollment WV Marketplace19,856 WV Stand Alone Dental 3,700 Medicaid Expansion 150,000+ (10/2014) CMS numbers are representative of 10/1/ /31/2014

4 West Virginia vs The Nation Numbers taken from CMS Report. National numbers represent all FFM states; State Exchanges not included.

5 In Person Assisters MAXIMUS, our IPA Management Contractor, oversees all DHHR based IPAs and IPA Entities There are 28 DHHR based IPAs with 7 Supervisors In addition to visiting and assisting the IPAs, the supervisors also hold office hours and can be flexible to provide additional coverage as needed

6 In Person Assister Entities 5 IPA Entities Partners In Health Network SHIP/BOSS (Bureau of Senior Services) Valley Health WV Community Care WV Primary Care Association

7 Navigators Navigator Grants are awarded directly from CMS In West Virginia, we have three Navigator Organizations: Clay-Battelle Health Services Association Advanced Patient Advocacy Healthy Start WVU

8 Certified Application Counselors (CAC) Every state is required to have a Certified Application Counselor program Interested organizations can submit a CAC application to CMS for approval CMS designates which organizations are certified as a CAC An agreement is signed between CMS and the organization outlining the duties each organization will be required to fulfill Each person in the organization helping consumers with the marketplace must complete training through CMS to become certified

9 Insurance Agents The only licensed assisters Can look at life situations and suggest plans Experienced with health insurance Available to insureds year round Can compare plans on and off the Marketplace to give consumers a complete look at their choices

10 Assisters Overview Assisters will be expected to: Distribute fair, accurate, and impartial information about enrollment in Qualified Health Plans (QHP) and other health programs such as Medicaid and CHIP Maintain expertise in eligibility, enrollment, and program specifications and conduct public education activities. Facilitate selection of a QHP Refer Consumers to other programs (Medicaid and CHIP) Must be certified through the CMS web-based training Cannot accept compensation from issuers for enrollment in QHP’s or non-QHP’s

11 Individual Mandate

12 Federal Poverty Guidelines 2014

13 Advanced Premium Tax CreditsCost Sharing Reductions Federal Subsidies for Individuals

14 Cost Sharing CSR Silver Plan for Enrollees with Incomes up to 150% FPL CSR Silver Plan for Enrollees with Incomes from 151% FPL to 200% FPL CSR Silver Plan for Enrollees with Incomes up from 201% FPL to 250% FPL Standard Silver Plan Portion of medical expenses typically paid by the health plan (Actuarial Value) 94%87%73%70% Portion of medical expenses paid for by typical enrollee 6%13%27%30% Limit on Annual Out-of- Pocket Costs $2,250 individual / $4,500 family $5,200 individual/ $10,400 family $6,300 individual/ $2,700 family

15 Advance Premium Tax Credits APTC must be reconciled each year If you receive APTC, you must file federal taxes for the tax year the APTC is received All income changes must be reported to the Federal Call Center immediately ( ) If your APTC is too high during the year, you will be required to pay back the difference

16 Supreme Court Case King v. Burwell The statutory language in the ACA links tax credits to health plans purchased through an Exchange established by the State. The IRS is extending tax credits to qualified people that purchase on the State or Federal Marketplace. Oral Arguments begin March 4. It is expected that the Court will release its opinion in June 2015.

17 Health Plans on the FFE Every plan covers the same set of Essential Health Benefits Plans come in 4 metal levels B RONZE 60% S ILVER 70% G OLD 80% P LATINUM 90%

18 Catastrophic Coverage Catastrophic Coverage is a set of federally mandated benefits for those 30 years old and younger or for those with extreme financial hardships. The catastrophic plans with all carriers will be the same. $6,600 Individual Deductible $13,200 Family Deductible 3 PCP Visits without meeting the deductible Plan pays 100% after the Deductible

19 On Exchange Medical Plans The same plans will also be offered “Off Exchange”. Highmark WV – 13 Individual Plans

20 Stand Alone Dental Plans On Exchange The same plans are offered “Off Exchange”. Delta – 4 Individual Plans Dentegra – 3 Individual Plans

21 Essential Health Benefits

22 Consumer Service Division Protect you by enforcing WV laws Provide you with consumer information Help you with insurance complaints TRY-WVIC

23 Enrollment for 2016 Open enrollment dates are currently set for October 1 – December 15, 2015 All Insurance Companies offering individual or small group health insurance in 2016 will send their submissions by April 1, 2015 to the WV Offices of the Insurance Commissioner

24 For more information Ellen Potter Director, Health Policy Ext Joylynn Fix Policy and Rate Analyst, Rates and Forms Ext Pam King Research Specialist, Health Policy Ext WV Offices of the Insurance Commissioner (304) ext. 1264


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