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ConnectorCare: The New Commonwealth Care Suzanne Curry MLRI Basic Benefit Training December 10, 2014.

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Presentation on theme: "ConnectorCare: The New Commonwealth Care Suzanne Curry MLRI Basic Benefit Training December 10, 2014."— Presentation transcript:

1 ConnectorCare: The New Commonwealth Care Suzanne Curry MLRI Basic Benefit Training December 10, 2014

2 Commonwealth Care o Comprehensive health coverage for adults at or below 300% FPL not eligible for MassHealth o Created through 2006 Massachusetts health reform law o Run by the Health Connector o Sliding scale premiums based on income, copays also based on income: Plan Type 1, 2, 3 o Cannot be offered health insurance from job o As of December 31, 2013, about 220,000 enrollees

3 Commonwealth Care As of January 1, 2014: o About 130,000 of Commonwealth Care enrollees transitioned to MassHealth o Due to systems issues, Commonwealth Care coverage for the remaining 90,000 members was extended multiple times and will end on January 31, 2015 o About 13,000 former Medical Security Program members also given the option of maintaining MSP coverage under the Commonwealth Care program – coverage is also extended to January 31, 2015

4 ACA Subsidized Insurance How does subsidized health insurance work under the Affordable Care Act?

5 Qualified Health Plans o Qualified Health Plan (QHP): insurance plan certified by health insurance marketplaces o In Massachusetts, the health insurance marketplace is the Health Connector

6 Types of QHPs o QHPS are categorized into different types or metallic tiers, based on how much cost-sharing the plan covers o Platinum (least cost-sharing, highest premiums) o Gold o Silver o Bronze (most cost-sharing, lowest premiums)

7 Federal Subsidies o ACA offers two types of help paying for health insurance to purchase a QHP through the health insurance marketplace: Advanced premium tax credits (APTCs) Cost-sharing reductions o Paid directly to the health plan, consumer pays the rest

8 Advanced Premium Tax Credits (APTCs) o Size of credit is based on a percentage of income and cost of 2 nd lowest cost “Silver” plan available through the marketplace o If you buy a more expensive plan (e.g. Gold, Platinum), pay the difference o If you buy a cheaper plan (e.g. Bronze), save the difference

9 Cost-Sharing Reductions o Lowers out-of-pocket costs, such as deductibles, co-pays or co-insurance o Must purchase “Silver” plan to get cost- sharing reductions

10 Federal Eligibility Requirements o Income at or below 400% FPL o At or below 250% FPL for cost-sharing reductions o US Citizen, national or lawfully present immigrant o Resident o Not incarcerated o Not eligible for or enrolled in: o Other “minimum essential coverage” (e.g. Medicaid, Medicare) o Affordable Employer Sponsored Insurance

11 Employer Sponsored Insurance o May be eligible for APTCs if ESI available to you: Costs more than 9.5% of household income for lowest-cost self-only plan Does not meet “minimum value” (i.e. does not cover 60% of average cost-sharing)

12 More on ESI o Application asks questions about premium cost of ESI & minimum value to see if uninsured person offered ESI may be eligible for APTCs o “Family glitch” – whether ESI is affordable for family members is also based on cost of self-only plan NOT cost of family plan o If “self-only” ESI is considered affordable, family members also cannot receive APTCs

13 ACA vs. MA Subsidies

14 ConnectorCare o Plans designed to look more like Commonwealth Care in terms of premiums & cost-sharing Federal APTCs + Federal Cost-Sharing Reductions + State Funds = ConnectorCare Subsidies

15 ACA Subsidized Coverage in Mass. 15

16 Eligibility for ConnectorCare o Income at or below 300% FPL o Meet eligibility standards for federal APTCs o Must choose from subset of plans offered through the Health Connector

17 Selecting a Plan o No automatic assignment, applicant must select plan o ConnectorCare-eligibles can choose any plan offered through the Health Connector BUT: o Added state subsidies lowering premiums and cost-sharing to Commonwealth Care levels are only available if choose ConnectorCare plan

18 ConnectorCare Plans Carriers offering ConnectorCare plans in 2015: o BMC HealthNet Plan o CeltiCare o Fallon Health Plan o Health New England o Minuteman Health o Neighborhood Health Plan o Tufts Health Plan - Network Health

19 ConnectorCare Plans ConnectorCare plan names do not display correctly on the Health Connector website. ConnectorCare Health Insurance CarriersConnectorCare plan name as it is displayed in the system Boston Medical Center HealthNet PlanBMC HealthNet Plan - Silver A CeltiCare Health PlanAmbetter Balanced Care Fallon HealthCommunity Care Silver Connector A Health New EnglandHNE Silver A Minuteman HealthMyDoc HMO Silver Basic Tufts Health Plan-Network HealthTufts Health Direct Silver Neighborhood Health PlanNHP Prime HMO 2000/4000 30/50 Although the names are wrong, the premiums, co-pays and benefits are displayed correctly.

20 ConnectorCare Premiums o Base enrollee premiums for members selecting the lowest- cost ConnectorCare plan in their region equals that in Commonwealth Care today o Plan Type I members will not be charged a premium, regardless of which plan they choose

21 Premium Payment o Must pay premium by the 23 rd of the month for coverage to be effective for the 1 st of the next month o If payment is received after the 23 rd, coverage will not be effective until the 1 st of the 2 nd month o Premiums must be received by the 23 rd of each month to maintain coverage.

22 Premium Non-Payment o After 30 days of non-payment, APTCs to the plan are suspended and plan suspends payment to providers o If all premiums owed are not paid after 90 days, coverage is terminated retroactively back to the end of the first 30 days of non- payment o Health Connector has process to apply for premium hardship waivers Same as Commonwealth Care process

23 ConnectorCare Cost-Sharing o Co-pays only; no deductibles or co-insurance o Plan Type 1 (at or below 100% FPL): MassHealth- level co-pays for prescription drugs only o Plan Type 2 (100-200% FPL): Low to moderate co-pays o Plan Type 3 (200-300% FPL): Moderate co-pays

24 Open Enrollment Period o Under federal rules, there is a set open enrollment period (e.g. for this year, it is November 15, 2014- February 15, 2015) – only time a consumer can enroll in plan through marketplace o Exception – experiencing a “triggering event” o In Massachusetts, being determined eligible for ConnectorCare is considered “triggering event” o Can enroll in ConnectorCare any time during the year

25 What about people over 300% FPL? o People with incomes between 300-400% FPL may be eligible to receive help paying for health insurance Must meet federal eligibility guidelines May be eligible for APTCs Choice of all plans offered through the Health Connector

26 Reconciliation o APTCs are based on annual income and “reconciled” at tax time o IRS compares amount of premium tax credits you qualify for at end of year with those you received in advance o Final premium tax credit is calculated based on actual income reported on federal taxes o If APTC is less than amount of final premium tax credit, you will receive the difference as a credit o If APTC is more than amount of final premium tax credit, you must repay the difference through your tax return

27 Reconciliation o Reconciliation amounts are capped for individuals and families at or below 400% FPL o Additional subsidies provided by the state are not subject to reconciliation

28 Thank you! Questions?

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