1. Presentation to: Alliance for Health Reform Congressional Briefing Kaitlyn Kenney Director, Policy & Research Health Connector May 24, 2010

2. 2 Role of the Health Connector The Massachusetts “Exchange” –Established as part of MA Health Care Reform in 2006 Responsibilities: –Administration of two programs: Commonwealth Care for subsidy-eligible adults (< 300% FPL) Commonwealth Choice for unsubsidized non-group & small-group insurance –Young Adult Plans (YAPs) offered through this program –Policy development: Affordability Schedule Minimum Creditable Coverage (MCC) regulations

3. Young Adult Plan Development DOI and Health Connector developed regulations to define YAP benefits –Coverage includes: inpatient and outpatient hospital services, physician services for physical and mental illness, emergency services, and all MA mandated benefits –Offered both with and without prescription drug coverage –May include annual benefit max of no less than $50,000 YAPs sold to individuals ages 18 – 26 solely through the Health Connector 3

4. YAPs vs. Catastrophic Plan Massachusetts YAPs PPACA Catastrophic Plan Eligibility: Age If access to ESI? 18 – 26 No Under 30 years old, OR, if access to affordable coverage is not available* Yes, if coverage is not affordable Benefit Design: First Dollar Coverage Annual limits Deductibles Out-of-Pocket Maximum Prescription Drug Coverage Yes, for some services Allowed, and most include $250 or $2,000 $5,000 Not required Yes, only for 3 primary care visits No Equal to Out-of-Pocket Maximum for HSA-qualified HDHPs ($5,950 ind in 2010) Same as above ($5,950 ind. in 2010) Required *This could have an impact on the demographics and risk profile of this population, which in turn could impact premium prices.

5. 5 Commonwealth Choice: Shopping Experience

6. 6 Commonwealth Choice: Shopping Experience (con’t) Step 1: Select Family Size Step 3: Provide demographic info and select coverage start date Step 2: Determine whether eligible for subsidized plan

7. 7 Commonwealth Choice: Shopping Experience (con’t)

8. 8 Step 5: Select High or Low and With or Without prescription drug coverage

9. YAP Enrollment YAP subscribers represent about 25% of total non-group enrollment (~4,700 subscribers) About 80% of those eligible for a YAP enroll in a YAP –About 67% of individuals choosing a YAP select a plan with prescription drug coverage MA extended dependent coverage, but expansion under PPACA may impact YAP take-up 9