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HEALTH CARE REFORM

HEALTH CARE REFORM. Washington HealthPlan Finder State Insurance Exchange, the Affordable Care Act January 1, 2014, Alan R. Zalewski, CLU, ChFC. A Fish Story. TWIN GOALS OF ACA. Accessible – No one can be denied health insurance or treatment by an insurance company .

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HEALTH CARE REFORM

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  1. HEALTH CARE REFORM Washington HealthPlan Finder State Insurance Exchange, the Affordable Care Act January 1, 2014, Alan R. Zalewski, CLU, ChFC

  2. A Fish Story

  3. TWIN GOALS OF ACA • Accessible – No one can be denied health insurance or treatment by an insurance company . • Affordable – Everyone has access to low cost, high quality health insurance and, therefore, health care.

  4. History of the Affordable Care Act • Signed into law March 23, 2010 • Requires everyone to have health insurance in 2014 • Creates state-based exchanges • Reforms insurance market – all can get insurance regardless of age or health • Establishes an essential benefit package • Provides individual subsidies • Creates Employer mandate to “Play or Pay”

  5. MINIMUM LOSS RATIO • 80% of All Premium must be paid out in benefits for individuals and small groups (< 50 Employees) • 85% of premium paid out in benefits for Large Groups (> 50 Employees) • Failure to meet Requirement forces Rebate back to policyholders

  6. WA Health Insurance Exchange

  7. WASHINGTON HEALTH PLAN FINDER • The Exchange was created in state statute in 2011 by SSB 5445 • Established as a “public-private partnership” separate and distinct from the state • In 2012, legislation was passed (ESSHB 2319) that established market rules, requirements for QHPs, essential health benefits

  8. HISTORY OF EXCHANGE • The Exchange initially started in the state’s Health Care Authority (HCA) and has transitioned to an independent organization • The Exchange will offer Plans that meet the “Metallic” Tiers: Bronze, Silver, and Gold. There will not be any Platinum Plans in 2014 • Plus a catastrophic plan for those under age 30 • No one can be denied insurance coverage based on health status, and there will be no pre-existing conditions waiting periods or limitations under the ACA as of January 1, 2014

  9. The Exchange Continued • Essential Health Benefits will include outpatient care, inpatient hospital care, prescriptions, lab and X-ray services, habilitative and rehabilitative care, maternity and related care, mental health and substance abuse care, doctors’ services, and preventive care, plus pediatric dental care. • “WashingtonHealthplanfinder” is a central location where multiple health insurance companies compete  • Goal: make side-by-side comparisons of multiple health insurance plans

  10. NOTE! • Only Plans that have been certified as “Qualified Health Plans” will be available on the Exchange, assuring quality to consumers • Major Benefit to Individuals and Families: Tax credits or financial help to pay for co-pays and premiums

  11. How does the Tax Credit/Subsidy Work? • in 2014, many individuals and families will be eligible to receive subsidized coverage in the Exchange if they are not eligible for Medicare, Medicaid or the Children's Health Insurance Program and are not offered affordable coverage through their employer* • * Affordable by IRS definition = < 9.5% of employee income for employee only coverage.

  12. SUBSIDY CONTINUED • The Subsidy is an Advanced Tax Credit that can either be taken immediately each month or deferred until year end filing of income taxes. • Subsidies available to households who make less than 400% of the Federal Poverty Level (FPL). • Individuals/Families at less than 138% of the FPL will receive Apple Health (Medicaid) at no cost. • Individuals/Families between 138% and 250% will be eligible for not only premium subsidies but additional assistance with co-pays and cost sharing, based on the second lowest cost Silver Plan in their area.

  13. Range of Household Income to Qualify

  14. Will Licensed Insurance Producers be able to offer plans on the Exchange? • Yes, but you must be “certified” and also licensed and appointed with the carriers offering QHP on the Exchange. • Producers are compensated directly by the carriers themselves, and not the Exchange • Many have not yet received their producer ID

  15. Certified Producer will receive: • A password-protected login and dashboard to track their client database, client contact information and application status • A unique profile for each agent and broker in the Washington Healthplanfindersystem will allow consumers and small businesses to easily locate them by name or zip code • Customer service will be available to answer questions and provide support to producers as they work with clients

  16. Open Enrollment October 1, 2013 - March 31, 2014 • Application must be made by the 25th of December to be effective on Jan 1, 2014 • Thereafter, application must be completed and received by 25th of the month to be effective for 1st of following month. • If application received between 26th and 31stof month, then plan is effective 1st of the second following month. (i.e., latest signup March 31st equals coverage effective date of May 1, 2014)

  17. Customer Service Center is Now Open • 1-855-WAFINDER (1-855-923-4633) Toll Free • Available Weekdays 7:30 AM to 8 PM • Also email: customersupport@wahbexhange.org

  18. New Plans in the Exchange

  19. Plans That Will Be Offered for Individual Coverage • Bridgespan • – King, Kitsap, Pierce, Skagit, Snohomish, Thurston, and Spokane • Note: Bridgespan is a Non-Blue Shield Subsidiary of Regence Blue Shield

  20. 2014 Bridgespan vs. 2013 Regence - King County Rates – Non-Smoker

  21. Quick Comparison: Old to New Plans: Evolve Plus to Gold

  22. Plans • Community Health Plan of Washington • – Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Ferry, Franklin, Grant, Grays Harbor, King, Kitsap, Lewis, Okanogan, Pacific, Pend Oreille, Pierce, Skagit, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Yakima

  23. Plans • Group Health Cooperative – Benton, Columbia, Franklin, Island, King, Kitsap, Kittitas, Lewis, Mason, Pierce, San Juan, Skagit, Snohomish, Spokane, Thurston, Walla Walla, Whatcom, Whitman, and Yakima

  24. Plans • Molina Healthcare of Washington, Inc. – King, Pierce and Spokane • LifeWise – All 39 counties • Premera Blue Cross – All counties except Clark

  25. LifeWise 2013 to 2014 Rates – King County – Non-Smoker

  26. Plans • Kaiser Foundation Health Plan of the Northwest – Clark and Cowlitz (Small Business and Individual Market) The only Plan in the S.H.O.P. (Small Business Health Options Plan)

  27. Plans • Delta Dental of Washington, Kaiser Foundation Health Plan of the Northwest, LifeWise, Premera Blue Cross – (Pediatric Dental Only)

  28. What will the new plans look like? • 5 Rating Areas • Maximum Ratio of 3 to 1, Oldest to Youngest • Rates not in 5 year bands, but each year • Range of Deductibles and co-pays • There must be a large enough network in the area to support the plan to be certified. • Emphasis on many for a Primary Care Physician to coordinate all care and refer to specialist required, as well as pre-authorization for many services

  29. What will the new plans look like? • Charge for each child under Age 20, up to 3 maximum • Charge for each Child over 20 through 26 on parents’ plan • Each adult pays rate for their own age. • Age rate set on effective date and remains so for the year, even if birthday occurs.

  30. Medicare Advantage • Medicare and Medicare Advantage rules are not affected as much by ACA and producers should follow all CMS Training and Certification requirements as before. • Expect higher rates in the future as ACA mandated cuts to reimbursement of providers continues.

  31. Health Reform Issues: • Both Federal (HHS) and State Governments must approve insurance plans • CBO originally scored ACA at $940 Billion in 2010; now revised to $1.76 Trillion • CBO reports that at least 7 million workers will lose employer coverage • Health Care costs are not going down; indeed are going up for most and younger.

  32. Issues (2) • CBO reports that 1 Year delay of Employer Mandate to cost another $12 Billion • Employers in face of uncertainty not hiring and shifting employees to part time (<30 hours) • WA State Medical Assoc found that 18% primary care doc had dropped Medicaid; 24% not taking new patients

  33. (LATEST!) Issues (3) • Tues Oct 22nd: Federal Judge allows lawsuit on Premium Subsidies Program in HHS Run States • Will rule by Feb 15, 2014 as the current effective date of Individual Mandate. • Thurs Oct 24th: Administration announce delay by 6 weeks of requirement to enroll (from Feb 15th to March 31st, 2014)

  34. THANK YOU! QUESTIONS?

  35. THANK YOU! • Questions? • Alan R. Zalewski, CLU, ChFC, LUTCF • 1919 North Pearl, Suite B-3 • Tacoma, WA 98406 • 253-752-9400 • alanz@groupservicesnorthwest.com

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