Health Insurance Exchange and Consumer Engagement

1. Health Insurance Exchange and Consumer Engagement April Todd-Malmlov Exchange Director Minnesota Department of Commerce

2. Existing Market Challenges • Quality is improving but unequal • Too little consumer engagement • Unsustainable health care cost growth • Growing uninsured • Small employers dropping coverage • Health care is too complex • Lack of information to make informed decisions

3. Challenges for Competition

4. Exchange Opportunities

5. Exchange Functions • Provide one-stop shop including a call center and website • Ensure health insurance plans meet certain standards • Provide comparative information on health benefit plans, costs, quality, and satisfaction using a standard format • Set up open enrollment and special enrollment periods • Facilitate “real-time” eligibility and enrollment using a uniform format • Determine eligibility for individual and employer tax credits, Medicaid, and coverage requirement exemptions • Communicate with employers regarding employee subsidy eligibility, cancelation of coverage, and penalty liability • Establish a “Navigator” program • Additional functions for small employers: Employee choice and premium aggregation

6. Eligibility and Enrollment • Eligibility: Individuals, Small Groups, and Medicaid • General Individual Market. Individual Subsidies (100-400% FPL): Through Exchange to those not eligible for “affordable” employer coverage. Subsidies limit “Silver plan” premiums to 2 - 9.5% of income and cost-sharing subsidies limit actuarial value to 94 - 70% for silver plan (100-250% FPL). • Small Employers: Eligible up to 100 employees, state can limit to 50 employees until 2016. Sliding scale tax credits through Exchange for 2 years for up to 50% of employer premium portion for < 25 employees and < $50,000 average wage. • Medicaid Eligibility (<133% FPL) • Enrollment: • Plans must provide essential benefits and fit an actuarial level (Bronze, Silver, Gold, Platinum, or “Young Invincible”) • Subsidies and cost-sharing based on “Silver Plan”

7. Behavioral Segmentation • People have different needs, desires and expectations – user experience needs to be responsive to all Passenger Apprentice Get it done for me Hold my hand Manager Engineer Keep me posted Get out of my way

8. Design Principles • Grounded in different user needs and serve to inspire creative solutions to address those needs Give Me Direction Keep Me Moving Support Me My Way

9. Contact Information • April Todd-Malmlov Exchange Director Department of Commerce email: april.todd-malmlov@state.mn.us phone: 651-296-6572 Exchange website: http://mn.gov/commerce/insurance/topics/medical/exchange/index.jsp