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CMS Updates May 28, 2014. Marketplace Enrollment Summary. Final ASPE Report: http:// aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014Apr_enrollment.pdf Report Highlights: Number of Eligible Persons who have Selected a Plan through the SBMs and FFM: 8 million

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marketplace enrollment summary
Marketplace Enrollment Summary

Final ASPE Report:http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014Apr_enrollment.pdf

Report Highlights:

  • Number of Eligible Persons who have Selected a Plan through the SBMs and FFM: 8 million
    • An additional 5 million may have purchased off-Marketplace
  • Number of Persons who have had a Medicaid/CHIP Determination or Assessment through the Marketplaces: 6.7 million (does not include individuals applying through State Medicaid/CHIP agencies.)
  • 20 percent of the persons who have selected a Marketplace plan have selected a Bronze plan / 65 percent selected a Silver plan
  • 85 percent of the persons who have selecteda Marketplace plan have selected a Marketplace Plan with Financial Assistance.
  • 46% Male/ 54% Female
slide3

Marketplace Enrollment Summary

  • States with Highest Marketplace Enrollment:
    • California (1,405,102, SBM)
    • Florida (983,775, FFM)
    • Texas (733,757, FFM)
    • New York (370,451, SBM )
    • North Carolina (357,584, SBM)
  • 15 SBMs enrolled 2,573,585
  • 36 FFMs enrolled 5,446,178
exchange and insurance market standards for 2015 and beyond
Exchange and Insurance Market Standards for 2015 and Beyond

CMS Updates to the Cover Arizona Coalition

Key policies include:

  • Standardizing Notices to Improve Consumer Education and Choices
  • Strengthening the Prescription Drug Exceptions Process
  • Implementing Quality Standards
  • Providing Additional Options for SHOP in 2015
  • Strengthening Standards for Navigators and Other Assisters
  • Clarifies Premium Stabilization Policies

Source: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/marketstandards-5-16-2014.html

special enrollment periods
Special Enrollment Periods

CMS Updates to the Cover Arizona Coalition

New Fact Sheets Posted to Marketplace.gov

  • SEP for People with COBRA: http://marketplace.cms.gov/help-us/sep-for-consumers-with-cobra.pdf
  • SEP People with Individual Market Plans coming up for renewal outside of the open enrollment period: http://marketplace.cms.gov/help-us/sep-up-for-renewal.pdf
  • SEP and Hardship Exemption for AmeriCorps Members: http://marketplace.cms.gov/help-us/5-6-14-americorp-sepfinal.pdf
  • Hardship Exemption for Consumers Who Obtained Coverage Outside the Marketplace That is Effective May 1, 2014: http://marketplace.cms.gov/help-us/2014-5-6-hardship-exemptionoep.pdf
  • Assisting Young Adults Enrolling in the Marketplace Outside Open Enrollment: http://marketplace.cms.gov/help-us/assisting-young-adults.pdf
special enrollment periods1
Special Enrollment Periods

CMS Updates to the Cover Arizona Coalition

People with COBRA

  • May not have been adequately informed of the available options
    • Can disenroll from COBRA and enroll into a Marketplace plan
  • One time SEP
    • Call the Marketplace call center
      • Select a plan by July 1, 2014
  • Refer to publication: http://marketplace.cms.gov/help-us/sep-for-consumers-with-cobra.pdf
special enrollment periods2
Special Enrollment Periods

CMS Updates to the Cover Arizona Coalition

Non-Renewing Individual Market plans (non QHP plans)

  • Consumers choosing not to renew
  • Report up to 60 days before the renewal date
  • Must select a plan within 60 days after the renewal date
  • Apply online

Refer to publication: http://marketplace.cms.gov/help-us/sep-up-for-renewal.pdf

slide8

Special Enrollment Periods

CMS Updates to the Cover Arizona Coalition

AmeriCorps/VISTA/National Civilian Corps Members

Members and their dependents with no coverage or coverage not considered minimum essential coverage

  • eligible to enroll when they experience the following triggering events:
    • on the date they begin their service terms; and
    • on the date they lose any coverage after their service term ends
  • have 60 days to select a plan

Refer to publication: http://marketplace.cms.gov/help-us/5-6-14-americorp-sepfinal.pdf

seps for young adults who lose health insurance
SEPS for young adults who lose health insurance

Young adults maybe eligible for a SEP when he/she

  • graduates and lose coverage,
  • otherwise leave college
  • age off their parent’s plan when he/she turn 26

Refer to:

http://marketplace.cms.gov/help-us/assisting-young-adults.pdf

consumers who are losing employer sponsored coverage
Consumers who are losing employer sponsored coverage

CMS Updates to the Cover Arizona Coalition

Losing employer-sponsored coverage- ongoing SEP

  • Two options – choose only one
    • Get an individual Marketplace plan
      • 60 days to enroll from the date the existing coverage ends
      • apply online or call the Marketplace call center
    • Get COBRA coverage
      • generally, will not be able get a Marketplace plan outside of the open enrollment period

Refer to publication: http://marketplace.cms.gov/help-us/assisting-consumers-losing-coverage.pdf

extended coverage for former foster children
Extended coverage for former foster children

CMS Updates to the Cover Arizona Coalition

Extended coverage for children who -

  • Aged out to foster care, and
  • Had previously received Medicaid

Former foster children will remain eligible for full scope Medicaid until they turn 26

Refer to: http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html and http://www.azahcccs.gov/applicants/categories/children.aspx

hardship exemptions and tips
Hardship Exemptions and Tips

CMS Updates to the Cover Arizona Coalition

Source: https://www.healthcare.gov/exemptions/

Ensure the applicant completes all questions for every adult in the tax household and any dependent child who also needs the exemption

Encourage consumers to submit any supporting documents requested on the application

Missing information may delay processing

Originals (other than the application itself) should not be sent. Applicants should keep a copy of completed application and all documents sent to the Marketplace, along with proof od mailing.

hardship exemptions
Hardship Exemptions

CMS Updates to the Cover Arizona Coalition

Source: https://www.healthcare.gov/exemptions/

You were homeless.

You were evicted in the past 6 months or were facing eviction or foreclosure.

You received a shut-off notice from a utility company.

You recently experienced domestic violence.

You recently experienced the death of a close family member.

You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.

hardship exemptions1
Hardship Exemptions

CMS Updates to the Cover Arizona Coalition

You filed for bankruptcy in the last 6 months.

You had medical expenses you couldn’t pay in the last 24 months.

You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.

You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child.

hardship exemptions2
Hardship Exemptions

CMS Updates to the Cover Arizona Coalition

Appeals decision found the individual eligible for enrollment in a QHP for time period when he or she wasn’t enrolled in a QHP.

Doesn’t qualify for Medicaid solely based on a state’s decision not to expand Medicaid eligibility.

Your individual insurance plan was cancelled and you believe other Marketplace plans are unaffordable.

You experienced another hardship in obtaining health insurance. Used for situations which don’t fit in other hardship categories, OR may be used for specific scenarios described in CMS guidance (ex: new guidance for AmeriCorps, VISTA, and NCCC members).

uniform glossary
Uniform Glossary

CMS Updates to the Cover Arizona Coalition

A consumer resource to

help people understand

some of the most common

but confusing jargon used

in health insurance.

Source: http://www.cms.gov/CCIIO/Resources/Files/Downloads/uniform-glossary-final.pdf

summary of benefits coverage
Summary of Benefits & Coverage

Purpose:

Allows consumers to make “apples-to-apples” comparisons when looking at different plans.

What it is:

An easy-to-understand summary about a health plan’s

benefits and coverage.

All individual and group health plans must use the same standard form to help compare plans and provide it to consumers prior to enrollment, at renewal, and anytime upon request, for example.

summary of benefits coverage1
Summary of Benefits & Coverage

Consumers have the right to get an SBC when shopping for, enrolling in, or renewing coverage.

The SBC is available for every plan in the Marketplace. Consumers will find a Web link to it on each plan page when they enroll through HC.gov.

Consumers also have a right to receive an SBC from their insurance company or group health plan upon request at any time.

Consumers may be able to request an SBC in Spanish, Chinese, Tagalog, or Navajo.