Implementation of the Affordable Care Act: Choose Health Delaware

Implementation of the
Affordable Care Act:
Choose Health
The Basics
• The Patient Protection and Affordable Care Act was passed and
signed into law in 2010
• Delaware began working immediately to plan for the law’s
• Governor Markell designated Department of Health and Social
Services to be the lead agency for healthcare reform with
Bettina Riveros as advisor
• Delaware Health Care Commission (HCC) is the public
information and policy face for the Health Care Reform efforts
• States could choose one of three models for implementation:
Fully Federal, State-based, State partnership
• Delaware chose a State/Federal Partnership model for the
implementation, retaining control over plan management and
consumer assistance while leaving the technical infrastructure to
the Federal Government
• Early part of open enrollment was stalled because of
performance issues related to web-based portal
• As a state/federal partnership, Delaware relies on the
enrollment portal managed by the Federally Facilitated
Marketplace (FFM)
• Delaware retains control over the Plan Management,
Consumer Assistance and Communications &
Outreach functions of the Marketplace
“Triple Aim”
• Delaware is engaged in an effort to transform its
health system:
• Improve the health of all Delawareans
• Improve the patient experience of care
• Reducing health care costs
• Access to care through expanded Medicaid and the
health insurance Marketplace is a critical component
of the Triple Aim
Delaware Landscape
• Delaware has approximately 92,000 individuals who
are uninsured
• The ACA allowed for the expansion of Medicaid for
those with incomes up to 138% of the Federal
Poverty Level. Since Jan. 1, 2014, more than 3,400
Delawareans have Medicaid due to the expansion.
• To date, more than 11,000 Delawareans have
enrolled in private coverage through the Marketplace.
Significant Dates
• March 31, 2014 – Open enrollment for Plan Year
2014 ended; Must have been enrolled in (or started
the application process for) minimum essential
coverage by this date to avoid penalty
• November 15, 2014-February 15, 2015 – Open
enrollment for Plan Year 2015
• Enrollment in Medicaid/CHIP can occur at any time.
If someone who can afford health insurance doesn’t have coverage in
2014, they may have to pay a fee. They also have to pay for all of their
health care.
For 2014, consumers will pay whichever of these amounts is higher:
• 1% of yearly household income. (Only the amount of income above
the tax filing threshold, $10,150 for an individual, is used to calculate
the penalty.) The maximum penalty is the national average yearly
premium for a bronze plan.
• $95 per person for the year ($47.50 per child under 18). The
maximum penalty per family using this method is $285.
The fee increases every year. In 2015, it’s the higher of 2% of income or
$325 per person. In 2016 and later years it’s the higher of 2.5% of income
or $695 per person.
For those uninsured for just part of the year, 1/12 of the yearly penalty
applies to each month without insurance. Those uninsured for less than 3
months do not have a penalty.
Tax Year
Tax Year
Tax Year
Beyond TY
1% of
income above
the filing
2% of
income above
the filing
2.5% of
income above
the filing
2.5% of
income above
the filing
$695 +
For more information on the Individual Shared Responsibility Payment, go to:
Plan Management
Plans: Consumer Opportunity and Choice
• In Plan Year 2014, individuals have a choice of 19 medical
qualified health plans (QHPs) offered by three carriers:
• Highmark Blue Cross Blue Shield of Delaware
• Coventry Life and Health
• Coventry Healthcare of Delaware
• Individuals may also choose from 2 multi-state plans offered
through OPM by Highmark BCBS
• There are also 2 stand-alone dental QHPs offered on the
• The medical QHPs include plans at the Platinum, Gold, Silver,
Bronze and Catastrophic levels to allow consumers to choose a
level of benefits and out-of-pocket costs that meet their needs
• Medicare-eligible individuals are not affected
• Medigap or Medicare Supplement plans are not affected
ACA Provisions
• Individuals with preexisting conditions have access to
insurance coverage in 2014
• Insurance Companies cannot rescind a policy except for
• Delaware requires Insurance Commissioner approval
for any rescission
• Plans will not have annual and lifetime dollar limits on
essential health benefits
Essential Health Benefits
Essential Benefits include:
• Rehabilitative and habilitative services
• Preventive services
• Paid at 100% with no deductible or copay
• Mammography is considered in the covered preventive
services (Baseline for ages 35-39, every 2 years for 40s, each
year 50+)
• Wellness services
• Chronic disease management
• Pediatric vision and dental care
• Ambulatory Patient
• Coverage for clinical trials
• Colorectal cancer screening
• Coverage for reconstructive surgery following mastectomies
• Specialty Tier prescription coverage—Effective January 1, 2014
Costs of Coverage
• Health status cannot be used to determine premiums
• Insurers can only use age, family composition,
geographic area and tobacco use to determine
• In Delaware, insurers must use one geographic area
for Qualified Health Plans sold in the
Preventive Task Force
State Laws that Enhance the ACA for
• Delaware passed a law to adopt the provisions of the
• Effective January 1, 2014.
• State Laws and Regulations
• Annual pap smear coverage
• Coverage of CA-125 monitoring of ovarian cancer
subsequent to treatment
• Equal reimbursement for Oral and Intravenous
anti- cancer medication
Advanced Premium Tax Credits
• Advanced Premium Tax Credits (APTCs) can reduce
monthly premium costs for those who qualify and
purchase QHPs through the Marketplace
• Paid in advance to provide immediate assistance
• IRS reconciles over/under payments of advance
premium tax credits when individual files his/her
taxes the following year
• APTCs are available to those between 138%-400%
of the Federal Poverty Level
Cost Sharing Reductions
• Cost Sharing Reductions (CSRs) help reduce out-ofpocket costs for enrollees in QHPs
• Payments are made directly to issuers to reduce
deductibles, co-insurance, and/or copayments
(out-of-pocket) costs
• CSRs are available to those between 138%-250% of
the Federal Poverty Level
Consumer Assistance
Consumer Assistance
• The State contracted with 4 organizations to provide inperson education and enrollment assistance to consumers
and small businesses:
• Brandywine Women’s Health Associates
• Christiana Care
• The Delmarva Foundation
• Westside Family Healthcare
• The Federal Government is also funding Navigators to
complement outreach efforts. Chatman, LLC has been
contracted to provide these services.
• Other enrollers are available through out the state
• FQHCs, other CAC organizations
• Consumer experience should be consistent no matter
where they seek assistance
Marketplace Guides
• Guides must complete Federal and Delaware-specific
training as well as Federal and state background
• Each organization developed a strategy for outreach
based on geographic and demographic variables
• All three counties have active outreach efforts; 68
FTE Guides available statewide
Communications and Outreach
Communications and Outreach
• Phase 1: September-December 2013
• Focus on high-level messaging: “Health Insurance for
All,” “Questions,” “Accidents Happen”
• Traditional media outlets
• Held back on media in Oct-Nov because of rocky rollout
• Phase 2: February-March 2014
• Targeted to “Young Invincible” demographic
• Focus on testimonials: “Why risk it?,” “It’s more
affordable than you think”
• Increased social media presence and digital tactics
• Focus on penalty/deadline
Communications and Outreach
• Targeted grassroots efforts
Drink coasters
Cash jackets
Door hangers
Outreach to providers, agents/brokers, small business
groups and other stakeholders
• Other Media
• Mall signs
• Transit
• Signs and brochures in barber shops, nail salons,
independent grocers, walk-in clinics, libraries, State
Service Centers
Communications and Outreach
• Website:
• Social Media
• Twitter @choosehealthde
• YouTube:
• Speakers Bureau: Organizations can request a
speaker through the website
• Email: [email protected]
Moving Forward
Next steps for Choose Health Delaware’s
Health Insurance Marketplace
• Currently in a period of evaluation and assessment
• What worked well?
• What needs to improve?
• Maintaining in-person support for those who qualify
for Special Enrollment Period
• Maintaining lesser but consistent marketing presence
throughout summer
• Will ramp-up with education and outreach in
September in preparation for start of open enrollment
(Nov. 15)
Contact Information
• Michelle Amadio, Director of Delaware’s Health
Insurance Marketplace, Department of Health and
Social Services
• Phone (302) 255-4491
• [email protected]
• Linda Nemes, Assistant Director Market Regulation,
Delaware Department of Insurance
• Phone (302) 674-7373
• [email protected]