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FEDERAL HEALTH INSURANCE(Affordable Care Act) EXCHANGE 2020 OPEN ENROLLMENT

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The Federal Health Insurance Exchange (also known as the Marketplace or Affordable Care Act) Open Enrollment Period runs from November 1, 2019 to December 15, 2019, for coverage starting on January 1, 2020. Similar to previous years, the Centers for Medicare & Medicaid Services (CMS) is taking a strategic and cost-effective approach to inform individuals about Open Enrollment, deliver a smooth enrollment experience, and use consumer feedback to drive ongoing improvements across the Exchange platform. Consumers can visit HealthCare.gov and CuidadodeSalud.gov to preview 2020 plans and prices before Open Enrollment begins and for the first time HealthCare.gov will also display quality rating information in states that use HealthCare.gov, expanding the information available for consumers in their decision-making when comparing health coverage choices.

NEW THIS YEAR

Key Updates and Enhancements to Healthcare.gov for the 2020 Open Enrollment

Quality Rating Information Displayed in HealthCare.gov States
Quality ratings will be displayed on HealthCare.gov when consumers view the list of plans available in their area in HealthCare.gov states this year. Under the five-star Quality Rating System, Exchange health plans are given an overall rating on a 1 to 5 scale, with 5 stars representing highest quality. The overall star rating is based on three categories: Medical Care, Member Experience and Plan Administration.  In some cases — such as when plans are new to the Exchange or have low enrollment — ratings may not be available. 

Star ratings in the Exchange help make it easy for consumers to compare health coverage choices by giving consumers a snapshot of how each health plan’s quality compares to that of other Exchange plans in each state in a given year. A quality rating of 3 or above means that a health plan is considered average or above average as compared to other plans across the country. For the 2020 coverage year, 80 percent of plans eligible to receive a rating of at least 3 stars.  Similar to national quality reporting programs due to the time needed to collect and analyze survey and clinical quality measure data, the data CMS uses to calculate star ratings is based on plan performance data from two years prior. When shopping for a plan in 2020, consumers should keep in mind that star ratings displayed on HealthCare.gov are generally based on how the plan performed in prior years.

HealthCare.gov will display the Overall Rating with the number of stars from 1 to 5 filled in towards the top of each plan, or let the consumer know if the individual plan hasn’t been rated.  Consumers can see three additional star ratings for Member Experience, Medical Care, and Plan Administration which comprises the Overall Rating when selecting an individual plan’s detailed information along with other coverage and benefits. The Overall Rating and the three additional quality rating categories are also displayed when consumers choose to compare up to three plans side-by-side.

For more information, please see the Exchanges Quality Rating System fact sheet.

Summary information is provided in the Plan Year 2020 quality ratings results at a glance. 

Expanded Streamlined HealthCare.gov Application
As part of the continued commitment to improving the customer experience, the streamlined application on HealthCare.gov is expanded this year to handle nearly all consumer applications, both simple and more complex eligibility scenarios.  The streamlined application provides improved content and integrates help information throughout the application in order to provide a more seamless enrollment experience from start to finish, as well as enhanced mobile optimization.   CMS will continue to make enhancements to the application based on consumer feedback and testing.

Visual Refresh of Consumer Shopping Experience
This year, the visual experience for consumers when they preview plans (“See plans & prices”) and shop, compare and enroll on HealthCare.gov has been refreshed based on consumer research and feedback. The visual refresh provides a more consistent user experience throughout the entire enrollment process on HealthCare.gov that includes updates to filters, the plan results list, improved help content and enhanced mobile optimization.

Enhanced Direct Enrollment (EDE) Expanded
Enhanced Direct Enrollment (EDE) will be available throughout the entire Open Enrollment Period for the first time this year.  This key development allows CMS to partner with the private sector to provide more avenues for consumers to apply and shop for Exchange coverage.  Through the EDE pathway, consumers have the option to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or to contact the Exchange Call Center. This year, more approved partners are offering EDE-capable websites. As of October 25, CMS has approved more than 5 private sector partners to operate an EDE pathway.

The safety and security of consumer information is our number one priority.  Enhanced direct enrollment partners are required to undergo rigorous audits to ensure compliance with strict privacy and security controls prior to being certified to use this new platform.  CMS continuously monitors each partner to ensure they remain in compliance with CMS requirements.

For more information please see the Enhanced Direct Enrollment Pathway for Health Insurance Exchange Coverage fact sheet.

New resources about Health Reimbursement Arrangements (HRA)
New rules released this year permit employers to fund individual market premiums for their employees through a new type of HRAs – Individual Coverage HRAs.  CMS is adding educational information and a consumer worksheet tool to assist employees in determining whether to use an individual coverage HRA from their employer to help pay for coverage. HRAs are employer-funded accounts from which employees are reimbursed tax-free for qualified medical expenses. 

For more information please see the Health Reimbursement Agreements webpage.

NEW THIS YEAR

Key Updates and Enhancements to Healthcare.gov for the 2020 Open Enrollment

Quality Rating Information Displayed in HealthCare.gov States
Quality ratings will be displayed on HealthCare.gov when consumers view the list of plans available in their area in HealthCare.gov states this year. Under the five-star Quality Rating System, Exchange health plans are given an overall rating on a 1 to 5 scale, with 5 stars representing highest quality. The overall star rating is based on three categories: Medical Care, Member Experience and Plan Administration.  In some cases — such as when plans are new to the Exchange or have low enrollment — ratings may not be available. 

Star ratings in the Exchange help make it easy for consumers to compare health coverage choices by giving consumers a snapshot of how each health plan’s quality compares to that of other Exchange plans in each state in a given year. A quality rating of 3 or above means that a health plan is considered average or above average as compared to other plans across the country. For the 2020 coverage year, 80 percent of plans eligible to receive a rating of at least 3 stars.  Similar to national quality reporting programs due to the time needed to collect and analyze survey and clinical quality measure data, the data CMS uses to calculate star ratings is based on plan performance data from two years prior. When shopping for a plan in 2020, consumers should keep in mind that star ratings displayed on HealthCare.gov are generally based on how the plan performed in prior years.

HealthCare.gov will display the Overall Rating with the number of stars from 1 to 5 filled in towards the top of each plan, or let the consumer know if the individual plan hasn’t been rated.  Consumers can see three additional star ratings for Member Experience, Medical Care, and Plan Administration which comprises the Overall Rating when selecting an individual plan’s detailed information along with other coverage and benefits. The Overall Rating and the three additional quality rating categories are also displayed when consumers choose to compare up to three plans side-by-side.

For more information, please see the Exchanges Quality Rating System fact sheet.

Summary information is provided in the Plan Year 2020 quality ratings results at a glance. 

Expanded Streamlined HealthCare.gov Application
As part of the continued commitment to improving the customer experience, the streamlined application on HealthCare.gov is expanded this year to handle nearly all consumer applications, both simple and more complex eligibility scenarios.  The streamlined application provides improved content and integrates help information throughout the application in order to provide a more seamless enrollment experience from start to finish, as well as enhanced mobile optimization.   CMS will continue to make enhancements to the application based on consumer feedback and testing.

Visual Refresh of Consumer Shopping Experience
This year, the visual experience for consumers when they preview plans (“See plans & prices”) and shop, compare and enroll on HealthCare.gov has been refreshed based on consumer research and feedback. The visual refresh provides a more consistent user experience throughout the entire enrollment process on HealthCare.gov that includes updates to filters, the plan results list, improved help content and enhanced mobile optimization.

Enhanced Direct Enrollment (EDE) Expanded
Enhanced Direct Enrollment (EDE) will be available throughout the entire Open Enrollment Period for the first time this year.  This key development allows CMS to partner with the private sector to provide more avenues for consumers to apply and shop for Exchange coverage.  Through the EDE pathway, consumers have the option to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or to contact the Exchange Call Center. This year, more approved partners are offering EDE-capable websites. As of October 25, CMS has approved more than 5 private sector partners to operate an EDE pathway.

The safety and security of consumer information is our number one priority.  Enhanced direct enrollment partners are required to undergo rigorous audits to ensure compliance with strict privacy and security controls prior to being certified to use this new platform.  CMS continuously monitors each partner to ensure they remain in compliance with CMS requirements.

For more information please see the Enhanced Direct Enrollment Pathway for Health Insurance Exchange Coverage fact sheet.

New resources about Health Reimbursement Arrangements (HRA)
New rules released this year permit employers to fund individual market premiums for their employees through a new type of HRAs – Individual Coverage HRAs.  CMS is adding educational information and a consumer worksheet tool to assist employees in determining whether to use an individual coverage HRA from their employer to help pay for coverage. HRAs are employer-funded accounts from which employees are reimbursed tax-free for qualified medical expenses. 

For more information please see the Health Reimbursement Agreements webpage.

Helping Consumers Connect with Agents & Brokers
CMS will continue to partner with a third party to offer the “Help On Demand” services from agents and brokers.  This service allows consumers to choose to request that an agent or broker in their area contact them directly for help applying and enrolling.  Registered agents and brokers are able to set times when they’re available and then reach out to consumers who expressed interest in assistance. 

Learn more about Help On Demand services. 

Find Local Help
Find Local Help is a tool that allows consumers to search by city and state or ZIP code to see a list of local people and organizations who can help them enroll in coverage. Consumers can search for a specific person or organization by entering their name and can filter the results based on their preferences and services provided. Additionally, consumers can filter agents and brokers by their minimum years of participation on the Federal Exchange.

Financial Assistance
Premium tax credits will be available in 2020 for individuals who qualify. Consumers can continue to use Exchange coverage and take advantage of its benefits, including premium tax credits. Plans available from insurance companies will continue to reflect reduced copayments, coinsurance, and deductibles for eligible consumers. 

https://insuranceconsultingservicesinc.com/contact/

Medicare Advantage Riding High As New Insurers Flock To Sell To Seniors

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By Phil GalewitzOCTOBER 15, 2018 (Kaiser Health News)

Health care experts widely expected the Affordable Care Act to hobble Medicare Advantage, the government-funded private health plans that millions of seniors have chosen as an alternative to original Medicare.

To pay for expanding coverage to the uninsured, the 2010 law cut billions of dollars in federal payments to the plans. Government budget analysts predicted that would lead to a sharp drop in enrollment as insurers reduced benefits, exited states or left the business altogether.

But the dire projections proved wrong.

Since 2010, enrollment in Medicare Advantage has doubled to more than 20 million enrollees, growing from a quarter of Medicare beneficiaries to more than a third.

“The Affordable Care Act did not kill Medicare Advantage, and the program looks poised to continue to grow quite rapidly,” said Bill Frack, managing director with L.E.K. Consulting, which advises health companies.

And as beneficiaries get set to shop for plans during open enrollment — which runs from Oct. 15 through Dec. 7 — they will find a greater choice of insurers.

Fourteen new companies have begun selling Medicare Advantage plans for 2019, several more than a typical year, according to a report out Monday from the Kaiser Family Foundation. (KHN is an editorially independent part of the foundation.)

Overall, Medicare beneficiaries can choose from about 3,700 plans for 2019, or 600 more than this year, according to the federal government’s Centers for Medicare & Medicaid Services.

CMS expects Medicare Advantage enrollment to jump to nearly 23 million people in 2019, a 12 percent increase. Enrollees shopping for new plans this fall will likely find lower or no premiums and improved benefits, CMS officials say.

With about 10,000 baby boomers aging into Medicare range each day, the general view of the insurance industry, said Robert Berenson, a Medicare expert with the nonpartisan Urban Institute, “is that their future is Medicare and it’s crazy not to pursue Medicare enrollees more actively.”

Bright Health, Clover Health and Devoted Health, all for-profit companies, began offering Medicare Advantage plans for 2018 or will do so for 2019.

Mutual of Omaha, a company owned by its policyholders, is also moving into Medicare Advantage for the first time in two decades, providing plans in San Antonio and Cincinnati.

Some nonprofit hospitals are offering Medicare plans for the first time too, such as the BayCare Health system in the Tampa, Fla., area.

While Medicare beneficiaries in most counties have a choice of several plans, enrollment for years had been consolidated into several for-profit companies, primarily UnitedHealthcare, Humana and Aetna, which have accumulated just under half the national enrollment.

These insurance giants are also expanding into new markets for next year. Humana in 2019 will offer its Medicare HMO in 97 new counties in 14 states. UnitedHealthcare is moving into 130 new counties in 13 states, including for the first time Minnesota, its headquarters for the past four decades.

Extra Benefits

Seniors have long been attracted to Advantage plans because they often include benefits not available with government-run Medicare, such as vision and dental coverage. Many private plans save seniors money because their premiums, deductibles and other patient cost sharing are lower than what beneficiaries pay with original Medicare. But there is a trade-off: The private plans usually require seniors to use a restricted network of doctors and hospitals.

The federal government pays the plans to provide coverage for beneficiaries. When drafting the ACA, Democratic lawmakers targeted the Medicare Advantage plans because studies had shown that enrollees in the private plans cost the government 14 percent more than people in the original program.

Medicare plans weathered the billions in funding cuts in part by qualifying for new federal bonus payments available to those that score a “4” or better on a five-notch scale of quality and customer satisfaction.

Health plans also gained extra revenue by identifying illnesses and health risks of members that would entitle the companies to federal “risk-adjustment” payments. That has provided hundreds of billions in extra dollars to Medicare plans, though congressional analysts and federal investigators have raised concerns about insurers exaggerating how sick their members are.

A study last year found that those risk adjustments could add more than $200 billion to the cost of Medicare Advantage plans in the next decade, despite no change in enrollees’ health.

For-profit Medicare Advantage insurers made a 5 percent profit margin in 2016 — twice the average of Medicare plans overall, according to the Medicare Payment Advisory Commission, which reports to Congress. That’s slightly better than the health insurance industry’s overall 4 percent margin reported by Standard & Poor’s.

Those profit margins could expand. The Trump administration boosted payments to Medicare Advantage plans by 3.4 percent for 2019, 0.45 percentage points higher than the 2018 increase.

Betsy Seals, chief consulting officer for Gorman Health Group, a Washington company that advises Medicare Advantage plans, said many health plans hesitated to enter that market or expand after President Donald Trump was elected because they weren’t sure the new administration would support the program. But such concerns were erased with the announcement on 2019 reimbursement rates.

“The administration’s support of the Medicare Advantage program is clear,” Seals said. “We have seen the downstream impact of this support with new entrants to the market — a trend we expect to see continue.”

Getting Consumers To Switch

Since the 1960s, Mutual of Omaha has sold Medicare Supplement policies — coverage to help beneficiaries in government-run Medicare pay the portion of costs that program doesn’t pick up. But the company only briefly entered the Medicare Advantage business once — in its home state of Nebraska in the 1990s.

“In the past 10 or 20 years it never seemed quite the right time,” said Amber Rinehart, a senior vice president for the insurer. “The main hindrance was around the political environment and funding for Medicare Advantage.”

Yet after watching Medicare Advantage enrollment soar and government funding increase, the insurer has decided now is the time to act. “We have seen a lot more stability of funding and the political tailwinds are there,” she said.

One challenge for the new insurers will be attracting members from existing companies since beneficiaries tend to stick with the same insurer for many years.

Vivek Garipalli, CEO of Clover Health, said his San Francisco-based company hopes to gain members by offering low-cost plans with a large choice of hospitals and doctors and allowing members to see specialists in its network without prior approval from their primary care doctor. The company is also focused on appealing to blacks and Hispanics who have been less likely to join Medicare Advantage.

“We see a lot of opportunity in markets where there are underserved populations,” Garipalli said.

Clover has received funding from Alphabet Inc., the parent company of Google. Clover sold Medicare plans in New Jersey last year and is expanding for 2019 into El Paso, Texas; Nashville, Tenn.; and Savannah, Ga.

Newton, Mass.-based Devoted Health is moving into Medicare Advantage with plans in South Florida and Central Florida. Minneapolis-based BrightHealth is expanding into several new markets including Phoenix, Nashville, Cincinnati and New York City.

BayCare, based in Clearwater, Fla., is offering a Medicare plan for the first time in 2019.

“We think there is enough market share to be had and we are not afraid to compete,” said Jim Beermann, vice president of insurance strategy for BayCare.

Hospitals are attracted to the Medicare business because it gives them access to more of premium dollars directed to health costs, said Frack of L.E.K. Consulting. “You control more of your destiny,” he added.

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What is Medicare?

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Medicare is a federal health insurance plan for people who are age 65 or older. People who are disabled or have permanent kidney failure can get Medicare at any age. Medicare has four parts—A, B, C, and D.

Part A (hospital insurance) is free for insured people and helps pay for inpatient hospital care and certain followup services. If you’re eligible, you should apply for Part A in the three months before you turn age 65, even if you’re covered by other health insurance.

The other three parts of Medicare require premium payments, and if you don’t enroll when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have coverage. Also, you may have to wait to enroll, which will delay coverage:

• Part B (medical insurance) helps pay for doctors’ services, outpatient hospital care, and other medical services; • Part C (Medicare Advantage plans) are available in many areas. People with Parts A and B can choose to receive all of their health care services through a private insurance company approved by Medicare; and • Part D (Prescription drug coverage) is available to everyone with Medicare. Private companies provide this coverage and you choose the Medicare drug plan

For more information, ask for Medicare (Publication No. 05-10043), or go online to http://www.socialsecurity.gov/pubs/EN-05-10043.pdf

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Medicare Advantage Plan – When can I join?

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When can I join a Medicare Advantage Plan?

You can join when you decide to get your Medicare coverage, you might want to choose a Medicare Advantage Plan (Part C) and/or Medicare prescription drug coverage (Part D).

There are specific times when you can sign up for a Medicare Advantage Plan, or make changes to coverage you already have.
You don’t need to sign up for Medicare each year. However, each year you’ll have a chance to review your coverage and change plans.
There are 2 separate enrollment periods each year: Open Enrollment period for medicare advantage and medicare prescription drug coverage which starts October 15 – December 7.
The other open enrollment period is for Medicare advantage open enrollment period which starts January 1 – March 31.

https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan

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