Health Care Cabinet Meeting and Enrollment Update
"Explore the latest updates from the Health Care Cabinet meeting on March 10, 2015, including open enrollment updates, benefits for individuals using opioids, anticipated costs, subsidies, operating metrics, membership data, and enrollment activity. Gain insights into the current status of enrollments, new QHP customers, Medicaid applicants, carrier enrollments, and more."
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Presentation Transcript
Health Care Cabinet March 10, 2015 1
Agenda A. Open Enrollment Update B. Benefits available for individuals using Methadone or other opioids C. Anticipated costs and subsidies available to the individuals at 138% of poverty who are anticipated to move from Medicaid to AHCT 2
Operating Metrics Total Volume - 536,436 600,000 500,000 400,000 300,000 200,000 100,000 - Oct 2013 Nov 2013 Dec 2013 Jan 2014 Feb 2014 Mar 2014 Apr 2014 May 2014 Jun 2014 Jul 2014 Aug 2014 Sep 2014 Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Insured without APTC 22,920 Insured with APTC 80,087 Medicaid 433,429 4
Operating Metrics Insured Membership- 103,007 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 - Oct 2013 Nov 2013 Dec 2013 Jan 2014 Feb 2014 Mar 2014 Apr 2014 May 2014 Jun 2014 Jul 2014 Aug 2014 Sep 2014 Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Insured without APTC 22,920 Insured with APTC 80,087 5
Open Enrollment Activity Update (2/13/15) Current enrollment volume across all plans and programs stands at 536,436 individuals Since the start of this open enrollment, we have processed more than 103k QHP enrollments and 235k Medicaid enrollments. Of these 35,887 were new QHP customers, and 153,828 were new Medicaid applicants. Net new enrollment for the OE period thus far stands at 189,715 (81% Medicaid/19% QHP) QHP Membership Medicaid Volume 103,007 35,887 433,429 153,828 67,120 81,170 198,431 Total New Repeat Enrollment Total New Repeat Enrollment Existing Membership Enrollment Enrollment Enrollment Enrollment 6
Additional Membership Information (2/13/15) To date, ConnectiCare continues to see the majority of new enrollments (42%) Anthem is currently taking 1 out of every 3 new enrollments (30%) Healthy CT has seen a dramatic uptick in selection, with nearly a quarter of individuals selecting their plans. Newly offered dental plans and our SHOP program continue to show solid gains New 2015 Enrollees Dental = 1,565 2015 OE Carrier Enrollment Anthem Blue Cross and Blue Shield ConnectiCare Benefits Inc HealthyCT Inc UnitedHealthcare 10,893 15,235 8,182 1,577 35,887 30% 42% 23% 4% 100% SHOP: Groups = 173 Members = 1,148 173 groups with 1148 7
Post Open Enrollment Another round of our new member census research will be conducted to gather information on key demographic and attitudinal variables. This will include questioning in the areas of : Prior uninsured status Race and ethnicity Enrollment channel use Reasons for sign up Post enrollment expectations Expected plan use 8
Benefits available for individuals using Methadone or other opioids 9
Benefits available for individuals using Methadone or other opioids Carrier Coverage Methadone maintenance is covered on all policies/products. Opioid treatment such as ambulatory detox, with the use of suboxone, is also covered as well as other levels of care such as inpatient, PHP, IOP and Residential when it meets medical necessity. Anthem formulary includes the Methadone and the generic form of Soboxon. Methadone treatment is not specified within CBI s EOC. Based on the definition for coverage for Behavioral Health, Inpatient, Outpatient regarding Substance Abuse, Methadone may get covered under the umbrella outlining the coverage. Methadone Treatment is covered. Prior Authorization is required for Inpatient services but is not required for Outpatient services. HealthyCT formulary includes Methadone. Soboxon as well as the generic form is available. This drug is used for opioids. Methadone is not covered. Anthem Connecticare HealthyCT United Healthcare 10
Anticipated costs and subsidies available to the individuals at 138% of poverty who are anticipated to move from Medicaid to AHCT 11
2015 Silver and 2015 Silver Cost-sharing Reduction Alternatives Qualified Health Plans - Single Individual, age 30, Hartford County FPL Level used for premiu m example Plan Inpatient Co- Pays Primary Care Co-Pays Monthly Premiums (cheapest silver plan) Pharmacy Co-Pays Speci alists Co- Pay Income Band (FPL) Emergency Departmen t Co-Pay Non- Preven tative Tier 2 Preferred Brand Tier 3 Non- Preferred Brand Tier 4 Specialt y Out-of- Pocket Max Medical Deductible Pharmacy Deductible Per Day Max per Stay Preven tative Tier 1 Generic 138- 150%* 94% CSR $600 139% $49.74 $0 $0 $100 $400 $75 $0 $20 $35 $5 $20 $35 $50 150- 200% 87% CSR $1,750 185% $102.56 $400 $25 $200 $800 $100 $0 $20 $35 $5 $20 $35 $50 200- 250% 73% CSR $5 $30 $55 $60 $5,200 201% $125.66 $1,900 $25 $500 $2,000 $150 $0 $30 $50 70% Silver $5 $30 $55 $60 $6,600 >250% 263% $218.07 $2,600 $25 $500 $2,000 $150 $0 $30 $50 Subject to the Medical deductible before listed cost-sharing benefit will apply Subject to the Pharmacy deductible before listed cost-sharing benefit will apply * 94% CSR plan is available to those who are eligible for APTCs and whose household MAGI is between 138% and 150% of the federal poverty level. The threshold drops to 0-150% for those HHs who do not qualify for HUSKY due to immigration prohibitions such as the 5 year bar. 12
2015 Silver and 2015 Silver Cost-sharing Reduction Alternatives - Qualified Health Plans - Single Parent age 30, child age 20, Hartford County Inpatient Co-Pays Primary Care Co-Pays Pharmacy Co-Pays Tier 3 Non- Preferr ed Brand FPL Level used for premium example Plan Monthly Premiums (cheapest silver plan) Emergency Depart- ment Co- Pay Income Band (FPL) Max per Stay Preven tative Visit Non- Prevent ative Tier 2 Preferre d Brand Out-of- Pocket Max Medical Deductible Pharmacy Deductible Per Day Specialis ts Co-Pay Tier 1 Generic Tier 4 Specialty 138- 150%* 94% CSR 141% $67.83 $0 $0 $100 $400 $75 $0 $20 $35 $5 $20 $35 $50 $1,200 150- 200% 87% CSR 185% $138.82 $800 $50 $200 $800 $100 $0 $20 $35 $5 $20 $35 $50 $3,500 200- 250% 73% CSR 201% $174.36 $3,800 $50 $500 $2,000 $150 $0 $30 $50 $5 $30 $55 $60 $10,400 70% Silver >250% 263% $293.48 $5,200 $50 $500 $2,000 $150 $0 $30 $50 $5 $30 $55 $60 $13,200 Subject to the Medical deductible before listed cost-sharing benefit will apply Subject to the Pharmacy deductible before listed cost-sharing benefit will apply * 94% CSR plan is available to those who are eligible for APTCs and whose household MAGI is between 138% and 150% of the federal poverty level. The threshold drops to 0-150% for those HHs who do not qualify for HUSKY due to immigration prohibitions such as the 5 year bar. 13
