Health Insurance Marketplace Survey of the 2019 Virginia QHP Options 12/17/2013 Health Insurance Marketplace Survey of the 2019 Virginia QHP Options Deepak Madala Enroll Virginia Program Manager Virginia Poverty Law Center October 28, 2018

Virginia Health Insurance Marketplace 12/17/2013 Virginia Health Insurance Marketplace 6 Plan Options Loss of Innovation Health, United Healthcare, and Aetna Health Anthem Smaller Service Area

Virginia Health Insurance Marketplace 12/17/2013 Virginia Health Insurance Marketplace Statewide coverage, Every County and City has at least 1 option Anthem Returned to Most of Virginia

Premiums and Projected Membership Avg Rate Change from 2018 to 2019 Avg 2019 Per Member Per Month Rates 2019 Projected Covered Lives CareFirst BlueChoice 14.5% $809.21 5,135 Cigna 11.0% $584.00 73,597 CareFirst PPO 45.1% $1389.34 3.101 Anthem HealthKeepers 2.5% $730.73 94,000 Kaiser Permanente 33.8% $641.44 54,232 Optima -7.2% $761.06 59,973 Piedmont 11.94% $858.80 17,786 Virginia Premier N/A $575.92 3,506 Source: Virginia Bureau of Insurance, 2019 ACA Rate Filing Data available at https://www.scc.virginia.gov/boi/co/acafilinginfo/files/acaratefile.pdf

2019 Rate Increase Drivers No Mandate in 2019 12/17/2013 2019 Rate Increase Drivers No Mandate in 2019 Increase in Medical Costs Short-Term and Association Health Plans Non-Payment of Cost-Sharing Reduction Reimbursement Decrease in Outreach and Enrollment Funding However – Medicaid Expansion reduces rates.

Cost Sharing Reductions (CSRs) Special protections for those with income under 250% FPL Limits on Out-Of-Pocket Costs: Deductibles, Co-Pays, and Co-insurance Only applies if Silver Plan is purchased Increases Actuarial Value of Silver Plan to: 94% AV (income 100%-150% FPL) 87% AV (income 150%-200% FPL) 73% AV (income 200%-250% FPL) Insurance companies provide these subsidies to reduce out-of-pocket costs for deductibles and co-pays for low-income people. If you qualify for a CSR, you’ll still get the subsidies because insurers are required to provide them whether they get reimbursed by the government or not. Insurers would compensate for that reduced revenue by raising premiums for 2018. So the people who would suffer the most are those with higher incomes, who don’t qualify for premium tax credits or CSRs. They would feel the pain of big rate hikes most.

Cost Sharing Reductions (CSRs) 12/17/2013 Cost Sharing Reductions (CSRs) Insurers are required to provide CSRs whether they get reimbursed by the government or not Insurers have compensated for loss of CSR reimbursement by raising premiums for 2018 People affected the most are those who don’t qualify for premium tax credits The Virginia Bureau of Insurance has confirmed that all of the exchange insurers have added the cost of CSR to their silver plans. Adding the cost of CSR to silver plan premiums protects most enrollees, as premium subsidies are based on the cost of the second-lowest-cost silver plan, and will thus grow to keep pace with the cost of silver coverage.

How Much Will Coverage Cost? Premium Cost is based on sliding-fee scale for people with income below 400% FPL: Premium Tax Credit picks up difference between required contribution and premium for second lowest cost silver plan. Income Percent of income required to pay toward premiums Up to 133% of poverty 2.01% 133-150% of poverty 3.02-4.03% 150-200% of poverty 4.03-6.34% 200-250% of poverty 6.34-8.10% 250-300% of poverty 8.10-9.56% 300-400% of poverty 9.56%

Premium Tax Credit Example Heather is 32-year old single female Annual Income of $18,090/year (150% FPL) Maximum Contribution 4% Income = $724/yr Cost of 2nd lowest Silver Plan $4,000 ($333.33/mo.) Subtract Contribution - $724 ($ 60.33/mo.) Annual Federal Tax Credit $3,276 ($273.00/mo.) Heather can pay as little as $60.33 per month Tax Credit of $3,276 can go straight to Health Plan

Premium Tax Credits Increase if Rates Increase Annual Income of $18,090/year (150% FPL) Maximum Contribution 4% Income = $724/yr Cost of 2nd Lowest Cost Silver Plan Maximum Contribution for Heather Annual Federal Tax Credit $4,000 ($333.33/mo.) $724 ($60.33/mo.) $3,276 ($273.00/mo.) $6,000 ($500.00/mo.) $5,276 ($439.67/mo.)

Silver Plan Options for People w/o APTCs 12/17/2013 Silver Plan Options for People w/o APTCs If an insurer sells the same plan ON and OFF the Marketplace then both will have same cost and as a result both will include the cost of CSRs But OFF exchange plan doesn’t qualify for APTC Some Issuers in Virginia have created slightly different OFF exchange only plans that do not have the cost of CSRs added Cigna, Anthem, Piedmont, and Virginia Premier do not have OFF exchange plans CareFirst, Kaiser Permanente, and Optima all have OFF exchange silver plans that are different from their ON exchange plans. These silver plans do not include the cost of CSRs KP VA Silver 2500/30/Dental Off $462.98 KP VA Silver 2500/30/Dental On/Off $562.14

12/17/2013 Anthem HealthKeepers Premiums for an Adult Individual Age 40 in Roanoke, VA Metal Level Plan Marketing Name Plan Type Premium Bronze Anthem HealthKeepers Bronze X 6500 HMO $439.87 Anthem HealthKeepers Bronze X 5250 $448.77 Anthem HealthKeepers Bronze X 5900 $460.74 Anthem HealthKeepers Bronze X 4900 for HSA $465.43 Anthem HealthKeepers Bronze X 5700 Online Plus $467.26 Gold Anthem HealthKeepers Gold X 1350 $569.87 Silver Anthem HealthKeepers Silver X 6100 $570.09 Anthem HealthKeepers Silver X 1800 $623.31 bronze and gold plans will be especially valuable in 2018 for enrollees who get premium subsidies, as the larger premium subsidies (based on the dramatically higher prices for silver plans) can be applied to plans at any metal level, despite the fact that premiums at the other metal levels don’t include the added cost to cover CSR

CareFirst Premiums for an Adult Individual Age 40 in Alexandria, VA Metal Level Plan Marketing Name Plan Type Premium Gold HealthyBlue HMO Gold $1,750 HMO $750.51 Silver BlueChoice HMO Silver $3,000 $801.57 HealthyBlue PPO Gold $1,750 PPO $1,166.85 BluePreferred Silver $3,000 $1,210.27

Cigna Premiums for an Adult Individual Age 40 in Sterling, VA Metal Level Plan Marketing Name Plan Type Premium Bronze Cigna Connect 7000 EPO $403.82 Cigna Connect 6750 $416.52 Silver Cigna Connect 6500 $507.85 Gold Cigna Connect 1500 $520.17 Cigna Connect 4500 $521.91

12/17/2013 Kaiser Permanente Premiums for an Adult Individual Age 40 in Fredericksburg, VA Metal Level Plan Marketing Name Plan Type Premium Bronze KP VA Bronze 5500/50/Dental HMO $517.40 Gold KP VA Gold 1500/20/Dental $611.16 KP VA Gold 1000/20/Dental $626.07 Silver KP VA Silver 6000/35/Dental $638.47 KP VA Gold 0/20/Dental $643.97 KP VA Silver 3200/20%/HSA/Dental $674.87 KP VA Silver 2500/30/Dental $718.42 Platinum KP VA Platinum 0/5/Dental $744.33 KP VA Silver 2500/30/Dental Off $462.98 KP VA Silver 2500/30/Dental On/Off $562.14

Silver Premiums Higher than Most Gold Plans 12/17/2013 Silver Premiums Higher than Most Gold Plans Premiums for an Adult Individual Age 40 in Fredericksburg, VA KP VA Standard Silver 6000/35/Dental KP VA Gold 1500/20/Dental Monthly Premium $638.47 $611.16 Deductible $6,000 $1,500 Out-of-Pocket Maximum $7,900 $6,850 Primary Doctor $35 $20 Specialist $55 $40 Tier 2 Brand Drugs $60 $30 KP VA Silver 6000/35/Dental Off $411.46 (1.278 age factor for 40 year old) Geo is 1.0 $525.85 KP VA Silver 6000/35/Dental On/Off $499.59

Optima Premiums for an Adult Individual Age 40 in Norfolk, VA Metal Level Plan Marketing Name Plan Type Premium Bronze OptimaFit Bronze 7200 20% Direct M HMO $443.48 OptimaFit Bronze 6000 20% HSA Direct M $478.79 Silver OptimaFit Silver 6600 30% Direct M $601.63 Gold OptimaFit Gold 1600 10% Direct M $610.31 OptimaFit Silver 1800 25% Direct M $663.65

Piedmont Premiums for an Adult Individual Age 40 in Lynchburg, VA Metal Level Plan Marketing Name Plan Type Premium Bronze Bronze Standard 6800 POS $468.66 Bronze 7800 $471.94 Bronze HSA 5500 $504.79 Gold Gold 1600/35/60 $606.84 Silver Silver 6600/20% $640.75 Silver 4500/40/25% $651.80

Virginia Premier Premiums for an Adult Individual Age 40 in Richmond, VA Metal Level Plan Marketing Name Plan Type Premium Bronze Preferred Bronze 6600 HMO $379.00 Gold Preferred Gold 1600 $499.02 Silver Preferred Silver 6500 $503.95 Preferred Silver 4500 $518.61

Premium Rates Will Vary Age Geographic Region (12 regions in Virginia) Metal Tier Tobacco Actual rates and plan details are available on www.healthcare.gov

Maximum Out-of-Pocket in 2019 12/17/2013 Maximum Out-of-Pocket in 2019 Puts a cap on what the enrollee pays in cost-sharing charges each year Only applies to in-network services Out-of-Pocket limit is not the amount that an enrollee must spend each year All people, regardless of whether they are in a family or individual health plan, will not have to pay more than the individual max for cost-sharing 2017 2018 2019 Individual Maximum $7,150 $7,350 $7,900 Family Maximum $14,300 $14,700 $15,800 The maximum out-of-pocket limit for self-only coverage is $7,150 (up from $6,850 in 2016). For coverage other than self-only (such as family coverage), the maximum out-of-pocket limit is $14,300 (up from $13,700 in 2016).

Tobacco Surcharge in Virginia 12/17/2013 Tobacco Surcharge in Virginia Tobacco use is defined as Using tobacco products an average of four times per week within no longer than the past six months Religious or ceremonial uses of tobacco is excluded  APTC does not apply to the tobacco surcharge Tobacco users will need to pay for this additional cost. Tobacco cessation services are included as an EHB with no cost sharing in all qualified health plans available on the marketplace

Tobacco Surcharge in Virginia 12/17/2013 Tobacco Surcharge in Virginia Insurance Company Tobacco Surcharge Anthem HealthKeepers Blue Cross Blue Shield 0-30% CareFirst BlueCross BlueShield 0% Cigna 25% Kaiser Permanente 20% Optima Health Piedmont 0-50% Virginia Premier 15% Tobacco use is defined as Using tobacco products an average of four times per week within no longer than the past six months Religious or ceremonial uses of tobacco is excluded  APTC does not apply to the tobacco surcharge Tobacco users will need to pay for this additional cost. Tobacco cessation services are included as an EHB with no cost sharing in all qualified health plans available on the marketplace

Anthem Tobacco Surcharge Age Tobacco Factors 0-17 0% 18-24 5% 25-29 10% 30-39 15% 40-49 20% 50-59 25% 60+ 30%

Piedmont Tobacco Surcharge Age Tobacco Factors 0-18 0% 19-24 5% 25-29 10% 30-34 15% 35-39 20% 40-44 25% 45-49 30% 50-54 40% 55+ 50%

Plan Selection Checklist 12/17/2013 Plan Selection Checklist Always consider all costs Any services not subject to the deductible? Check provider networks: many providers are now out-of-network Check the prescription drug formulary and cost sharing requirements for the various drug tiers Remind consumers to take advantage of no-cost sharing preventive services Are there any exclusions or limitations on covered services? premiums, deductibles, co-pays, and coinsurance vary quite a bit and can make a big difference in what people pay.

12/17/2013 QUESTIONS? Thank you!