Vermont’s Health Insurance Exchange September 17, 2013 Paul Harrington, EVP Vermont Medical Society

ACA Health Insurance Exchange equals Vermont Health Connect. The Federal Affordable Care Act (ACA), enacted in 2010, requires each state to have a health benefit exchange where individuals and small businesses (employs 50 or fewer full- time employees) purchase standardized health insurance products from health plans, using an online marketplace. In Vermont, the online marketplace or exchange is called Vermont Health Connect.

2011 Health Care Reform Bill H Act 48 Green Mountain Care Board: 5 person established to oversee cost containment strategies Vermont Health Connect: Benefit Exchange created in Medicaid Dept. to help achieve universal insurance coverage, as required under the federal Patient Protection and Accountable Care Act (ACA). Green Mountain Care: Anticipates the evolution of the Health Benefit Exchange into Green Mountain Care: the state’s publicly financed single-payer health care system for all Vermonters beginning in 2017.

Act 171: 2012 Health Care Reform Bill Established Vermont Health Connect As the Exclusive Health Benefit Exchange Beginning on Jan. 1, 2014, the exchange will help provide qualified health benefit plans to eligible individuals and small businesses with 50 or fewer employees and employers with 100 employees or fewer in DHVA/Medicaid Dept will contract with BCBSVT and MVP. Federal premium subsidies will be available to individuals who enroll in exchange plans (at silver plan level) – provided that their income is above 133 % of FPL and no more than 400 % of FPL. Estimated enrollment in 2014 = 115,000 (626,000 total) Medicaid will cover individuals and families up to 133% FPL

Vermont Health Connect Enrollment Begins on October 1, 2013 Individuals can enroll in the system from October 1, 2013 through March 31, Small businesses will have an open enrollment period beginning on October 1, 2013 and ending on December 15, 2013 Insurance payments will be to the State of Vermont and the state will forward premium payments to BCBS or MVP.

ACA Individual Mandate to Purchase Health insurance Coverage The ACA includes a mandate that individuals obtain health insurance by January 1, If someone doesn’t purchase coverage, they will have to pay a penalty at tax time. This penalty starts in 2014 at $95 per adult and $47.50 per child (or 1 percent of income, whichever is higher) in the household who goes without coverage. The penalty goes up each year until 2016, when it will be $695 per adult and $ per child (or 2.5 percent of income, whichever is higher).

Employer Responsibilities Under the ACA Employers with 50 or more full-time employees must offer all employees working an average of 30 hours per week “qualified” health care coverage, beginning on January 1, 2015, or pay a penalty of $2,000 times the total number of full- time employees (minus the first 30). “Qualified” coverage must cover at least 60% of employees’ healthcare costs on average.

Catamount & VHAP Sunset Under Vermont Health Connect Both VHAP and Catamount will end on 12/31/13 Vermonters in these programs will transition based on their income to either Medicaid or a private plan under Vermont Health Connect MedicaidBCBS or MVP VHAP38,60228,58710,015 Catamount11,4272,2949,133

All Plans on Vermont Health Connect Offer Standard Benefits All plans must have “essential health benefits” but the amount that insurance will cover and additional benefits will vary The plans offered in the state must be “substantially equal” to this benchmark plan Ambulatory patient services Emergency services Prescription drugs Rehabilitative and habilitative services and chronic disease management Hospitalization Maternity and newborn care Mental health and substance use disorder services, including services behavioral health treatment Laboratory services Preventive and wellness Pediatric services, including oral and vision care

The four levels of insurance coverage - bronze, silver, gold and platinum - are based on actuarial value, a measure of the level of financial protection a health insurance policy offers

GREEN MOUNTAIN CARE BOARD APPROVES PREMIUMS FOR INSURANCE PLANS OFFERED THROUGH VERMONT HEALTH CONNECT On July 8, the GMCB approved rates resulting in an estimated single-person premium of approximately $395 per month for the benchmark “silver plan” sold through Vermont Health Connect by Blue Cross. The MVP premium for an equivalent plan will be approximately $410 per month. The approved premiums will be offset by federal and state tax credits. For example, for a single Vermonter making $34,488 per year – approximately the state’s mid-point wage in 2012 – subsidies bring the final monthly cost of the same Blue Cross silver plan down to approximately $230 per month and reduce the cost of the MVP plan to approximately $252 per month.

Federal Subsides Available Only Through Vermont Health Connect Under the ACA, individuals who purchase insurance after January 1, 2014 through an Exchange will be eligible for subsidies for health insurance premiums and cost-sharing if their income is less than 400 percent of the federal poverty level (FPL). The subsidy is based on the premium for a benchmark plan (the second lowest cost silver plan available in an Exchange). A subsidy calculator can be found at: ator ator

Premium Limits for Consumers on Vermont Health Connect Based on Income IncomePremium Limit Up to 133% FPL2% of income % FPL3 - 4% of income % FPL % of income % FPL % of income % FPL % of income % FPL 9.5% of income

Questions? Paul Harrington, EVP Vermont Medical Society