The Latest On What Is Coming In 2014? What I Learned from the Humana Webinar #2* * some material taken directly from the Humana Power Point

State Decisions on Exchanges

Exchange Timeline July Federal and Partnership Marketplaces register and train agents August 2013 – Agent Marketplace training completed, publish agent lists, individual products September 2013 – Federal and Partnership Marketplaces publish agent lists (small group)

Exchange Timeline October 1, 2013 to December 15, 2013 is Open Enrollment for 01/01/2014 effective date. December 16, 2013 to March 31, 2014 continuing enrollment –If application is finalized between the 1 st and 15 th of the month, the effective date will be the first of the following month. –If between the 16 th and the end of the month, effective date will be the first of the second following month

Exchange Timeline April 1, 2014 to September 30, 2014 will be Qualifying Events enrollments only –Marriage, divorce, job change, plan termination, etc. –This means someone cannot go without insurance, get diagnosed with an illness or have an accident and then buy health insurance on the exchange.

What can I do now? Reach out to clients and calculate their FPL and potential subsidies Set an appointment date in Oct to discuss their options Stay up to date on your state’s decisions Talk to small businesses without group health about a defined benefit plan to allow their employees to pay for their individual health insurance with pre-tax dollars now. Encourage them to lock in today’s rates now.

Why Are Premiums Going Up In 2014? Only 3 Age Bands (currently 5 in 41 states) No Underwriting (guaranteed availability) New Taxes and Fees on Premiums On average, plans will have more benefits due to mandated Minimum Essential Benefits Know these things so you can explain to your customer why there is going to be further price increases Use this to create urgency to buy now

Essential Health Benefits Plans must cover 10 categories of mandated essential health benefits 1.Ambulatory Patient Services 2.Emergency Services 3.Maternity and Newborn Services 4.Pediatric Services Including Dental and Vision 5.Rehabilitative Services and Devices

Essential Health Benefits 6. Mental Health and Substance Use Services 7. Preventative and Wellness Services and Chronic Disease Management 8. Hospitalization 9. Prescription Drugs 10. Laboratory Services

Exchange Plans Remember these percentages

Federal Assistance on the Exchange Help your customer determine if they are eligible for financial assistance on the exchange (subsidies) Use the calculator on your USABG Agent Website

Federal Assistance on the Exchange

Plug in the numbers See the results

What is the Federal Poverty Level?

Exchanges: Your Book of Business Many of the 30 million new to health insurance will go on the expanded Medicaid program Group 1- low income, must purchase on Exchange to qualify for subsidies Group 2 – Option to purchase On or Off the Exchange, will not receive subsidies Group 3 those who opt to pay penalty/tax –These may be candidates for limited benefit or short term plans

Who is Eligible? Individuals and Families with incomes between 100 – 400% of FPL (Group 1) Cannot be Medicaid or Medicare eligible Some people on group insurance today –Employer no longer offers coverage –Employer coverage is not affordable (premium more than 9.5% of income) –Employer coverage does not provide Minimum Essential Coverage

Financial Assistance Available On the Exchange - 2 types of assistance Advance Premium Tax Credits –For clients who are 100 to 400% FPL –Ensure that your clients do not have to pay more than a percentage (9.5%) of their income for health insurance premiums Credit applied at time of monthly premium payment (paid to the insurance company) Based on household income of the most recent tax return available –If entered income is not correct, you may owe money back at time of tax return; or you may get a refund

Financial Assistance Available On the Exchange - 2 types of assistance Cost-Sharing Subsidies –For clients who are 100% to 250% FPL –Protects your clients from high out-of- pocket costs at point of service. Adds percentage to the actuarial value of the Silver plan.

Assistance Example 1 Bob’s family of 4 Household income of $75,000, FPL 318% Because Bob’s FPL is less than 400% but more than 250%, they only get the Advance Premium Tax Credit.

Assistance Example 2 Betty 60, Household Income $20,000, FPL 174% FPL less than 250%, she gets Advanced Premium Tax Credit, plus Cost Sharing Subsidy of 87% on the Silver plan. (Silver standard % plan)

Plan Continuation Customers will be able to keep their current plans into 2014 and at renewal apply for an exchange or off-exchange plan, or keep their plan and it will be upgraded to ACA compatible They purchase a plan today with 6/1/13 eff date, in Oct they can see if the exchange plan with subsidies is a better option. If not, they can keep their plan until 5/31/2014 and then change.

Coordination between Private and Public Exchanges Final exchange regulations enable States to allow agents and brokers that operate a “web-based entity” to sell individuals health plans offered on the “public” exchange…qualifying individuals may use subsidies for this purchase. If a State chooses to work with a web-based entity, the entity must Make sure that the individual completes a single, streamlined eligibility verification and enrollment application through the “public” Exchange. Provide consumers the ability to view all plans offered through the “public” Exchange. Provide standardized comparative information on each available QHP Allow consumers to go directly to the “public” exchange website if they choose. State exchanges will determine how brokers can be compensated for bringing business to exchanges

Final Thoughts Exchanges and subsidies should free up some premium dollars to put into Total Protection products. It is going to be confusing for most people. They are going to need your help. Federal exchanges will only offer the metallic health plans We can have Private Exchanges and offer all our products. October open enrollment will be our opportunity to make huge commissions in 2½ months. How many people can you enroll?