1. Delaware Health Care Commission April 7, 2016 Secretary Rita Landgraf Department of Health and Social Services Delaware’s Health Insurance Marketplace: Update on Activity

2. Agenda Enrollment Update Marketplace Enrollment Medicaid Expansion Enrollment Stories from the Ground Tax Reminder Plan Management Key Dates and Reminders Questions/Comments 2

3. Enrollment Update 3

4. Marketplace and Medicaid Enrollment Update As of Jan. 31, 2016, 38,152 Delawareans have enrolled in health care coverage through Medicaid expansion and the Health Insurance Marketplace. 4

5. Marketplace and Medicaid Enrollment Update Enrollment as of Jan. 31, 2016: Total Number of Enrollees Increase from previous year Marketplace*28,25613% Medicaid9,8963% Total38,15210% *This number represents Delawareans who have selected a Marketplace plan, either through Healthcare.gov or through direct enrollment with an issuer (with or without the first premium payment having been received directly by the Insurance Company.) 5

6. Marketplace Enrollment 6

7. Delaware Enrollment at a Glance Number enrolled: 28,256 Number who completed applications: 39,361 Percentage who received tax credit: 82% Average monthly premium before tax credit: $477 Average monthly tax credit: $328 Average monthly premium after tax credit: $150 Average percentage reduction in premium after tax credit: 69% 7 7

8. Growth in Covered Lives 8 8

9. Delaware’s Uninsured Rate Delaware Behavioral Risk Factor Surveillance System (adults age 18- 64): 9.7% in 2015. In 2014, the rate was 10.8% and in 2013, 14.3%. Gallup-Healthways Well Being Index (adults 18 and older): 7.4% in 2015. In 2014, the rate was 9.6% and in 2013, it was 10.5%. CDC – National Health Interview Survey (ages 0-64): 5.4% in 2014, down from 10.7% in 2013. No results yet for 2015. 9 9

10. Enrollment Type Used HealthCare.gov for Enrollment Total Selecting 2016 Plan New Consumers Total Reenrollees Active Enrollees Auto- Renewals Delaware28,25633%67%42%25% All FFM States 9.6 million42%58%41%17% 10

11. Reenrollee Status Used HealthCare.gov for 2015 and 2016 Coverage Years % of Reenrollees % Auto- Renewed % Active Renewals % Chose New Plan Avg Monthly Premium Savings of Switchers Delaware70%38%32%30%$25 All FFM States 57%30%27%43%$40 11

12. Premium Tax Credit Delaware (2015)Delaware (2016) All FFM States (2016) Description Total Enrollment25,03628,2569.6 million % with Tax Credit84%82%85% Monthly Premium (before Tax Credit) $404$477$396 Avg Monthly Tax Credit $264$328$290 Avg Monthly Premium (after Tax Credit) $140$150$106 Avg % Reduction in Premium (after Tax Credit) 65%69%73% 12

13. Financial Assistance DelawareAll FFM States Description Total Enrollment28,2569.6 million % with Financial Assistance 82%85% % with Premium Tax Credit 82%85% % with Cost-Sharing Reduction 43%59% 13

14. Comparison by Age Enrollees% Enrolled Age Groups 0 -173,67313% 18 – 252,2608% 26 – 344,52116% 35 – 444,23815% 45 – 545,93421% 55 – 647,34726% 65+2831% Total28,256100% 14

15. Enrollment Update: Comparison by Gender All FFM States Delaware Marketplace Delaware Medicaid Expansion Description Total Enrollment 9.6 million28,2569,896 % Female54% 63% % Male46% 37% 15

16. Metal Level Comparisons 16 Metal LevelDelawareAll FFM States Bronze 22%21% Silver* 61%71% Gold 13%6% Platinum 3%1% Catastrophic 0%1% Total Enrollment 28,2569.6 million *Only silver plans are eligible for a cost-sharing reduction.

17. Self-Reported Race/Ethnicity % Delaware Marketplace Delaware Population (all ages)* % from FFM States U.S. Population (all ages) Self-Reported Race/Ethnicity White68%70.8%63%77.4% African- American 13%22.2%12%13.2% Asian9%3.8%9%5.4% Latino8%8.9%15%17.4% American Indian0%0.7%0%1.2% Native Hawaiian/Pacific Islander 0%0.1%0%0.2% Multi-Racial2%2.5%1%2.5% Total20,307935,6146.1M318.8M 17 * Total Delaware and U.S. population breakdowns from U.S. Census (2014).

18. Household Income % from Delaware % from FFM States Household Income (% of FPL) < 100%2%3% 100%-149%15%38%* 150%-199%27%25% 200%-249%21%15% 250%-299% 14%9% 300%-399% 16%8% > 400% 4%2% Total Enrollment with Data 25,5478.9 million 18 *18 of the 19 states that have not expanded Medicaid are part of the FFM.

19. Medicaid Expansion Enrollment 19

20. Medicaid Enrollment: January 2016 As of the end of January, 9,896 Delawareans ages 19-64 qualified for Medicaid under the expanded eligibility requirements (income between 100% and 138% of the Federal Poverty Level). Of those:  63% were female, 37% male  54% New Castle County, 19% Kent, 26% Sussex  24% ages 19-25  24% ages 26-34  21% ages 35-44  18% ages 45-54  13% ages 55-64 20

21. Medicaid Enrollment by Age: 2014-2016 AgeJan. 2014Jan. 2015Jan. 2016 19-2515%20%24% 26-3434%26%24% 35-4427%22%21% 45-5412%18% 55-6412%13% 21 Percentage of Delawareans ages 19-64 who qualified for Medicaid under the expanded eligibility requirements from 2014 to 2016.

22. Medicaid Enrollment by Gender: 2014-2016 Jan. 2014Jan. 2015Jan. 2016 Female74%64%63% Male26%36%37% 22 Percentage of adult Delawareans ages 19-64 who qualified for Medicaid under the expanded eligibility requirements from 2014 to 2016.

23. Stories from the Ground 23

24. Stories from the Ground A 47-year-old single mother from Dover who also cares for her grandchildren re-enrolled with Westside. She was eligible for a tax credit of $395 a month plus cost sharing, choosing a silver Highmark plan for $37.14 a month. During a Coverage to Care Workshop on Palm Sunday at Iglesia De Dios Maranatha in Seaford, a Chatman navigator was able to enroll two parishioners through a Special Enrollment Period. The church’s pastor wants Chatman to come back for a full-day workshop. A 30-year-old man and his wife from Claymont enrolled through an SEP with Westside. They qualified for a $566 tax credit and chose a silver Aetna plan with a monthly premium of $107.87. They were very happy because the QHP has no deductible and a low monthly premium. 24

25. National Update 25

26. Tax Reminder Make sure you use your health insurance tax form to file your 2015 federal income taxes. Marketplace: Use Form 1095-A, Health Insurance Marketplace Statement. If you received a tax credit, you will use this form to reconcile your credit with your final income for 2015. Employer-based, retiree plan, SHOP or COBRA: Use Form 1095-B, Health Coverage, or Form 1095-C, Employer-Provided Health Insurance Offer and Coverage. Other coverage, including Medicare, Medicaid or CHIP: Use Form 1095-B, Health Coverage. No coverage: Either pay the penalty with your federal return or you must claim a health coverage exemption. 26

27. Plan Management Updates 27

28. Insurer Letters of Intent for Plan Year 2017 In January the Department of Insurance (DOI) invited insurance companies to submit a letter of intent to apply for QHP certification for Plan Year 2017 The following companies submitted letters of intent: 28 Medical PlansStand Alone Dental Plans AetnaDelta Dental Highmark BCBSDEDentegra Dominion 28

29. QHP Review for Plan Year 2017 The DOI is working with insurance companies to prepare for the review of Qualified Health Plans (QHPs) for Plan Year 2017. The DOI has released state-specific standards, guidance and templates to insurers to support their QHP applications. 29

30. Marketplace QHP Review Timeline ActivityProposed Timeline Issuers submit QHP applications including initial rate and form filings April – May 2016 DOI reviews plans for compliance with state and federal laws and standards May – September 2016 DOI conducts public information sessions and accepts written comments June – July 2016 DOI completes review of QHP applications and rates and makes recommendations to CMS August – September 2016 CMS sends final list of certified QHPs to stateOctober 2016 DOI posts final premium ratesMid-October 2016 30

31. Key Dates 31  Consumers who experience qualifying life events such as birth/adoption of a child; marriage or divorce; loss of minimum essential coverage; denial of Medicaid; aging out of parents’ insurance at age 26; or domestic violence eligibility may enroll outside of open enrollment.  Navigators, assisters and agents and brokers are available to help with enrollments outside open enrollment.  Visit www.ChooseHealthDE.com to find free assistance.  Enrollment in Medicaid and in the SHOP marketplace for small businesses is open year-round. DateMilestone Nov. 1, 2016 Open enrollment begins for Plan Year 2017 Jan. 31, 2017 End of open enrollment for Plan Year 2017

32. Questions/Comments  Health Care Commission  Public 32