1. To the Participants: The phone lines have been muted
You may type your questions in the GoToWebinar box on the right
Q & A will be sent in a follow up
Follow up will include:
Link to this presentation
Follow up will include more info on all resources
Recorded webinar will be posted at

2. ACA Open Enrollment 2018: Updates and Observations
Where are we now and where are we headed?

3. During this session we will cover:
Quick legislative overview
Review changes to the ACA certification process
Current product availability in Texas (this webinar is designed for Texas opportunities)
Alternative products for health insurance coverage
Charging a service fee vs. commission
Sales ideas to grow your agency during the 2018 OEP

4. ACA Legislative Overview
The uncertainty surrounding Senate Republicans' latest repeal-and-replace bill is putting more pressure on Democrats to reach a deal to stabilize the Affordable Care Act
Sens. Lamar Alexander and Patty Murray have been working on a plan to tweak the ACA through a mix of looser regulations and more reliable funding
Alexander's hand in those talks may be getting stronger as a side effect of the momentum behind a repeal bill sponsored by Sens. Lindsey Graham and Bill Cassidy
ACA Legislative Overview

5. Sens. Lisa Murkowski and John McCain are publicly rooting for the stabilization effort to succeed, and Graham-Cassidy can't pass without at least one of them
Murkowski has actively participated in the four hearings the Health, Education, Labor and Pensions Committee has held on stabilization, often staying longer than most other members
On Sunday, McCain mentioned this effort by name on Face the Nation, saying Republicans shouldn't "ram" their proposal through
Why?

6. The Problem
While Democrats say the negotiations are going well and weekend talks were "productive," per a Democratic aide, Republicans disagree
"There's no deal, and one doesn't look imminent. If there's no deal, I assume that means Republicans are going to flock to the only thing that's on the table," a senior GOP aide said

7. Yes, but…
McCain and Murkowski could vote against Cassidy-Graham-Heller- Johnson regardless
Both their states stand to lose under the bill, according to an early analysis by the left-leaning Center on Budget and Policy Priorities
But it seems that if what they've been calling for all along is within reach, it gives them a lot more of an excuse to vote against a GOP- only bill

8. Who to watch:
Murray
If she can strike a deal with Alexander — which hinges on giving states more flexibility through innovation waivers — it could deeply influence McCain and Murkowski's decision

9. Authored by Republicans Lindsey Graham of South Carolina and Bill Cassidy of Louisiana.
The new repeal bill would replace the Affordable Care Act’s insurance subsidies with block grants to states 01
The measure would end Obamacare’s requirements that individuals obtain health insurance and that most employers provide it to their workers 02
Would give states flexibility to address the needs of people with pre-existing medical conditions. 03

10. Need to act by Friday, Sept 29
Republican Rand Paul of Kentucky said Monday he’s opposed to the Graham-Cassidy bill, saying it doesn’t go far enough
John McCain of Arizona said he’s “not supportive” yet, citing the rushed legislative process
If it passed the Senate, the House would have to pass the bill without any changes. House Speaker Paul Ryan said Monday that the measure is Republicans’ last best chance to repeal Obamacare.
Need to act by Friday, Sept 29

11. July 2017, Majority Leader Mitch McConnell’s effort to pass a replacement with only Republican support suffered a spectacular defeat in the Senate
Despite all the obstacles, Democrats quickly geared up for another campaign against repeal, warning that the latest bill is a serious threat
"This bill is worse than the last bill," Senate Democratic leader Chuck Schumer of New York told reporters Monday. "It will slash Medicaid, get rid of pre-existing conditions. It’s very, very bad."\
Republicans Lindsey Graham of South Carolina and Bill Cassidy of Louisiana

12. State based, hybrid high risk pools
Designed to stabilize the individual major medical marketplace
For the purpose of providing financial backing for the higher risk associated with some individuals
New hybrid high-risk pools are one of an important set of ideas to improve the cost, plan choice and healthcare provider options available to consumers in the individual market
They would serve as an important market stabilizer and should be a first priority in actions taken to improve healthcare in the individual market

13. Stabilize the exchange marketplace
1. Change the age banding ratio to five to one 2. Evaluate Essential Health Benefits to determine which are most critical to good health based on medical evidence 3. Evaluate preventive care benefits to determine which truly prevent future illness and ensure good health 4. Encourage value-based purchasing and transparency in the cost of healthcare 5. Make electronic medical records interoperable

14. Sanders offers Medicare-for-all
a significant change from 2013 when Sanders, who lost the 2016 Democratic presidential nomination to Hillary Clinton, attracted no co- sponsors

15. Sanders offers Medicare-for-all
Support for Sanders’s plan may be stronger among potential 2020 presidential candidates seeking to appeal to those who backed the Vermont senator’s campaign last year 01
Supporters include: 02
All frequently mentioned as potential 2020 Presidential candidates – are among the co-sponsors 03

16. Single Payer in our future?
Senator Claire McCaskill of Missouri said the proposal is “premature,” and she would prefer allowing people age 55 to 64 to buy into the Medicare program
The Democratic Party is increasingly wrapping itself in the flag of Medicare for all,” said Adam Green, co-chairman of the Progressive Change Campaign Committee
Senator Tim Kaine of Virginia, Clinton’s 2016 running mate, said “I want everybody to be able to buy a public health plan; I want more choices rather than fewer”

17. ACA 2018 Penalties FPL Subsidies HealthCare.gov for on-exchange
Off-Exchange – suggest using the carrier website directly
ACA

18. 01 02 03 04 Basic reminder There is only one ACA
OEP is shortened to 45 days (Nov 1-Dec 15) 02
On Exchange means you qualify for an Advanced Premium Tax Credits 03
Off Exchange means you do not qualify for subsidies 04

20. ACA Certification Requirements

31. Current ACA Products at The Brokerage

32. “Belynda’s 2018 ACA Cheat Sheet”

33. BCBSTX ACA plans in all 254 Texas Counties
On and Off Exchange plans in all TX Counties
Bronze, Silver, Gold
HMO Only, no PPO plans
New, tiered commission implemented in 2017
2018 rate increase expected to be up to 25%

36. Quotes
Enrollment
App Tracking
Commissions

38. Baylor Scott and White Off Exchange plans only
HMO and EPO plan options
Bronze plan only
PPO Plans MUST BE REWRITTEN as EPO
This opens an SEP for and eff dates
HMO Members MUST set up a new 2018 or risk lapsing their coverage
Specific plans by county located at
Agent commission
EPO – 1%, HMO 2%

39. 2018 Product Overview Off Exchange Only HMO-Bronze CTX/NTX EPO-Bronze
For agent use only, not for consumer/beneficiary distribution.

40. Service Area
Denton
Collin
Rockwall
HMO/EPO
HMO Only
Tarrant
Dallas
El Paso
Hood
Johnson
Ellis
Erath
Somervell
Hill
Coke
Bosque
Runnels
Sterling
Coleman
Hamilton
Freestone
Limestone
Mills
McLennan
Reagan
Tom Green
Coryell
Irion
Concho
McCulloch
Leon
Falls
Lampasas
San Saba
Bell
Robertson
Madison
Schleicher
Menard
Burnet
Milam
Crockett
Mason
Llano
Walker
Williamson
Brazos
Grimes
Sutton
Kimble
Burleson
Travis
Blanco
Lee
Washington
Hays
Bastrop
Bexar, Comal, and El Paso networks are approved but not fully built
Austin
Comal
Caldwell
Fayette
Waller
Bexar

41. Summary of Major Changes to the Individual and Family Plan Portfolio – PY2017 to PY2018
HMO
HMO offering changed from Bronze 6400 to Bronze 7300
Deductible: $7,300 ind/$14,600 family
MOOP: $7,350/$14,700
Rx drugs: Deductible + 20%
PPO
PPO not available for 2018
EPO
New for plan year 2018
Bronze 7300 plan added

42. Individual HMO Plans PY 2017: PY 2018: Benefits INN
Bronze HMO 6400/50OV
Benefits
INN
Individual/Family Deductible
$6,400 / $12,800
Member Coinsurance
20%
Individual/Fam MOOP
$7,150 / $14,300
Inpatient hospitalization
Deductible then 20%
Outpatient Facility Fee
Skilled Nursing Facility
Primary Care Office Visit
$50 copay (first visit), then Deductible then 20%
Specialist Office Visit
OP Mental Health/ Substance Abuse
PT/OT & Rehabilitative ST
Urgent Care
$50 copay (first visit)
Emergency Room
Imaging (PET, CT, MRI)
OP X-ray
OP Lab
Pharmacy Deductible
N/A
Preferred generic drugs
$17 copay
Preferred brand drugs
Deductible then 50%
Non-Preferred brand
Specialty drugs
HMO
Bronze 7300
Benefits
INN
Individual/Family Deductible
$7,300 / $14,600
Member Coinsurance
20%
Individual/Fam MOOP
$7,350 / $14,700
Inpatient hospitalization
Deductible then 20%
Outpatient Facility Fee
Skilled Nursing Facility
Primary Care Office Visit
$50 copay (first visit), then Deductible then 20%
Specialist Office Visit
OP Mental Health/ Substance Abuse
PT/OT & Rehabilitative ST
Urgent Care
$50 copay (first visit)
Emergency Room
Imaging (PET, CT, MRI)
OP X-ray
OP Lab
Pharmacy Deductible
N/A
Preferred generic drugs
Preferred brand drugs
Non-Preferred brand
Specialty drugs

43. HMO IFP Service Area
Mirrors our current commercial service area, plus Bexar, Comal, and El Paso (networks still in development)
Available in 61 Counties:
Austin, Bastrop, Bell, Bexar, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coke, Coleman, Collin, Comal, Concho, Coryell, Crockett, Dallas, Denton, Ellis, El Paso, Erath, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Hood, Irion, Johnson, Kimble, Lampasas, Lee, Leon, Limestone, Llano, Madison, Mason, McCulloch, McLennan, Menard, Milam, Mills, Reagan, Robertson, Rockwall, Runnels, San Saba, Schleicher, Somervell, Sterling, Sutton, Tarrant, Tom Green, Travis, Walker, Waller, Washington, and Williamson

44. Individual EPO 2017 PPO 2018 EPO Bronze EPO 7300 Bronze PPO 7150
Benefits
INN
OON
Individual/Family Deductible
$7,150 / $14,300
$14,300 / $28,600
Member Coinsurance 0%
50%
Individual/Fam MOOP
7,150 / 14,300
14,300 / 28,600
Inpatient hospitalization
Deductible then 0%
Deductible then 50%
Outpatient Facility Fee
Skilled Nursing Facility
Primary Care Office Visit
$60 copay (first 2 visits), then Deductible then 0%
Specialist Office Visit
$100 copay (first 2 visits), then Deductible then 0%
OP Mental Health/ Substance Abuse
PT/OT & Rehabilitative ST
Urgent Care
Emergency Room
Imaging (PET, CT, MRI)
OP x-ray
OP Lab
Pharmacy Deductible
N/A
Preferred generic drugs
$40 copay
Preferred brand drugs
$100 copay
Non-Preferred brand
Specialty drugs
2018 EPO
Bronze EPO 7300
Benefits
INN
Individual/Family Deductible
$7,300 / $14,600
Member Coinsurance
20%
Individual/Fam MOOP
$7,350 / $14,700
Inpatient hospitalization
Deductible then 20%
Outpatient Facility Fee
Skilled Nursing Facility
Primary Care Office Visit
$50 copay (first visit), then Deductible then 20%
Specialist Office Visit
OP Mental Health/ Substance Abuse
PT/OT & Rehabilitative ST
Urgent Care
$50 copay (first visit)
Emergency Room
Imaging (PET, CT, MRI)
OP x-ray
OP Lab
Pharmacy Deductible
N/A
Preferred generic drugs
Preferred brand drugs
Non-Preferred brand
Specialty drugs

45. EPO Service Area
EPO service area does not include El Paso or San Antonio.
Available in 55 Counties:
Austin, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coke, Coleman, Collin, Concho, Coryell, Crockett, Dallas, Denton, Ellis, Erath, Falls, Fayette, Freestone, Grimes, Hamilton, Hill, Hood, Irion, Johnson, Kimble, Lampasas, Lee, Leon, Limestone, Llano, Madison, Mason, McCulloch, McLennan, Menard, Milam, Mills, Reagan, Robertson, Rockwall, Runnels, San Saba, Schleicher, Somervell, Sterling, Sutton, Tarrant, Tom Green, Travis, Waller, Washington , and Williamson

46. Baylor Scott and White
To quote and enroll 2017 plans, you are now required to log into Broker Office.  At this time there will be no paper applications available.  You can access this information at the Baylor Scott and White website  
You can find instructions on this process on The Brokerage Inc website under individual major medical-ACA-Baylor Scott and White

48. Molina Healthcare of Texas
On Exchange plans only
Caters to government run programs like Medicaid, for example
Specific plans by county located at
PMPM* agent commission
*Per Member Per Month, up to five per app
OEP sales - $16.88 first year only

49. Molina Healthcare of Texas
When process 2017 Applications, you will have 3 options:
You can log into your agent portal with Molina. Select your block of business tab and you will see the “Healthsherpa” tab.  Once you click here you will be taken to you personal link with “Healthsherpa” to process your application.
You can also process your application directly online at healthcare.gov or Rabbitt App.  Remember Molina is On Exchange only.
You can use HealthCare.gov
There are instructions for navigating the agent website located on

50. Memorial Hermann
Exited the ACA marketplace

53. Oscar Health
News plans in Austin (Hays, Travis and Williamson Counties)
New plans in Comal
Strong sales in Bexar County
Dallas, Collin and Tarrant Counties have ACA Bronze plans, but they non- commissionable
On and Off Exchange plans
EPO Network

54. Oscar Health Updates
You can still use hioscar.com to generate quotes and subsidy estimates for your clients
Oscar continues to offer free telemedicine, concierge style service and simple-to-use tools that make it easy to find and receive great care
Please check with The Brokerage on how to get appointed or recertified for 2018!

55. Health Insurance Alternatives
ACA plans not available through The Brokerage
Healthcare Sharing Ministry programs
Minimum Essential Coverage (MEC)
Short Term Major Medical
Other
Health Insurance Alternatives

56. How do employers move their employees to ministry plans?
What if the employee does not share the same faith of the employer?
Do employees have to attest that they practice the faith in order to join?
Underwriting?
How does the employer meet the employer mandate?
Will it leave an employer open to a penalty?
Questions for Health Care Sharing Ministry – The Brokerage does not offer these plans!

58. Keep in mind STM is not considered creditable coverage under the ACA and leaves the person subject to penalties!

59. Charging a fee vs. commission
Can this be done legally in Texas?

60. Charging a fee vs. Commission
General Life & Health Agent License
Chapter 4054, Texas Insurance Code
Agent defined broadly in Insurance Code to include acts on behalf of an insurer
Dual Compensation is not Prohibited
Ch. 4054: agents often have a dual role representing customers and on behalf of insurers

61. Charging a fee vs. a Commission
Agent Fees and Policy Fees
Permitted under Tex. Ins. Code §
Not restricted to only property/casualty agents
Charging of fees has been common place, especially for health agents after the ACA
No reported enforcement cases on charging agent fees by health agents

62. Charging a fee vs. Commission
Disclosure Requirements if Dual Compensation Received by Agents
Tex. Ins. Code § If agent receives compensation from both a customer (fees) and an insurer, the agent makes disclosure and obtain customer’s acknowledge that dual compensation will be received.
Disclosure must include a description of the method and factors used to compute compensation received from an insurer.

63. Sample disclosure of Commission
We Disclose to you that our agency receives compensation from an insurer or other third party. The compensation we receive includes the following if one or more boxes are checked
[____] Commission computed as a percentage of the premium you pay for insurance.
[____] Contingent commission, profit sharing or nonfinancial rewards, computed annual and based on the amount of premium and profitability of all insurance business we place through the insurer. This compensation [is/is not] guaranteed.
[____] Other: _______________________________________
By signature below, I agree to pay the fees specified above to the [INSERT AGENCY NAME] and acknowledge receipt of the disclosure from the agency as referenced above in this acknowledgement and disclosure document.
________________________ Date:__________________
[Customer Signature]

64. Note from The Brokerage:
This “Commission vs. Fee” info was provided by Thompson Coe. This info was a part of their presentation at the TX Assn of Health Underwriters Convention, May 2016

65. Ideas to grow your health insurance sales
TRS Care

66. 2018 TRS-Care “Educate the Educators”

67. HB 3976 made sweeping changes to TRS-Care
Fueled by a $1.3 billion budget shortfall*
Non-Medicare Eligible retirees will be offered an Aetna $1,500 High Deductible Health Plan (HDHP)
Medicare Eligible Retirees will be placed into a Medicare Advantage PPO plan from Humana

68. Demographics of TRS-Care
20,000 new retirees added to the plan each year
Retired teachers presently average $24,000 a year
Medicare Status
Retiree Count,
July 2017
Participant Count as of July 2017, including dependents
Medicare A & B
139,950
176,718
Medicare B Only
14,742
15,053
Non-Medicare
54,012
76,833
Total
208,704
268,604

69. 2018 TRS-Care Non-Medicare Benefits
High Deductible Health Plan
Health Savings Account Optional
In-Network
$1,500/$3,000 Deductible
$5,650/$11,300 Maximum Out-of-Pocket, 80%/20% Coinsurance
Out-of-Network
$6,000/$12,000 Deductible
$14,300/$28,600 Maximum Out-of-Pocket, 60%/40% Coinsurance

70. Monthly premiums for non-Medicare retirees in 2018
Retiree/Surviving Spouse Only: $200
Retiree + Spouse: $689
Retiree/Surviving Spouse + Child(ren): $408
Retiree + Family: $999

71. Humana MA-PPO Plan

72. 2018 TRS-Care Medicare Benefits
Medicare Advantage Plan – Humana
Drug benefits to be provided separately through SilverScript
PPO – same benefits in or out of network
$500 Deductible – all benefits subject to the deductible except for preventive
$3,500 Maximum Out-of-Pocket
$500 IP Hospital Copay per Visit
$250 OP Hospital Copay per Visit

73. 2018 TRS-Care Medicare Benefits
Medicare Advantage Plan – Humana
PPO – same benefits in or out of network
$5 PCP Office Visit copay, $10 Specialist
$0 Preventive Services copay
$35 Urgent Care copay, $65 ER copay

74. Retiree/Surviving Spouse Only: $135 Retiree + Spouse: $529
Monthly premiums for Medicare retirees in 2018
Retiree/Surviving Spouse Only: $135
Retiree + Spouse: $529

75. 2018 TRS-Care Rx Benefits

76. 2018 TRS-Care Rx Benefits
January 1, 2018, SilverScript will begin administering the prescription drug plan
The new pharmacy benefit provider is CVS Caremark
Retail Pharmacy = $5/$25/$50
Mail Order = $15/$70/$125
No “Donut Hole”

77. TRS-Care Marketing Ideas
Social Media
Teachers are better “networkers” than most industries
Facebook – check out the TRTA Facebook webpage
Read the live comments from the participants – angry!
Grass Roots
Ask “who do you know that is a retired educator that may be impacted by the TRS changes ?”
Incorporate this message into all AEP/OEP sales events
Host “Educational and Sales Events” across Texas

78. TRS Care Marketing Assistance
Agent referral letter
TRS Care Member presentation
Flyers to hand out
Mailers
We are developing a web page at to post all of these marketing tools

79. 2018 AEP and OEP should be the best enrollment season yet!
Thank you
2018 AEP and OEP should be the best enrollment season yet!